Gnani Shamini, Gray Jeremy, Khunti Kamlesh, Majeed Azeem
Office for National Statistics, 1 Drummond Gate, London SW1V 2QQ.
J Public Health (Oxf). 2004 Mar;26(1):42-7. doi: 10.1093/pubmed/fdh102.
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.
This study was carried out in two general practices (total list size 19,600) 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.
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.
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.
心力衰竭很常见，会导致相当高的发病率，并给社会和国民医疗服务体系带来重大经济负担。冠心病国家服务框架（NSF）为英格兰心力衰竭患者的管理制定了国家标准。我们研究了心力衰竭患者的检查和治疗情况与NSF标准相比如何，并探讨了当前改善这些患者护理的制约因素。
本研究在伦敦南部的两家全科诊所（总登记人数19600人）进行。采用计算机检索策略，识别可能患有心力衰竭的患者，并从其病历中提取临床数据。在一次初级保健疾病管理全国会议上举办了关于心力衰竭的研讨会，并对关键利益相关者进行了访谈，以确定改善管理的制约因素。
通过计算机检索识别出90例心力衰竭患者。78例（87%）患者的电子病历中有心力衰竭的Read编码。48例（53%）患者为男性，10例（12%）患者年龄小于65岁。49%的患者接受了心电图检查，42%的患者接受了超声心动图检查。54%的患者开具了血管紧张素转换酶（ACE）抑制剂。在研讨会和利益相关者访谈中，医疗保健专业人员和管理人员报告了实施NSF存在困难。他们对确诊心力衰竭的困难表示担忧，包括获得超声心动图检查的机会、老年患者中开具ACE抑制剂以及确保符合心力衰竭NSF标准所需的额外工作量和资源。
如果初级保健团队要达到NSF标准，就需要改善心力衰竭患者的准确识别以及作为疾病登记一部分的临床信息记录。在初级保健中改善心力衰竭患者的检查和治疗也有空间。实现这些目标将需要额外的资源。
