Investigation in general practice of patients with suspected heart failure

摘要

Heart failure is a life threatening disorder that affects between 0.4% and 2% of the general population and up to 10% of elderly subjects in Europe and North America. Annual mortality exceeds 60% in severe cases, and the five year mortality approaches 50% in milder cases. These rates are as high as for many forms of cancer. The morbidity caused by heart failure is reflected in the workloads of both the hospital service and general practice: there are 120 000 hospital admissions per year (5% of all admissions to adult medical and geriatric wards), and it is estimated that for each hospital admission 14 consultations take place in general practice. The cost to the National Health Service is considerable: £360 million a year is spent on the management of heart failure, and 60% of this goes on hospital treatment alone. In several large trials angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and also to improve symptoms and quality of life. These drugs are now licensed for use in general practice, where considerable marketing pressure is being applied.