Key result
Primary care heart failure management shows gaps in meeting standards, with only ~54% prescribed ACE inhibitors.
Why the study?
Heart failure management in primary care often falls short of the National Service Framework standards, with challenges in diagnosis, investigation, and treatment.
How does the investigation and treatment of heart failure patients in primary care compare to National Service Framework standards?
Cross-Sectional (n=90)
Yes
How does the investigation and treatment of heart failure patients in primary care compare to National Service Framework standards?
There are significant gaps in the investigation and treatment of heart failure in primary care compared to national standards, driven by resource and diagnostic constraints.
Shortfalls in primary care HF diagnostics and treatment persist; leaves open optimal strategies to improve adherence to national standards.
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. CONCLUSION: 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.
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Gnani et al. (2004) conducted a cross-sectional in Heart failure (n=90). Primary care management was evaluated on Adherence to National Service Framework standards (ECG, echocardiogram, ACE inhibitor prescription). Primary care management of heart failure showed gaps in meeting National Service Framework standards, with only 49% undergoing an ECG, 42% an echocardiogram, and 54% prescribed ACE inhibitors.
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