1. The ACE inhibitors are beneficial and cost-effective in most but not all causes of heart failure.
2. The cost of ACE inhibitors is falling. Their use in heart failure will be cost-saving if the resources saved in hospital are released for use in primary care.
3. Echocardiography is a valuable investigation and we recommend that general practitioners should have access to it.
Ideally, this should be by a rapid cardiology consultation including echocardiography as part of a total assessment of heart failure. If this cannot be provided, an open access service providing an echocardiography interpretation is the second option, and can provide a useful triage system to reduce the workload of the cardiology service.