BMJ 1995;311:327 (29 July)

Letters

Single assessment may be dangerous

EDITOR,--Both the paper by C M Francis and colleagues1 and the accompanying editorial2 regarding open access echocardiography for heart failure might be interpreted as suggesting that a key role of such a service is the withdrawal of "inappropriate" drug treatment. It is suggested that this decision should be based on one echocardiographic examination per subject, with what might be regarded as a higher than average rate of non-quantitative study (42% quoted). If it is assumed, as is implied, that there was no corroborative history nor examination performed to assess patients further, might an alternative interpretation be that the echocardiographic appearances simply reflected effective treatment?

Secondly, for some patients loop diuretics and angiotensin converting enzyme inhibitors may restore an appearance of normal contractility and wall thickness or luminal dimensions. As left ventricular function is not static regardless of pharmacological treatments, is not one examination in isolation and at rest inadequate to . . . [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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