title: Evidence of inadequate investigation and treatment of patients with heart failure.
abstract: 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.
  
  
  METHODS
  A retrospective survey.
  
  
  METHODS
  Nottingham Health District.
  
  
  METHODS
  505 patients receiving loop diuretic treatment prescribed by their general practitioner.
  
  
  METHODS
  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.
authors.affiliation: University Hospital, Nottingham.
authors.forename: K W
authors.initials: KW
authors.lastname: Clarke
authors.forename: D
authors.initials: D
authors.lastname: Gray
authors.forename: J R
authors.initials: JR
authors.lastname: Hampton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016507:Cardiology Service, Hospital / Q000592:standards*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography / Q000706:statistics & numerical data; D004562:Electrocardiography; D004739:England; D005194:Family Practice / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008297:Male; D008485:Medical Audit; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics