Spironolactone prescribing in heart failure: comparison between general medical patients and those attending a specialist left ventricular dysfunction clinic.

We compared the rate of prescription of low-dose spironolactone among patients with heart failure in a general medical inpatient setting and in a specialist left ventricular (LV) dysfunction clinic. 38% of general medical patients and 72% of patients attending the specialist clinic had been prescribed spironolactone. When contraindications were considered, 54% of patients in the general medical group and 77% of patients in the specialist clinic group were appropriately treated in respect of spironolactone prescribing. Patients attending a specialist LV dysfunction clinic are therefore more likely to be treated with low dose spironolactone, an accepted appropriate treatment for heart failure, than those admitted to general medical and acute geriatric units. Improvement in care for patients with CHF may be achieved either by increasing the use of specialist clinics or by better dissemination of evolving evidence.