Heart failure guidance ‘ignored’

Many GPs, and even some hospital specialists, are failing to follow guidelines for managing heart failure, a Europe-wide survey suggests.

British GPs frequently did not use recommended tests or drugs, which the researchers said could be unsafe.

The European Heart Journal report said the results were "very worrying".

However, one specialist GP disputed whether the survey answers were clear evidence of poor practice among family doctors in the UK.

I have several thoughts about this article.  I tire of subspecialists publishing guidelines and then criticizing generalists for not following the guidelines.  Many guidelines have conflicts with other guidelines.  So I usually recoil from such proclamations.

On the other hand, the measures that this guideline proposes are reasonable and logical.  They are not controversial.  Every clinical diagnosis of heart failure should require an echocardiogram.  I teach that we find 5 features of the echocardiogram which can change our approach to the patient:

1. Left ventricular ejection fraction – treating patients with decreased ejection fractions is different from patients with normal left ventricular function
2. Occult valvular disease – including IHSS or HOCUM
3. Regional wall motion abnormalities – suggesting significant CAD
4. Occult pericardial effusion
5. Pulmonary hypertension with normal LVEF

I see all these results.

I would make this suggest to cardiologists and heart failure experts – understand how to help generalists learn these important concepts.  Publishing a guideline is somewhat self serving.  I agree with the standards that they advocate.  They have the responsibility to learn how to positively influence practice.  This should be an active event not a passive publication.