October 1, 2002Open Access
Contemporary management of heart failure in clinical practice
Key Result
The management of heart failure in clinical practice remains suboptimal, with significant underutilization of proven therapies such as ACE inhibitors and beta-blockers due to inadequate organization of care.
Structured PICO
P
Population
Patients with suspected or confirmed heart failure in clinical practice
Despite good theoretical knowledge among physicians, the practical organization and delivery of guideline-directed medical therapy for heart failure remains inadequate in clinical practice.
Limitations
- Surveys of clinical practice may not be representative of actual practice.
- Hospital discharge coding databases have limited clinical information and substantial miscoding.
- Diagnostic uncertainty by clinical means alone.
Abstract
Heart failure is common. It affects, depending on defini-tion, between 1–5 % of the population or between 0.5and 3million people in the UK.1 Prospective follow up of a large cohort of non-institutionalised elderly patients (aged70 years) over six years showed that 15 % developed heart failure before they died and that 24 % of all deaths over this period were preceded by heart failure.2 Heart failure is the most common reason for admission to hospital in people aged over 60 years and complicates many more admissions.3–5 Using narrowly defined criteria, about 5 % of medical beds are occu-pied by patients with heart failure,4 6 but broader definitions of heart failure suggest it may be 2–4 times this figure. A survey of elective, non-cardiovascular, surgical admissions suggested that 14 % of patients also suffered from heart failure.7 Heart failure is disabling. As reported above, heart failure is sufficiently debilitating to cause a large number of hospital admissions. It is also the most common reason for early readmission of patients.8 Studies conducted in non-