Health care delivery for chronic congestive heart failure in the United Kingdom.

Abstract

Since the United Kingdom has fewer cardiology specialists than other countries, the United Kingdom cardiologist cannot provide direct care for all patients with chronic congestive heart failure (CHF). Most CHF care is provided by general practitioners, physicians or geriatricians. A survey of 100 CHF patients attending a health center revealed that these patients visited their general practitioners 270 times in 1 year, compared with only 34 outpatient visits. The cardiologist mainly provides echocardiography. The accurate diagnosis of mild CHF became imperative with the advent of angiotensin converting enzyme (ACE) inhibitors. Results of a survey showed that although 1.6% of the population are taking diuretics for CHF, only 0.84% of the population have left ventricular systolic dysfunction on echocardiography. An estimated 22 echocardiograms per 1000 population per year are required (10 for structural reasons, three for suspected new CHF, three to identify patients with a low left ventricular ejection fraction and six to identify left ventricular hypertrophy in hypertensive patients). However, district general hospitals in Scotland can only provide 3.3-6 echocardiograms per 1000 population per year. The elderly CHF patient may not receive adequate treatment because of the lack of resources and a dislike of 'overinvestigating' or 'overtreating' the elderly. The benefits of echocardiography and ACE inhibitor therapy for all patients with CHF should be stressed.