New GP contract may not improve treatment for heart failure patients

May 4 2005

The new contract for GPs may improve identification and diagnosis of chronic heart failure, but there is a danger that it may fall short of ensuring optimal treatment for these patients, says research published this week in Postgraduate Medical Journal.

Researchers from Edinburgh questioned and got responses from 379 GPs about their perception of the new general medical services (GMS) contract and how guidelines will impact on CHF services.

Changes to the GMS contract are intended to put more emphasis on management of cardiovascular disease -- still a large cause of death in the UK --but the contract only has three specific performance indicators for patients with left ventricular dysfunction caused by coronary artery disease and does not include heart failure caused by other causes.

Of the doctors responding, most (89%) said they were aware of a national guideline on the subject, but as many as 41% had not read it.

The report says the three performance indicators -- creating a patient register, obtaining echocardiographic confirmation of left ventricular dysfunction, and establish patients on an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocking drugs (ARB) -- fall well short of ensuring the implementation of best practice, partly because they do not include the use of a number of other important treatments such as Beta blockers.

Around four fifths of doctors said two of the indicators were achievable, but only 46% thought it would be easy to meet the target for echocardiography.

Doctors spoke of concerns over the level of support provided by secondary care, particularly in relation to diagnostic resources and limited access to specialist advice, but those who had access to a community heart failure nurse - around 44% - valued them highly.

The authors conclude: 'The new contract may improve identification and diagnosis of CHF but there is a danger that it may fall short of ensuring optimal treatment for patients with CHF.'

Click here to view the full paper.