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

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.