BMJ 1995;311:326-327 (29 July)

Letters

Study's conclusion is misleading and cannot be generalised

EDITOR,--C M Francis and colleagues' conclusion that echocardiography led to advice about a change in management in 70% of patients with established or suspected heart failure as diagnosed by their general practitioners is misleading.1 Their 70% represented 82 of 119 patients receiving treatment at the time of referral, 53 of whom, they concluded, were taking unnecessary diuretics. But the actual figure should also include those in the group with suspected heart failure for whom the authors advised a change in management (14/99). Therefore the true proportion of echocardiograms resulting in advice was 96/218 (44%).

We find it difficult to accept that the authors could advise on the appropriateness of prescribing by general practitioners when guided only by patients' self reported symptoms. We believe that, in the absence of additional clinical information provided by the general practitioners, the authors were not in a position to advise on changes in treatment. Input . . . [Full text of this article]


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Relevant Article

Open access echocardiography in management of heart failure in the community
C M Francis, L Caruana, P Kearney, M Love, G R Sutherland, I R Starkey, T R D Shaw, and J J V McMurray
BMJ 1995 310: 634-636. [Abstract] [Full Text]

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