Evidence of inadequate investigation and treatment of patients with heart failure.

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Abstract
OBJECTIVE--To determine the referral rates to hospital and level of investigation of patients with heart failure, and to assess whether they are receiving optimum management. DESIGN--A retrospective survey. SETTING--Nottingham Health District. PATIENTS--505 patients receiving loop diuretic treatment prescribed by their general practitioner. MAIN OUTCOME MEASURES--Referral to hospital as an inpatient or outpatient for assessment of assumed cardiac failure; investigations--electrocardiography, chest radiography, and echocardiography; treatment with angiotensin converting enzyme inhibitors. RESULTS--Only 56% of patients prescribed loop diuretics fulfilled the diagnostic criteria for heart failure. Of these, 74% had been referred to hospital, of whom 80% had had an electrocardiograph, 75% a chest radiograph, but only 31% an echocardiogram. Only 17% of patients with heart failure were being treated with angiotensin converting enzyme inhibitors in conjunction with loop diuretics. CONCLUSIONS--Patients with heart failure in the Nottingham Health District are not being adequately investigated or receiving the optimum treatment.