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GPs are facing a Government crackdown on heart failure care after a major international study branded them the worst in Europe.

The SHAPE study, which surveyed thousands of GPs, specialists and patients across Europe, put UK GPs last for use of ?-blockers and ACE inhibitors.

Cardiologists said they were 'shocked' by the findings. GPs blamed a lack of support from secondary care, desperate shortage of diagnostic services and fears over drug side-effects.

But the Healthcare Commission said it was 'concerned' over implementation of heart failure guidelines and would be issuing 'strong recommendations' in a report in February.

The Department of Health warned that PCTs that restricted access to heart failure care would be 'subject to judicial review'.

Only 20 per cent of UK GPs regularly used ?-blockers in heart failure, according to the study, which surveyed 378 GPs, 610 specialists and 879 patients in the UK. Similar numbers were polled in eight other European countries.

Just 36 per cent of UK GPs started heart failure treatment with an ACE inhibitor either alone or in combination with a diuretic, again the lowest of any country in the study. Three-quarters of GPs were diagnosing heart failure by signs and symptoms alone.

Professor John McMurray, member of the SHAPE steering committee and professor of medical cardiology at the University of Glasgow, accused GPs of holding 'old-fashioned attitudes' and being unwilling to take on the workload of ?-blocker use.

He said: 'We were really shocked when we saw GPs' attitudes to some of the key lifesaving treatments in heart failure.'

Cardiologists were particularly 'surprised' by GPs' 'completely untrue' beliefs on ?-blockers and ACE inhibitors. In the UK, 95 per cent of GPs thought ?-blockers could worsen heart failure and 45 per cent thought the same of ACE inhibitors.

Professor Gregory Lip of Birmingham's City Hospital said: 'I am surprised at that figure as ACE inhibitors have been around for a good decade and very early on showed a benefit in heart failure.'

But heart tsar Dr Roger Boyle defended UK care at the survey's launch, claiming prescribing of heart drugs had been 'increasing exponentially' since the new contract. He said a £60 million investment in echocardiography was addressing the shortage in facilities.

Are GPs to blame?

GPs need more resources and more support from secondary care. We don't have good back-up~

When I was training, if you said people with heart failure should be given ?-blockers you wouldn't pass~

GPs work flat out. Chronic disease management gets squeezed~

It must reflect some failure in medical education. I can't believe UK GPs are genetically worse than Romanian GPs~

UK branded 'worst in Europe' for use of ?-blockers in heart failure

Percentage of GPs who

regularly use ?-blockers

Germany 69%

Poland 65%

Sweden 47%

Italy 39%

Romania 37%

France 35%

Spain 32%

Netherlands 22%

UK 20%

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