Identification, diagnosis and treatment of heart failure: could we do better?

Numerous studies have shown that it is very difficult to diagnose mild heart failure accurately on clinical grounds alone. Routine echocardiography would help to solve this problem but studies have shown that this technique is greatly underused. Providing open access echocardiography, and/or targeting this resource to the most deserving cases by measuring plasma natriuretic peptides may help to optimize the use of this technique while improving the diagnosis of heart failure patients. Studies have also demonstrated the value, but apparent underuse, of angiotensin-converting enzyme (ACE) inhibitor therapy. Further questions for the management of heart failure patients have been presented by these investigations. Uncertainty remains over the appropriate timing of ACE inhibitor therapy and whether low or high doses are more effective. The ongoing ATLAS study aims to answer these questions and promotes an improvement in the treatment of heart failure patients.