Evaluation of the management of heart failure in primary care.
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 beta-blockers but only 2732 (29.3%) were prescribed an ACE inhibitor or ARB and a beta-blocker in combination. Thirty-five per cent of patients prescribed ACE inhibitor and 11.5% of those prescribed beta-blockers met ESC guideline target doses. Age, gender and comorbidity predicted whether patients received beta-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 beta-blocker. Optimum treatment appears to be most likely for young men. New strategies are required to ensure equitable and optimal treatment for all.
Calvert
Melanie J
MJ
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK. m.calvert@bham.ac.uk
Shankar
Aparna
A
McManus
Richard J
RJ
Ryan
Ronan
R
Freemantle
Nick
N
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005194:Family Practice; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D006113:United Kingdom
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors