Author response

Thank you Dr Shavill for reading my editorial.¹ As a practising GP, I appreciate how difficult heart failure diagnosis can be, particularly in the presence of multimorbidity, and I was very mindful of the intense pressures on general practice when writing the piece.

Reference 2 is widely cited given the novel findings and our more recent work confirms patients are still frequently admitted to hospital at the time of heart failure diagnosis and have worse outcomes. Reference 7 is our survival analysis of over 55 000 people with heart failure published in the BMJ. Almost half of patients had heart failure as a contributory factor on their death certificate, and the Kaplan–Meier curve in Figure 5 of the article shows the significant differences in mortality: people with heart failure were three times more likely to die than comparators of the same age and sex (hazard ratio 3.36 [95% CI = 3.31 to 3.42]).

The National Institute for Health and Care Excellence (NICE) chronic heart failure guideline recommends natriuretic peptide testing for patients presenting with symptoms suggestive of heart failure to guide referral decisions, but I agree that there can then be a significant wait for echocardiography and the reports are often complex. NICE recommends that a diagnosis of heart failure is made by a specialist. I agree that accessible training in a variety of formats for the busy GP could help to raise awareness of the opportunities for earlier heart failure diagnosis.

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