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Chronic heart failure due to left ventricular systolic dysfunction has a high morbidity and mortality. Angiotensin converting enzyme inhibitors reduce symptomatic deterioration, hospitalisation, and death. Most patients with suspected heart failure present first to general practitioners. Recent studies have emphasised the difficulty of diagnosing heart failure in the community. Fewer than half of patients treated for heart failure by general practitioners CommentThis study shows that left ventricular systolic dysfunction is unlikely to be present if the electrocardiogram is normal (or shows only minor abnormalities). Conversely, there is usually a major electrocardiographic abnormality in the presence of left ventricular systolic dysfunction. The electrocardiogram is not a substitute for echocardiography, as an abnormal electrocardiogram does not accurately predict the presence of left ventricular systolic dysfunction. A patient with an abnormal electrocardiogram has about a one in three chance of significant left ventricular systolic dysfunction. Sensitivity 90/96=94%; specificity 269/438=61%; positive predictive value 90/259=35%; negative predictive value 269/275=98%. tNormal or minor abnormality (atrial enlargement, bradycardia, tachycardia, broadening of QRS complex, poor R wave progression, right axis deviation, myocardial ischaemia, first degree atrioventricular block, nonspecific ST-T wave changes).

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Objective-To assess the value of an open access echocardiography service.Design-Study of new open access service for general practitioners, who were invited to refer patients taking diuretics for suspected heart failure, untreated patients with symptoms of possible heart failure, and asymptomatic patients with risk factors for left ventricular systolic dysfunction.Setting-Regional cardiology centre.