Evidence of inadequate investigation and treatment of patients with heart failure.

K. W. Clarke, D. Gray, J. R. Hampton

University Hospital, Nottingham.

OBJECTIVE--To determine the referral rates to hospital and level of investigation of patients with heart failure, and to assess whether they are receiving optimum management. DESIGN--A retrospective survey. SETTING--Nottingham Health District. PATIENTS--505 patients receiving loop diuretic treatment prescribed by their general practitioner. MAIN OUTCOME MEASURES--Referral to hospital as an inpatient or outpatient for assessment of assumed cardiac failure; investigations--electrocardiography, chest radiography, and echocardiography; treatment with angiotensin converting enzyme inhibitors. RESULTS--Only 56% of patients prescribed loop diuretics fulfilled the diagnostic criteria for heart failure. Of these, 74% had been referred to hospital, of whom 80% had had an electrocardiograph, 75% a chest radiograph, but only 31% an echocardiogram. Only 17% of patients with heart failure were being treated with angiotensin converting enzyme inhibitors in conjunction with loop diuretics. CONCLUSIONS--Patients with heart failure in the Nottingham Health District are not being adequately investigated or receiving the optimum treatment.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Evidence of inadequate investigation and treatment of patients with heart failure.

J Zarifis, D G Beevers, and G Y Lip
Heart 1994 72: 593. [PDF]

This article has been cited by other articles:

