title: Managing heart failure in primary care: first steps in implementing the National Service Framework.
abstract: BACKGROUND
  Heart failure is common, causes considerable morbidity, and imposes a major financial burden on both society and the National Health Service. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set national standards for the management of people with heart failure in England. We examined how patients with heart failure were investigated and treated compared with NSF standards, and explored the current constraints in improving the care of these patients.
  
  
  METHODS
  This study was carried out in two general practices (total list size 19,600) in south London. Using a computer search strategy, patients with possible heart failure were identified and clinical data extracted from their medical records. Workshops on heart failure were held at a national conference on disease management in primary care, and key stakeholders were interviewed to identify constraints in improving management.
  
  
  RESULTS
  Ninety patients with heart failure were identified through the computerized search. Seventy-eight patients (87 per cent) had a Read code for heart failure on their electronic medical record. Forty-eight (53 per cent) patients were men and 10 (12 per cent) were aged less than 65 years. Forty-nine per cent of patients had undergone an electrocardiogram and 42 per cent an echocardiogram. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to 54 per cent of patients. In the workshops and stakeholder interviews, healthcare professionals and managers reported difficulties in implementing the NSF. They expressed concerns regarding the difficulties in confirming a diagnosis of heart failure, including access to echocardiograms, prescribing ACE inhibitors among older patients, and the additional workload and resources needed to ensure they met the NSF standards for heart failure.
  
  
  CONCLUSIONS
  The accurate identification of heart failure patients and recording of clinical information as part of disease registers needs to improve if primary care teams are to meet the NSF standards. There is also scope to improve the investigation and treatment of heart failure patients in primary care. Achieving these objectives will require additional resources.
authors.affiliation: Office for National Statistics, 1 Drummond Gate, London SW1V 2QQ. shamgnani@yahoo.co.uk
authors.forename: Shamini
authors.initials: S
authors.lastname: Gnani
authors.forename: Jeremy
authors.initials: J
authors.lastname: Gray
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008131:London / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012042:Registries; D013222:State Medicine / Q000592:standards*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors