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Accuracy of heart failure registers in doubt

A general practice audit has thrown the accuracy of heart failure registers into doubt.

Up to half of patients may be wrongly treated for the condition and should be removed from the register, the study suggested.

Researchers also found that BNP testing failed to identify patients with heart failure once they had been labelled with the condition.

The audit of 217 patients on the heart failure register in a practice in the West Midlands found 30 patients where the clinical notes contained no evidence to suggest heart failure.

A further 56 had never been investigated.

After an echocardiogram more than half of these turned out not to have heart failure.

In total, 50% of patients on the register had been receiving medication unnecessarily, according to the study, published online by the BMC Cardiovascular Disorders.

Study leader Dr Russell Davis, a consultant cardiologist at Sandwell and West Birmingham NHS Trust, said the findings would translate to many other practices as many patients with 'puffy ankles' were mislabelled as having heart failure.

He said practices should go through their records to make sure diagnoses were backed up by echo.

And he added: 'BNP might be a good test for those who present with symptoms, but for those on treatment it's not a useful discriminator.'

Dr Ahmet Fuat, a GP in Darlington who runs a heart failure diagnostic clinic, said in anyone who had not been previously investigated 'every effort' should be made for them to get an echo.

'Once people have been treated, their BNP can go down near normal, so BNP shouldn't be used to screen patients who are already being treated.'

He added: 'When we validated our register it was clear that some patients didn't have heart failure – if they're stuck on a diuretic, they may be getting treatment they don't need.'

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