Despite good evidence that ACE inhibitors in patients with left ventricular systolic dysfunction reduce mortality and improve quality of life, patients with heart failure are misdiagnosed and under treated. Two recent papers try to identify ways of aiding general practitioners (GPs) in the identification of patients with left ventricular systolic dysfunction.
Khunti K, Baker R, Grimshaw G. Diagnosis of patients with chronic heart failure in primary care: usefulness of history, examination and investigations. Br J Gen Prac 2000;50:50.
This paper reviews the evidence as to whether signs, symptoms and investigations in primary care are useful in diagnosing heart failure. It concludes that while these are useful in alerting doctors that heart failure may exist, only objective tests such as ECG and ideally echocardiography are sufficiently specific to confirm left ventricular systolic dysfunction. A useful algorithm is included.
Nielsen OW, Hansen JF, Larsen CT, Svanegaard J. Risk assessment of left ventricular systolic dysfunction in primary care: cross sectional study evaluating a range of diagnostic tests. BMJ 2000;320:220.
This study is useful because it was carried out in three general practice surgeries in Copenhagen (most heart failure studies have been carried out in secondary care) to assess probability of left ventricular systolic dysfunction without access to echocardiography. The authors conclude that risk can be assessed using three factors: abnormal ECG combined with raised natriuretic peptide plasma concentration and/or a heart rate greater than diastolic blood pressure. Screening should be undertaken in patients with signs or symptoms of heart disease, diabetes or hypertension and if positive referred for echocardiography for confirmation.
What's in the medical press? - The rapidly changing situation in primary care means that it is often difficult to keep up to date with what is happening politically and clinically. This section of Primary Care Pharmacy will try to pick out a few articles that may be useful in day-to-day practice or have importance for the primary care role.