GPs are 'under-dosing' heart failure patients
By Emma Wilkinson
GPs are prescribing ?-blockers and ACE inhibitors for heart failure at far lower doses than is recommended, a major new study reveals.
The researchers also found GPs continued to use the drugs less often than would be expected even in patients eligible for clinical trials.
Their study found only 9 per cent of patients overall were treated with ?-blockers and less than half of those fulfilling eligibility criteria for at least one major clinical trial.
Among those who would have been eligible for at least one trial looking at use of ?-blockers alone, only 6 per cent were on the target dose.
Most patients who fulfilled trial criteria were treated with ACE inhibitors, but more than a third of patients were on less than half the target dose.
Study researcher Professor John Cleland, professor of cardiology at the University of Hull, said: 'There is a feeling the clinical trial populations are not entirely representative, which is true to a substantial extent. But ?-blockers are still underused. People are always looking for excuses.'
He added: 'Often patients are started on treatment and then not titrated up. It's a fear of side-effects rather than the side-
effects themselves. There is not enough emphasis on follow-up.'
Dr Andreas Arvanitis, CHD lead for Wyre PCT and a GP in Cleveleys, Lancashire, said: 'There is still a belief from
many years ago that ?-blockers are contraindicated in heart failure.
'GPs don't feel confident. We do undertreat people and we are depriving them.'
Dr Gerald Partridge, CHD lead for Airedale and Bradford North PCT and a GP in Keighley, West Yorkshire, said more community heart failure nurses were needed to help patients receive optimum treatment.
'Nurses in the community are very good at badgering GPs with chronic management plans, encouraging them to prescribe drugs,' he said.
The new study, published in the latest issue of the European Heart Journal, analysed 10,700 patients who took part in the Euro Heart Survey.