PREVALENCE, ETIOLOGY AND MANAGEMENT OF HEART-FAILURE IN GENERAL-PRACTICE

Background. There is a high level of morbidity and mortality among pat ients with heart failure. Management of the condition has changed subs tantially in recent years. However, there is little information on the management of heart failure in general practice. Aim. A study was car ried out in 1994 to assess the prevalence, aetiology and management of heart failure in a general practice setting. Method. A retrospective review was undertaken of the manual and computerized medical records o f patients in two group practices in Liverpool (combined patient popul ation of 17 400). Results. A total of 266 patients with heart failure were identified (a prevalence of 15 per 1000). The two practices had 2 747 patients who were aged 65 years and over and 221 of these had hear t failure (prevalence of 80 per 1000). The principal aetiological fact or considered responsible for heart failure was: coronary heart diseas e in 45% of patients, hypertension 18%, valve disease 9%, cor pulmonal e 7%, cardiomyopathy 2% and a metabolic problem 2% (aetiology unknown in 17% of cases). Urea and electrolytes had been checked in the last y ear in 59% of patients. Chest xray and electrocardiography had been pe rformed in 89% and 80% of patients, respectively, and echocardiography in 30%. Angiotensin converting enzyme (ACE) inhibitors were being pre scribed to 33% of patients. Conclusion. The study found a high prevale nce of heart failure among patients aged 65 years and over. Coronary h eart disease was considered to be the main aetiological factor. Patien ts were being investigated mainly by means of chest x-ray and electroc ardiography. Most patients with heart failure were not receiving treat ment with ACE inhibitors. Evaluation of heart failure by clinical crit eria alone is now deemed insufficient. Echocardiography should be used routinely to assess cardiac dysfunction. Patients with confirmed left ventricular dysfunction will benefit from treatment with ACE inhibito rs unless contraindications exist. The study suggests that there is a need to explore ways of optimizing the management of patients with hea rt failure.