Are GPs' heart failure registers reliable? The role of BNP in improving quality in primary care

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Abstract:

Objectives To improve care for patients with heart failure (HF): establishing local prevalence of HF by finding cases, validating diagnostic registers and reducing poly-pharmacy in patients where the HF diagnosis could be confirmed or excluded.

Setting Urban general practices.

Design Population-based, quality improvement intervention centrally led by the primary care trust.

Participants Patients on HF registers, those who had had an echocardiogram, and patients receiving repeat prescriptions for beta-blockers, diuretics and angiotensin converting enzyme inhibitors. Excluding uncomplicated hypertensive and confirmed HF patients.

Results Data were received from 77.4% of local practices. Thirty-three percent of HF patients were found to be misdiagnosed and thus removed from registers, whereas only 7% of newly diagnosed cases were added. The local prevalence of confirmed HF was 1.57% (95% CI 1.51–1.63). After medication review, 7% and 4.5% of patients had their doses altered for ACE inhibitors and beta-blockers, respectively. Medication was stopped for 2.7% of the patients.

Conclusion The local prevalence of confirmed HF was lower than the national average. A clinically important proportion of HF patients had their medication reviewed or stopped, enhancing quality of care and patient safety. Clinical diagnosis was demonstrated to be frequently inaccurate with national implications for prevalence calculations within the Quality and Outcomes Framework. Indeed, national data for prevalence may be a poor marker for local performance.

Keywords: BNP; GENERAL PRACTICE; HEART FAILURE; QUALITY OF CARE

Document Type: Regular Paper

Publication date: July 1, 2006

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