General practice p 1113

Heart failure is common, serious, and treatable, 1 2 so great efforts should be made to manage it correctly. In this issue Mason et al point out that fear of side effects may be a major barrier to the use of angiotensin converting enzyme inhibitors by general practitioners (p 1113).3 However, management is not just about prescribing the correct treatment; it also involves obtaining a proper diagnosis.

An estimated 10 million patients in Europe have heart failure secondary to left ventricular systolic dysfunction. 1 2 They are dwarfed by the estimated additional 40 million who have symptoms and signs of heart failure2 but in whom the diagnosis is subsequently refuted by investigation4 or attributed to another cause such as “diastolic” heart failure,2 a condition that is not known to respond to angiotensin converting enzyme inhibitors.5 Only once a diagnosis of heart failure has been established and underlying left ventricular systolic dysfunction confirmed is treatment with a combination of angiotensin converting enzyme inhibitors and β blockers (Cochrane reviews in preparation) generally appropriate.

Who then should manage patients with suspected or confirmed heart failure? The diagnostic burden of suspected heart failure is about 50 000 patients per million population, of which …