Journal of Public Health 26(1) © Faculty of Public Health 2004; all rights reserved.
Managing heart failure in primary care: first steps in implementing the National Service Framework
Shamini Gnani, Specialist Registrar Public Health Medicine1,4
Jeremy Gray, Director2
Kamlesh Khunti, Senior Lecturer in General Practice3
Azeem Majeed, Professor of Primary Care4
1 Office for National Statistics, 1 Drummond Gate, London SW1V 2QQ
2 Battersea Research Group, Bolingbroke Hospital, London SW11 6HN
3 Department of General Practice, University of Leicester, Leicester LE5 4PW
4 Primary Care Research Unit, School of Public Policy, University College London, 29–30 Tavistock Square, London WC1H 9EZ
Address correspondence to Dr Shamini Gnani, at Primary Care Research Unit, School of Public Policy, University College London, 29–30 Tavistock Square, London WC1H 9EZ. E-mail: shamgnani{at}yahoo.co.uk
Background Heart failure is common, causes considerable morbidity, and imposes a major financial burden on both society and the National Health Service. The National Service Framework (NSF) for Coronary Heart Disease (CHD) set national standards for the management of people with heart failure in England. We examined how patients with heart failure were investigated and treated compared with NSF standards, and explored the current constraints in improving the care of these patients.
Methods This study was carried out in two general practices (total list size 19600) in south London. Using a computer search strategy, patients with possible heart failure were identified and clinical data extracted from their medical records. Workshops on heart failure were held at a national conference on disease management in primary care, and key stakeholders were interviewed to identify constraints in improving management.
Results Ninety patients with heart failure were identified through the computerized search. Seventy-eight patients (87 per cent) had a Read code for heart failure on their electronic medical record. Forty-eight (53 per cent) patients were men and 10 (12 per cent) were aged less than 65 years. Forty-nine per cent of patients had undergone an electrocardiogram and 42 per cent an echocardiogram. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to 54 per cent of patients. In the workshops and stakeholder interviews, healthcare professionals and managers reported difficulties in implementing the NSF. They expressed concerns regarding the difficulties in confirming a diagnosis of heart failure, including access to echocardiograms, prescribing ACE inhibitors among older patients, and the additional workload and resources needed to ensure they met the NSF standards for heart failure.
Conclusion The accurate identification of heart failure patients and recording of clinical information as part of disease registers needs to improve if primary care teams are to meet the NSF standards. There is also scope to improve the investigation and treatment of heart failure patients in primary care. Achieving these objectives will require additional resources.
Keywords: heart failure, primary care, disease registers, national service framework