UK
National Service Framework for heart failure required
By BMJ Specialty Journals
Jun 16, 2005, 18:02

A new National Service Framework for chronic heart failure is urgently needed, because patients with heart failure are getting a raw deal, despite the availability of effective treatment, say leading cardiologists in Heart.

There is a wealth of reliable evidence on the appropriate treatment of heart failure and an increasing range of effective treatments, they say.

Timely treatment can roughly double life expectancy and reduce the need for repeated hospital admissions. Yet heart failure continues to be inadequately investigated and treated.

Dr Andrew Clark and Professor John Cleland of Castle Hill Hospital, in Hull, north east England, point to the evidence of a large annual European survey of 11,000 patients admitted to hospital with heart failure.

This showed that only two thirds had ever been given a heart tracing (ECG). Recommended drugs for heart failure include ACE inhibitors, beta blockers, and diuretics.

But an ACE inhibitor had not prescribed to four out of 10 patients, while a beta blocker had only been given to just over a third. And a combination of all three recommended drugs had only been prescribed to 17% of patients.

This is not just of concern to individual patients whose lives are being curtailed by lack of treatment, but also to society as a whole, warn the authors.

"Heart failure is an enormous consumer of healthcare resources. The largest proportion of these costs is on inpatient hospital care, and heart failure patients have an extremely high readmission rate," they write.

Structured management programmes, including multidisciplinary teams of nurses, pharmacists, and physiotherapists, and partnership working with patients and carers, are the way forward, say the authors.

A study from the University of East Anglia, also published in this issue, shows that multidisciplinary treatment can cut both hospital admissions and deaths from heart failure.

The current framework on coronary heart disease, while laudable in its aims, is failong patients with heart failure, say the authors.

"What is needed is recognition by central government that heart failure is common and expensive, but treatable. A National Service Framework for hear failure with specific targets is a priority," they write.

Politicians should stop prevaricating. In the end, such a move will save money, they write.

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