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GPs must use echo to diagnose heart failure

GPs will be told they must confirm every diagnosis of heart failure with an echocardiogram under forthcoming Government guidance.

But the GPC warned that 'patchy' access to echocardiography services could leave many patients with suspected heart failure facing a long wait for appropriate drug therapy.

Draft guidelines on heart failure released last week by the National Institute for Clinical Excellence recommend 12-lead electrocardiogram and brain natriuretic peptide blood tests to rule out the condition in patients with symptoms. But GPs are told not to make a definitive diagnosis without an echocardiogram (see box).

Dr George Rae, a member of the GPC prescribing sub-committee and a GP in North Tyneside, said most GPs did not have direct access to echocardiography. He said: 'Referrals to specialists will go up and there will be delays getting treatment. Some people then slip through the net.'

The NICE recommendations ­ out for consultation until May 2 and due to be launched in July ­ will form the basis of new targets for the national service framework for coronary heart disease.

PCOs will have to make funds available for implementing the guidance.

Problems with access to echocardiography led GP negotiators to demand an exemption reporting scheme under the quality framework, which awards six points for

using echocardiography to confirm left ventricular dysfunction.

NICE guidance

Step 1 In patients with suspected heart failure (because of history, symptoms and signs), GPs should exclude

the condition using 12-lead ECG and/or brain

natriuretic peptide tests (BNP or N-terminal proBNP)

where available

Step 2 If either test is abnormal, GPs should request echocardiography

Step 3 If the echocardiography confirms a diagnosis of heart failure, start ACE inhibitor therapy

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