Experts call for beta-blocker use in heart failure
GPs should not be afraid to put patients on beta-blockers when treating them for heart failure, experts have said.
NICE published updated guidance on chronic heart failure in August this year recommending the use of both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers in all patients with heart failure due to left ventricular dysfunction.
This should include older patients and those with peripheral vascular disease, diabetes, interstitial pulmonary disease, erectile dysfunction and chronic obstructive pulmonary disease (COPD) without reversibility.
The guidance leaves it open to clinicians to use their clinical judgement when deciding on which drug to use first.
But speaking at the Royal College of General Practitioners annual conference in Harrogate yesterday, Dr Ahmet Fuat, a GP in Darlington and a member of the NICE heart failure guideline group, warned that there was a reluctance among GPs to prescribe beta-blockers because of the history of side-effects.
“There is a misconception around the use of beta-blockers which requires a lot of educating to overcome, “ he warned.
“We should not be depriving patients, and older patients in particular, with heart failure the use of beta-blockers.
“Lots of trials for mild to severe heart failure have shown that the drugs can achieve a significant reduction in mortality.
“Once patients are on beta-blockers, they should be counselled by their GP that it may take some time before they are available to get up to the target dose of beta-blocker. But being on some beta-blocker is better than on none at all.”
As well as the recommendations on beta-blocker use, there are a lot of other good pieces of advice and help on implementation in the updated NICE guideline, added Dr Fuat.
“It's a good review that is very helpful for GPs because it's very explicit about diagnosis.”
The updated guideline now recommends that GPs make a diagnosis of heart failure in patients suspected to have the condition who have not had a myocardial infarction by testing for elevated levels of natriuretic peptides rather than doing an electrocardiogram (ECG).
This can either be by measuring B-type natriuretic peptides (BNP) or N-terminal pro-B type natriuretic peptides (NTproBNP).
Dr Fuat welcomed the use of peptide testing when making a diagnosis but said that it was another area where GPs could benefit from greater education.
“We also need to push down the cost of performing BNP testing. It can vary dramatically across the country from £11 a test to £50,” he said.
To help GPs fully implement the updated guidance on heart failure, NICE has developed an online learning module offering advice and clinical case-studies on areas such as drug use and BNP testing.
Dr Nigel Rowell, a GP from Middlesbrough, said: “This module is well put together and at a level that would classify the GP completing it as NICE compliant.
“If we could have just one GP in every practice up-skilled to that level, it would be a great step forward in the care of heart failure patients.”
8 October 2010
This page was last updated: 14 October 2010