Family Practice Advance Access originally published online on January 18, 2009
Family Practice 2009 26(2):145-153; doi:10.1093/fampra/cmn105
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Evaluation of the management of heart failure in primary care
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
Correspondence to Melanie J Calvert, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Email: m.calvert{at}bham.ac.uk
Received 30 June 2008; Revised 24 November 2008; Accepted 8 December 2008.
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Abstract |
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Background. The extent to which guidelines for the treatment of heart failure are currently followed in primary care in the UK is unclear.
Objective. To evaluate the prevalence of heart failure and the pharmacological management of heart failure in relation to European Society of Cardiology (ESC) and National Institute for Health and Clinical Excellence guidelines.
Methods. Retrospective cohort study using routinely collected data from 163 general practices across Great Britain contributing data to the Doctors Independent Network (DIN-LINK) database over a 5-year period until December 31, 2006.
Results. From a patient population of nearly 1.43 million, 9311 patients with heart failure were identified [mean age 78 years (SD 12)], giving an estimated prevalence of 0.7%. Of these, 7410 (79.6%) were prescribed a loop diuretic, 6620 (71.1%) were prescribed an angiotensin-converting enzyme (ACE) inhibitor or ARB, 3403 (36.6%) were prescribed β-blockers but only 2732 (29.3%) were prescribed an ACE inhibitor or ARB and a β-blocker in combination. Thirty-five per cent of patients prescribed ACE inhibitor and 11.5% of those prescribed β-blockers met ESC guideline target doses. Age, gender and comorbidity predicted whether patients received β-blocker or ACE inhibitor with younger males being more likely to receive maximal therapy.
Conclusions. These data suggest that while most patients with heart failure receive an ACE inhibitor/ARB in primary care, few are titrated to target dose and many do not receive a β-blocker. Optimum treatment appears to be most likely for young men. New strategies are required to ensure equitable and optimal treatment for all.
Keywords. Heart failure, prevalence, pharmacological management, primary care.
Calvert MJ, Shankar A, McManus RJ, Ryan R and Freemantle N. Evaluation of the management of heart failure in primary care. Family Practice 2009; 26: 145–153.