• Hobbs, F.D.R. (2009). Clinical burden and health service challenges of chronic heart failure. Eur J Heart Fail Suppl 8: i1-i4 [Full Text]  
• Parthenakis, F. I., Patrianakos, A. P., Haritakis, C. N., Zacharis, E. A., Nyktari, E. G., Vardas, P. E. (2008). NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. Eur J Heart Fail 10: 475-481 [Abstract] [Full Text]  
• Khunti, K., Stone, M., Paul, S., Baines, J., Gisborne, L., Farooqi, A., Luan, X., Squire, I. (2007). Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial. Heart 93: 1398-1405 [Abstract] [Full Text]  
• Jeyaseelan, S., Goudie, B. M., Pringle, S. D., Donnan, P. T., Sullivan, F. M., Struthers, A. D. (2007). A critical re-appraisal of different ways of selecting ambulatory patients with suspected heart failure for echocardiography. Eur J Heart Fail 9: 55-61 [Abstract] [Full Text]  
• Adlam, D., Silcocks, P., Sparrow, N. (2005). Using BNP to develop a risk score for heart failure in primary care. Eur Heart J 26: 1086-1093 [Abstract] [Full Text]  
• Valle, R., Aspromonte, N., Barro, S., Canali, C., Carbonieri, E., Ceci, V., Chinellato, M., Gallo, G., Giovinazzo, P., Ricci, R., Milani, L. (2005). The NT-proBNP assay identifies very elderly nursing home residents suffering from pre-clinical heart failure. Eur J Heart Fail 7: 542-551 [Abstract] [Full Text]  
• Phillips, C. O., Singa, R. M., Rubin, H. R., Jaarsma, T. (2005). Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse-led heart failure clinics. A meta-regression analysis. Eur J Heart Fail 7: 333-341 [Abstract] [Full Text]  
• Nielsen, O. W., McDonagh, T., Cowburn, P., Blue, L., Robb, S. D., Dargie, H. (2004). Patient differences related to management in general practice and the hospital: a cross-sectional study of heart failure in the community. Eur Heart J 25: 1718-1725 [Abstract] [Full Text]  
• Nielsen, L. S., Svanegaard, J., Klitgaard, N. A., Egeblad, H. (2004). N-terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea. Eur J Heart Fail 6: 63-70 [Abstract] [Full Text]  
• Khunti, K. (2004). Systematic review of open access echocardiography for primary care. Eur J Heart Fail 6: 79-83 [Abstract] [Full Text]  
• Unal, B, Critchley, J A, Capewell, S (2003). Missing, mediocre, or merely obsolete? An evaluation of UK data sources for coronary heart disease. J. Epidemiol. Community Health 57: 530-535 [Abstract] [Full Text]  
• Rutten, F. H., Grobbee, D. E., Hoes, A. W. (2003). Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in every-day practice. Eur J Heart Fail 5: 337-344 [Abstract] [Full Text]  
• Rutten, F. H., Grobbee, D. E., Hoes, A. W. (2003). Diagnosis and management of heart failure: a questionnaire among general practitioners and cardiologists. Eur J Heart Fail 5: 345-348 [Full Text]  
• Sparrow, N., Adlam, D., Cowley, A., Hampton, J. R. (2003). The diagnosis of heart failure in general practice: implications for the UK National Service Framework. Eur J Heart Fail 5: 349-354 [Abstract] [Full Text]  
• Fuat, A., Hungin, A P. S, Murphy, J. J. (2003). Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ 326: 196-196 [Abstract] [Full Text]  
• Khunti, K., Hearnshaw, H., Baker, R., Grimshaw, G. (2002). Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners. Eur J Heart Fail 4: 771-777 [Abstract] [Full Text]  
• Davis, R C, Hobbs, F D R, Kenkre, J E, Roalfe, A K, Hare, R, Lancashire, R J, Davies, M K (2002). Prevalence of left ventricular systolic dysfunction and heart failure in high risk patients: community based epidemiological study. BMJ 325: 1156-1156 [Abstract] [Full Text]  
• Maggioni, A. P., Anand, I., Gottlieb, S. O., Latini, R., Tognoni, G., Cohn, J. N., the Val-HeFT Investigators, (2002). Effects of valsartan on morbidity and mortality in patients with heart failure not receiving angiotensin-converting enzyme inhibitors. J Am Coll Cardiol 40: 1414-1421 [Abstract] [Full Text]  
• Cleland, J G F (2002). Contemporary management of heart failure in clinical practice. Heart 88: ii5-8 [Full Text]  
• Jong, P., Vowinckel, E., Liu, P. P., Gong, Y., Tu, J. V. (2002). Prognosis and Determinants of Survival in Patients Newly Hospitalized for Heart Failure: A Population-Based Study. Arch Intern Med 162: 1689-1694 [Abstract] [Full Text]  
• PAULIK, E., MULLER, A., BELICZA, E., BODA, K., NAGYMAJTENYI, L. (2002). Use of echocardiography among patients with heart failure: practice variations in Hungarian hospitals. Int J Qual Health Care 14: 313-319 [Abstract] [Full Text]  
• Stewart, S., MacIntyre, K., Hole, D. J., Capewell, S., McMurray, J. J.V. (2001). More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 3: 315-322 [Abstract] [Full Text]  
• Cleland, J.G.F., Khand, A., Clark, A. (2001). The heart failure epidemic: exactly how big is it?. Eur Heart J 22: 623-626  
