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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, Oxford University, Oxford, UK

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    Heart failure is a condition that eventually kills most of those who have it, and at the very least causes misery, anxiety, and repeated visits to hospital. The evidence base for treatment has been built up by adding one drug class to another, so patients are usually on a long list of medication about which many have little understanding. Short term outcomes can be improved by patient education, as in a trial of 223 patients with systolic heart failure who were randomised to receive 1 hour of nurse-educator teaching at the time of hospital discharge (

    ). At 6 months, the intervention group totalled fewer days dead or in hospital, and showed reduced costs. A larger community-based trial (n = 1069) in all types of heart failure used a telephonic disease management programme and showed an average 76 days longer survival at 18 months, but no improvement in objective measures of function, hospitalisation, or healthcare costs (
    ). Looking beyond heart failure, a randomised trial of home medication review in patients over 80 taking ⩾2 drugs …

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