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Heart failure care still biased against women

The quality and outcomes framework has pushed up standards in the care of heart failure but failed to tackle sharp differences between the sexes, a major national audit reports.

The Healthcare Commission survey of 9,387 patients with heart failure admitted to NHS acute trusts found increases in the proportion who had been investigated with echocardiography and prescribed a ß-blocker.

The findings represent an improvement over the SHAPE study of 2005, in which UK GPs were branded the worst in Europe for heart failure care.But cardiology experts warned that ß-blockers were still underprescribed with the new research finding only 28% of patients were taking the drugs on admission.

And the retrospective study, presented at the Heart Failure 2007 Congress in Hamburg, Germany, last week, found women were less likely than men to be investigated with echocardiography. Women were also less likely than men to be taking ß-blockers, ACE inhibitors or ARBs, or any combination of heart failure medication.

Study leader Dr Ed Nicol, cardiologist at the Royal Brompton Hospital in London and medical adviser to the Healthcare Commission, said: 'It is a decent improvement, but not enough – we can't afford to pat ourselves on the back yet.'

Dr Nicol said women were possibly treated less aggressively because they were more likely to have diastolic heart failure, which GPs did not recognise as being 'true' heart failure.

He warned GPs: 'If you send a patient for an echo and they come back with a normal ejection fraction don't assume that means no heart failure. It could either be the early signs of heart failure or diastolic heart failure. You should consider referring.'

The survey, which examined the notes of patients discharged with heart failure in September 2005, found 96% were on some heart failure medication and 73% on a diuretic at admission.

About 57% of patients were on an ACE inhibitor or ARB, 14% on an aldosterone antagonist and only 4% on all four classes of heart failure treatment.

Dr Gerald Partridge, CHD lead for Airedale and Bradford North PCT and a GP in Keighley, West Yorkshire, said: 'Most GPs were so steeped in the idea that ß-blockers had to be avoided at all costs that it will take a long time to get over that.'

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