Audits of clinical practice should be encouraged. Use of loop diuretics in patients without a diagnosis of heart failure should be discouraged

Relevant improvement has been achieved in the last 30 years in the management of patients with heart failure, with the introduction in the current guidelines 1,2 of several evidence-based treatments able to reduce the rate of occurrence of cardiovascular death and heart failure hospitalizations.As a consequence, the patients' outcomes have shown a favourable trend in the last decades. 3,4However, some further issues need to be tackled and solved: a) there is still the problem of misdiagnosis; 5 b) effective pharmacological or nonpharmacological treatments are available just for patients with heart failure and reduced ejection fraction (HFrEF); c) even in patients with HFrEF, adherence to the guidelines is suboptimal in terms of prescription of effective treatments but even more in terms of the use of the recommended appropriate dosage, 6,7 with evidence that poor compliance has a significant impact on morbidity and mortality of patients treated inappropriately. 8,9bviously, to address all these issues, the key element is a correct diagnosis of heart failure.The paper of Cuthbert et al. 10 aimed to evaluate whether patients with heart failure are correctly diagnosed and then reported in registries of general practitioners and the reasons why there is potential underreporting.The analysis was performed using audit software able to identify patients with heart failure through the consideration of different features suggesting the diagnosis of heart failure.The potential overlooked cases of heart failure were then diagnostically validated by a heart failure specialist nurse.The authors conclude that a relevant proportion of patients with heart failure are not included in the specific registries by general practitioners and that the main reason for non-inclusion is an inaccurate way of electronically coding the patients.The prevalence of heart failure was 0.63% before the audit and 1.12% after the audit, in both cases inferior to the current prevalence rates reported by epidemiological studies.