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Background. The extent to which guidelines for the treatment of heart failure are currently followed in primary care in the UK is unclear. Objective. To evaluate the prevalence of heart failure and the pharmacological management of heart failure in relation to European Society of Cardiology (ESC) and National Institute for Health and Clinical Excellence guidelines. Methods. Retrospective cohort study using routinely collected data from 163 general practices across Great Britain contributing data to the Doctors Independent Network (DIN-LINK) database over a 5-year period until December 31, 2006. Results. From a patient population of nearly 1.43 million, 9311 patients with heart failure were identified [mean age 78 years (SD 12)], giving an estimated prevalence of 0.7%. Of these, 7410 (79.6%) were prescribed a loop diuretic, 6620 (71.1%) were prescribed an angiotensin-converting enzyme (ACE) inhibitor or ARB, 3403 (36.6%) were prescribed β-blockers but only 2732 (29.3%) were prescribed an ACE inhibitor or ARB and a β-blocker in combination. Thirty-five per cent of patients prescribed ACE inhibitor and 11.5% of those prescribed β-blockers met ESC guideline target doses. Age, gender and comorbidity predicted whether patients received β-blocker or ACE inhibitor with younger males being more likely to receive maximal therapy. Conclusions. These data suggest that while most patients with heart failure receive an ACE inhibitor/ARB in primary care, few are titrated to target dose and many do not receive a β-blocker. Optimum treatment appears to be most likely for young men. New strategies are required to ensure equitable and optimal treatment for all. [ABSTRACT FROM AUTHOR]

Background. Type 2 diabetes is common, largely managed in primary care and requires effective glycaemic control to reduce the risk of microvascular complications. Oral hypoglycaemic agents are typically the first pharmacological intervention used to improve glycaemic control. Objectives. To evaluate the management of people with type 2 diabetes with oral hypoglycaemic agents in primary care. Methods. This retrospective cohort study included people with type 2 diabetes treated with oral agents drawn from 243 general practices in the UK over a 5-year study period from 1999 to 2003. Primary outcome measures were glycaemic monitoring and control on oral hypoglycaemic agents. Results. Of the 71 561 patients identified with prevalent type 2 diabetes, 20 922 received their first prescription for an oral hypoglycaemic agent during the study. Only 49% of patients had a recorded HbA1c within 6 months of starting therapy. Forty per cent of patients had poor glycaemic control (HbA1c ≥ 7.5%) after starting a single hypoglycaemic agent. There was a statistically significant association between post-therapy HbA1c with pre-therapy HbA1c, metformin dose, age and geodemographical classification. Greater reductions in HbA1c were observed in older patients, those with a high pre-treatment HbA1c and those from less-deprived areas. Patients remained on a single therapy for a median of 3.8 years. During the study, 7009 of those who started a single agent were prescribed a second agent. Of those with a recorded HbA1c, 50% had poor glycaemic control (HbA1c ≥ 7.5%) post-therapy. Conclusions. Management of type 2 diabetes with oral hypoglycaemic agents appears to be suboptimal for many patients. Oral treatment is often not started until glycaemic control is poor, and many patients do not receive adequate monitoring or have poor glycaemic control following treatment with oral agents. Many patients with a high pre-treatment HbA1c are not controlled on a single oral agent even at high dose suggesting that earlier, more aggressive treatment in primary care is required. [ABSTRACT FROM AUTHOR]