[The practice guideline 'Heart failure' (first revision) from the Dutch College of General Practitioners; a response from the perspective of cardiology]

Abstract

The Dutch College of General Practitioners' practice guideline 'Heart failure' provides a clear insight into the history, diagnosis and treatment of patients with chronic heart failure. The revised guideline does however warrant some minor comments. It suggests that an elevated BNP value contributes towards the diagnosis of heart failure, however taking into account the high negative predictive value, BNP should, for the time being at least, only act as an 'instrument of exclusion' in the diagnosis of heart failure. The section on pharmacological treatment could have been expanded with the additional information that ACE-inhibitors should be replaced by angiotensin-II receptor blockers ifangioneurotic oedema appears. Another recommendation might be that early treatment with ACE-inhibitors and statins in high-risk patients reduces the incidence of heart failure. Furthermore, the guideline does not provide information about non-pharmacological treatment such as biventricular pacing and implantable cardioverter defibrillators. Prevention is not dealt with even though it is a task particularly suited to the GP. Lastly, it could have been more clearly pointed out that outpatient clinics providing special care for heart-failure patients are well-recognized support facilities for patients with heart failure. In conclusion, the first revision can be considered as an adequate and workable practice guideline for the GP.