• Gomberg-Maitland, M., Baran, D. A., Fuster, V. (2001). Treatment of Congestive Heart Failure: Guidelines for the Primary Care Physician and the Heart Failure Specialist. Arch Intern Med 161: 342-352 [Abstract] [Full Text]  
• Mason, J., Young, P., Freemantle, N., Hobbs, R. (2000). Safety and costs of initiating angiotensin converting enzyme inhibitors for heart failure in primary care: analysis of individual patient data from studies of left ventricular dysfunction. BMJ 321: 1113-1116 [Abstract] [Full Text]  
• MacIntyre, K., Capewell, S., Stewart, S., Chalmers, J.W.T., Boyd, J., Finlayson, A., Redpath, A., Pell, J.P., McMurray, J.J.V. (2000). Evidence of Improving Prognosis in Heart Failure : Trends in Case Fatality in 66 547 Patients Hospitalized Between 1986 and 1995. Circulation 102: 1126-1131 [Abstract] [Full Text]  
• Cleland, J.G.F., Swedberg, K., Cohen-Solal, A., Cosin-Aguilar, J., Dietz, R., Follath, F., Gavazzi, A., Hobbs, R., Korewicki, J., Madeira, H.C., Preda, I., van Gilst, W.H., Widimsky, J., Mareev, V., for The Study Group on Diagnosis of the Working Gr, , Mason, J., Freemantle, N., Eastaugh, J., for The Medicines Evaluation Group Centre for Heal, (2000). The Euro Heart Failure Survey of The EUROHEART Survey Programme: A survey on the quality of care among patients with heart failure in Europe. Eur J Heart Fail 2: 123-132 [Abstract] [Full Text]  
• Toal, M., Walker, R. (2000). Angiotensin converting enzyme (ACE) inhibitors in the treatment of heart failure in general practice in north Cumbria. Eur J Heart Fail 2: 201-207 [Abstract] [Full Text]  
• Cohen-Solal, A, Desnos, M, Delahaye, F, Emeriau, J.P, Hanania, G (2000). A national survey of heart failure in French hospitals. Eur Heart J 21: 763-769 [Abstract]  
• Mejhert, M., Holmgren, J., Wandell, P., Persson, H., Edner, M. (1999). Diagnostic tests, treatment and follow-up in heart failure patients -- is there a gender bias in the coherence to guidelines?. Eur J Heart Fail 1: 407-410 [Abstract] [Full Text]  
• Capewell, S, Pell, J.P, Morrison, C, McMurray, J (1999). Increasing the impact of cardiological treatments. How best to reduce deaths. Eur Heart J 20: 1386-1392 [Abstract]  
• Diller, P. M., Smucker, D. R., David, B., Graham, R. J. (1999). Congestive Heart Failure Due to Diastolic or Systolic Dysfunction: Frequency and Patient Characteristics in an Ambulatory Setting. Arch Fam Med 8: 414-420 [Abstract] [Full Text]  
• Bart, B.A., Ertl, G., Held, P., Kuch, J., Maggioni, A.P., McMurray, J., Michelson, E.L., Rouleau, J.L., Warner Stevenson, L., Swedberg, K., Young, J.B., Yusuf, S., Sellers, M.A., Granger, C.B., Califf, R.M., Pfeffer, M.A., for the SPICE investigators, (1999). Contemporary management of patients with left ventricular systolic dysfunction. Results from the Study of Patients Intolerant of Converting Enzyme Inhibitors (SPICE) Registry. Eur Heart J 20: 1182-1190 [Abstract]  
• Ryden, L., Remme, W.J. (1999). Treatment of congestive heart failure. Has the time come for decreased complexity?. Eur Heart J 20: 867-871  
• Petrie, M. C., Dawson, N. F., Murdoch, D. R., Davie, A. P., McMurray, J. J. V. (1999). Failure of Women's Hearts. Circulation 99: 2334-2341 [Full Text]  
• Davie, A. P, McMurray, J. J (1999). ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?. Postgrad. Med. J. 75: 219-221 [Abstract] [Full Text]  
• Zannad, F., Briancon, S., Juilliere, Y., Mertes, P.-M., Villemot, J.-P., Alla, F., Virion, J.-M., and the EPICAL Investigators, (1999). Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study. J Am Coll Cardiol 33: 734-742 [Abstract] [Full Text]  
• Lough, M., Cleland, J., Langan, J., Cowley, A., Wade, A. (1998). Initiating angiotensin converting enzyme inhibitors in mild to moderate heart failure in general practice: randomised, placebo controlled trial. BMJ 317: 1352-1353 [Full Text]  
• Feenstra, J, Grobbee, D E, Jonkman, F A M, Hoes, A W, Stricker, B H C. (1998). Prevention of relapse in patients with congestive heart failure: the role of precipitating factors. Heart 80: 432-436 [Abstract] [Full Text]  
• Eccles, M., Freemantle, N., Mason, J. (1998). North of England evidence based development project: guideline for angiotensin converting enzyme inhibitors in primary care management of adults with symptomatic heart failure. BMJ 316: 1369-1375 [Full Text]  
• Stafford, R. S., Saglam, D., Blumenthal, D. (1997). National Patterns of Angiotensin-Converting Enzyme Inhibitor Use in Congestive Heart Failure. Arch Intern Med 157: 2460-2464 [Abstract]  
• Hampton, J R, Barlow, A R (1995). Open access. BMJ 310: 611-612 [Full Text]  
• Francis, C M, Caruana, L, Kearney, P, Love, M, Sutherland, G R, Starkey, I R, Shaw, T R D, McMurray, J J V (1995). Open access echocardiography in management of heart failure in the community. BMJ 310: 634-636 [Abstract] [Full Text]