Changing patterns of investigation and treatment of cardiac failure in hospital.

G. S. Hillis, A. Al-Mohammad, M. Wood, K. P. Jennings

Department of Medicine and Therapeutics, University of Aberdeen.

OBJECTIVE: To assess the investigation and treatment of cardiac failure in 1995 and to compare this with management in 1992. DESIGN: Retrospective consecutive case study. SETTING: University teaching hospital. SUBJECTS: All patients (n = 265) discharged from Aberdeen Royal Infirmary in the first quarter (January 1-31 March) of 1995 with a diagnosis of congestive cardiac failure, left ventricular failure, or heart failure (unspecified). These correspond to the International Classification of Diseases 9th revision codings of 428.0, 428.1, and 428.9 respectively. METHODS: Sociodemographic and clinical data were extracted from the case notes of the above subjects and compared with similar data from the final six months of 1992. MAIN OUTCOME MEASURES: The use of echocardiography in confirming the diagnosis and delineating the aetiology of heart failure and the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of patients diagnosed as having heart failure and without contraindications to these agents. RESULTS: The number of patients discharged in 1995 with a diagnosis including cardiac failure had increased by 55.7% since 1992. The use of echocardiography had also risen from 36.6% to 72% (P < 0.0001) with an associated increase in the proportion of patients discharged on treatment with an ACE inhibitor (40% in 1992 v 55.1% in 1995: P < 0.001). The doses of ACE inhibitors used had also increased significantly (P < 0.001). Most patients with cardiac failure continue to be treated by general physicians, who are less likely to use echocardiography (P < 0.01) or prescribe an ACE inhibitor (P < 0.05) than cardiologists. CONCLUSIONS: There is increasing recognition, more thorough investigation, and improved treatment of heart failure. Despite this there are grounds for concern, both in terms of the adequacy of management and resource implications.

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

This article has been cited by other articles:

• Lien, C. T.C., Gillespie, N. D., Struthers, A. D., McMurdo, M. E.T. (2002). Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 4: 91-98 [Abstract] [Full Text]  
• Weil, E., Tu, J. V. (2001). Quality of congestive heart failure treatment at a Canadian teaching hospital. CMAJ 165: 284-287 [Abstract] [Full Text]  
• Khand, A., Gemmel, I., Clark, A. L., Cleland, J. G. F. (2000). Is the prognosis of heart failure improving?. J Am Coll Cardiol 36: 2284-2286 [Full Text]  
• Cleland, J. G F, Clark, A., Caplin, J. L (2000). Taking heart failure seriously. BMJ 321: 1095-1096 [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 (2000). Improving patient outcomes in heart failure: evidence and barriers. Heart 84: 8i-10 [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]  
• CHENG, T. O (1999). Amiodarone in atrial fibrillation.. Postgrad. Med. J. 75: 703-703 [Full Text]  
• Cleland, J. G.F., Gemmell, I., Khand, A., Boddy, A. (1999). Is the prognosis of heart failure improving?. Eur J Heart Fail 1: 229-241 [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]  
• 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]