EVIDENCE OF INADEQUATE INVESTIGATION AND TREATMENT OF PATIENTS WITH HEART-FAILURE

Objective-To determine the referral rates to hospital and level of inv estigation of patients with heart failure, and, to assess whether they are receiving optimum management. Design-A retrospective survey. Sett ing-Nottingham Health District. Patients-505 patients receiving loop d iuretic treatment prescribed by their general practitioner. Main outco me measures-Referral to hospital as an inpatient or outpatient for ass essment 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 elec trocardiograph, 75% a chest radiograph, but only 31% an echocardiogram . Only 17% of patients with heart failure were being treated with angi otensin converting enzyme inhibitors in conjunction with loop diuretic s. Conclusions-Patients with heart failure in the Nottingham Health Di strict are not being adequately investigated or receiving the optimum treatment.