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Evaluation of the management of heart failure in primary care

Melanie J Calvert1, Aparna Shankar, Richard J McManus

  • 1Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK. m.calvert@bham.ac.uk

Family Practice
|January 21, 2009
PubMed

Insights

Most heart failure patients in UK primary care receive ACE inhibitors/ARBs, but few reach target doses. Beta-blocker use is low, with younger males receiving optimal treatment. New strategies are needed for equitable care.

Area of Science:

  • Cardiology
  • Primary Care Research
  • Pharmacotherapy

Background:

  • Guideline adherence for heart failure treatment in UK primary care is not well understood.
  • Current practices may not align with established European Society of Cardiology (ESC) guidelines.

Purpose of the Study:

  • To determine the prevalence of heart failure in a large UK primary care population.
  • To assess the pharmacological management of heart failure against ESC and NICE guidelines.

Main Methods:

  • A retrospective cohort study analyzed routinely collected data from 163 UK general practices.
  • Data spanned a 5-year period up to December 31, 2006, from the DIN-LINK database.
  • Nearly 1.43 million patients were screened to identify heart failure cases.

Main Results:

  • An estimated 0.7% prevalence of heart failure (9311 patients) was identified, with a mean age of 78 years.
  • While 79.6% received loop diuretics and 71.1% received ACE inhibitors/ARBs, only 36.6% were prescribed beta-blockers.
  • Combination therapy (ACE inhibitor/ARB and beta-blocker) was used in only 29.3% of patients, with low rates of guideline target dose achievement for ACE inhibitors (35%) and beta-blockers (11.5%).

Conclusions:

  • Most heart failure patients receive ACE inhibitors/ARBs, but optimal titration to guideline-recommended doses is infrequent.
  • Beta-blocker prescription rates are suboptimal, indicating a gap in guideline implementation.
  • Younger males with heart failure appear more likely to receive maximal therapy, highlighting potential inequities in treatment that require new strategies for universal optimal care.
Abstract

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