The number of patients with heart failure is increasing despite a general decline in the manifestations of ischaemic heart disease, the most important aetiologic factor today.1 The increasing prevalence is mainly because of the growing number of elderly heart failure patients who are often hospitalised and frequently readmitted owing to exacerbation; at least 30% are readmitted within one year and many within 30 days.2 Hospitalisation for heart failure is a major economic burden on health care.

Most heart failure patients are treated by primary care physicians. This requires special considerations in relation to the implementation of diagnostic and treatment guidelines issued by the European Society of Cardiology.3 The diagnosis and treatment of heart failure requires objective analysis of ventricular function, usually by echocardiography, which is not routinely used in primary care.4 ,5 Angiotensin converting enzyme (ACE) inhibitors are recommended as first line treatment for heart failure patients with reduced systolic function; however, this is difficult to achieve if cardiac function is not assessed. Consequently, patients with heart failure are not being managed in accordance with evidence-based medicine. Neither diagnosis nor treatment is optimal—how can this situation be improved?