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GP uptake of heart failure guidelines has ‘substantially’ increased, study finds

GPs are referring more patients for diagnostic tests and prescribing more drugs for heart failure, a study has found.

GPs are following heart failure guidelines more closely now than they were in 2002, with substantial increases in prescribing and referral rates, according to the study.

The study, led by researchers at the University of Oxford, looked at records for 93,000 patients diagnosed with heart failure between 2002 and 2014. They looked at how many patients were given diagnostic tests and how many were prescribed appropriate medications.

They said that in patients who were seen by their GP following a heart failure diagnosis, ‘guideline-indicated diagnostic investigations and treatment initiation increased substantially’ between 2002 and 2014.

They found that the proportion of patients who were referred for tests such as natriuretic peptide tests or echocardiogram rose from 33% in 2002 to 77% in 2014.

Prescription rates also increased in 2014, with 63% of eligible patients were prescribed beta blockers with either an ACE inhibitor or an ARB within three months of diagnosis, compared to just 18% in 2002.

The study did find, however, that the proportion of patients who were followed up in primary care declined during the study period, from 63% in 2002 to 44% in 2014, and that men were almost 50% more likely than women to be referred for diagnostic tests.

They said in the paper: ‘In the UK, general practitioners’ uptake of guideline-indicated diagnostic tests and treatments have increased over time. However, medication dosages remain far below the guideline-indicated target dosages and significant care gaps were observed in women and the elderly.

‘Moreover, the declining number of patients who receive heart failure care in the primary care setting is concerning and may affect the overall care of patients with heart failure.’

But study author Professor Kazem Rahimi, associate professor of cardiovascular medicine at the University of Oxford, said that observed shortcomings were ‘not necessarily related to GPs’ behaviour’.

He said: ‘We believe that prescription dosages remain below guideline-recommended targets due to the fact that GPs are initiating treatment in more patients but are unable to achieve it at a high dose for all patients.

‘This in turn could be due to patient-related factors, [such as] real tolerability issues among elderly patients, physician-related issues [such as] perceived concerns about higher doses or doubts about the value of higher doses, or health system factors [such as] insufficient resources for the often slow and time-consuming dose changes.’

RCGP vice chair Dr Mike Holmes commented: ‘Whilst the paper shows that more patients with heart disease have had appropriate tests in primary care over the past couple of decades, even better access for GPs to diagnostic tools in the community would certainly help to improve detection of heart disease.

‘There also needs to be improved communication between hospitals and GPs which… can have a huge impact on the quality of follow-up care for heart failure patients, and the starting point for this will be greatly enhanced, joined up IT systems between primary and secondary care.’


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