June focus.

摘要

Writing a while ago in the BMJ, Richard Lehman was making the case that we should no longer talk of heart failure, but replace it with 'cardiac impairment'.1 The paper on page 393 takes this one stage further, with a plea to think in terms of 'ventricular wall stretch' indicated by the release of B-type natriuretic peptide (BNP). The authors argue that this is a better predictor of ventricular function than echocardiography, and in this study they used BNP levels to guide GPs' use of drugs. The results make interesting reading: the bottom line an important reduction in overall BNP levels, mostly by switching from one beta blocker to another. But at the end, only 28% had BNP levels below the target threshold. This might be the best that anyone could achieve, and illustrates the folly of assuming that 'best practice' can be applied universally.