Changing patterns of investigation and treatment of cardiac failure in hospital.

OBJECTIVE: To assess the investigation and treatment of cardiac failure in 1995 and to compare this with management in 1992. DESIGN: Retrospective consecutive case study. SETTING: University teaching hospital. SUBJECTS: All patients (n = 265) discharged from Aberdeen Royal Infirmary in the first quarter (January 1-31 March) of 1995 with a diagnosis of congestive cardiac failure, left ventricular failure, or heart failure (unspecified). These correspond to the International Classification of Diseases 9th revision codings of 428.0, 428.1, and 428.9 respectively. METHODS: Sociodemographic and clinical data were extracted from the case notes of the above subjects and compared with similar data from the final six months of 1992. MAIN OUTCOME MEASURES: The use of echocardiography in confirming the diagnosis and delineating the aetiology of heart failure and the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of patients diagnosed as having heart failure and without contraindications to these agents. RESULTS: The number of patients discharged in 1995 with a diagnosis including cardiac failure had increased by 55.7% since 1992. The use of echocardiography had also risen from 36.6% to 72% (P < 0.0001) with an associated increase in the proportion of patients discharged on treatment with an ACE inhibitor (40% in 1992 v 55.1% in 1995: P < 0.001). The doses of ACE inhibitors used had also increased significantly (P < 0.001). Most patients with cardiac failure continue to be treated by general physicians, who are less likely to use echocardiography (P < 0.01) or prescribe an ACE inhibitor (P < 0.05) than cardiologists. CONCLUSIONS: There is increasing recognition, more thorough investigation, and improved treatment of heart failure. Despite this there are grounds for concern, both in terms of the adequacy of management and resource implications.