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GPs told to check through 750,000 heart failure notes

GPs have been told to trawl through hundreds of thousands of heart failure diagnoses and refer any patient who has never had an echocardiogram.

Government advisers on the National Institute for Clinical Excellence heart failure guidelines group said diagnoses made more than five years ago may not be accurate.

But GPC members said the recommendation would add to GP workload and clog up massively overstretched echo-cardiography services.

Professor Martin Cowie, clinical adviser to the guideline development group and professor of cardiology at the

National Heart and Lung Institute in London, said: 'There are about 750,000 people with heart failure in the UK. If people had a diagnosis made five to 10 years ago they wouldn't have benefited from modern technology. They should have their diagnosis revisited. If they have a diagnosis of heart failure then they should be given an echo.'

The comments came as NICE issued guidelines for diagnosis and initial management of the condition (see above).

Dr Rob Barnett, GPC member and Liverpool LMC secretary, said many GPs faced long waits for echocardio-

graphy services: 'With a limited workforce, GPs are unlikely to drop everything to trawl notes to find these patients.'

Heart failure: diagnosis and initial treatment

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 NTproBNP)

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

Step 3 If the diagnosis is confirmed, prescribe an ACE inhibitor for any patient

with LVSD and a diuretic if needed ­ a ?-blocker should be added in a

'start low, go slow' manner Source: NICE

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