title: Difficulties of introducing the National Service Framework for heart failure into general practice in the UK.
abstract: BACKGROUND
  The National Service Framework (NSF) sets standards for the management of heart failure in the UK. Loop diuretics are commonly first prescribed in primary care. Some patients taking these drugs have heart failure and may benefit from other treatments including ACE inhibitors. Accurate diagnosis in primary care is essential for the aims of the NSF to be realised.
  
  
  OBJECTIVE
  To investigate loop diuretic prescribing in general practice, to analyse recorded clinical features, patient investigations and ACE inhibitor use in this population.
  
  
  METHODS
  One thousand three hundred and one patients taking loop diuretics were identified from prescription records of seven general practices. Demographic details, clinical features, investigations and drug treatments were extracted from patient records.
  
  
  RESULTS
  The prevalence of loop diuretic prescribing increased with age. Twenty percent of patients were attributed a diagnosis of heart failure but relevant clinical features were recorded in less than 50% of patient records. Open access echocardiography was used in 8.9% of patients. ACE inhibitors were prescribed in 39.8% of patients considered to have heart failure. 18.2% of these were taking the recommended target dose.
  
  
  CONCLUSIONS
  Loop diuretics are prescribed commonly, particularly in the elderly. There is no clear pattern of documented clinical features that leads to prescription of these drugs. Open access echocardiography is rarely used to aid diagnosis. ACE inhibitors are under-prescribed and under-dosed in patients diagnosed with heart failure in this study population.
authors.affiliation: Newthorpe Medical Practice, Chewton Street, Eastwood, Nottingham NG16 3HB, UK. nigelsparrow@aol.com
authors.forename: Nigel
authors.initials: N
authors.lastname: Sparrow
authors.forename: David
authors.initials: D
authors.lastname: Adlam
authors.forename: Alan
authors.initials: A
authors.lastname: Cowley
authors.forename: John R
authors.initials: JR
authors.lastname: Hampton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000584:Amiloride / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D005194:Family Practice; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008788:Metolazone / Q000008:administration & dosage; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000584:Amiloride; D005665:Furosemide; D008788:Metolazone