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Recently, the Dutch College of General Practitioners released a Practice Guideline on Sexual Problems which provides clear directives for the diagnosis and management of various sexual disorders in men and women. Patients who are managed in general practice and in outpatient clinics might experience distress related to sexual problems due to their age, medical condition or treatment, or distress related to problems in establishing and maintaining intimate relationships. We present two clinical cases. The first case is a woman aged 44 years with breast cancer treated by mastectomy and adjuvant tamoxifen. The second case is a man aged 54 years with heart failure due to myocardial infarction and resultant loss of physical strength. Both cases illustrate that taking a short sexual history could result in the right treatment and patient satisfaction, without having to go into detail about very intimate and private matters.

Background: The prevalence of heart failure (HF) is gaining epidemic proportions. Recent data stress the importance of multidisciplinary strategies for the management of HF patients, but the practical consequences of such programmes remain unclear. Objective: To describe our experience with a dedicated heart failure programme involving two HF nurses and a cardiologist. Method: All patients admitted to the cardiology department with NYHA class III-IV heart failure were included. After admission, patients received optimal medical therapy according to current guidelines, and extensive instructions from a dedicated HF nurse. On discharge they were given comprehensive lists of medications and symptoms, and a weighing list. They were advised to call a nurse in case of questions or problems. Results: 861 patients were included: 63% >75 years, 47% with LVEF >45%. From 2000 onwards, the number of patients admitted once a year increased but seemed to level off in 2004. Most phone calls involved weight changes as well as general physical complaints. In 1266 (46%) of calls, the medication change was a consequence of a problem raised by the patient. The nurse received and answered almost all phone calls. Conclusion: The patient group will grow substantially during the first years of the programme, but the number of patients seen in the outpatient clinic appears to stabilise after five years. Many issues regarding the care of these patients can be handled by the HF nurse

In the current era of growing incidence and prevalence of chronic heart failure (CHF) the functional status assessment of CHF patients is increasingly needed, as it is one of the tools to investigate severity of CHF. Btype natriuretic peptide (BNP) is gradually more used in the diagnosis, prognosis and management of CHF patients. Since BNP is an easy, cheap and readily available test, an investigation that evaluates the value of BNP in functional status assessment is important. In their recent paper in Cardiovascular Drugs and Therapy Abdulla et al. evaluate the potential of BNP as a surrogate marker for traditional methods of assessing functional status of patients with left ventricular systolic dysfunction [1]. The authors describe a meta analysis of four articles that all reported the correlation between BNP and functional status as assessed by either peak VO2 or 6-minute walk test. Because the meta analysis showed only a moderate correlation (r = − 0.59), the authors carefully concluded that the traditional methods should still be considered as standard methods in assessing functional capacity. We agree with this conclusion, but we would like to add some strength to it and support the notion that BNP is not a good marker for measuring functional capacity. Also we would like to make a few comments. First, we noticed that two relevant papers were not included in the meta analysis. These studies by Brunner-La Rocca et al. [2] and Kinugawa et al. [3] also described the correlation between BNP and peak VO2 in a tertiary care centre and an outpatient clinic setting respectively. Both studies reported a very low correlation coefficient between BNP and peak VO2 (r ≤ −0.33), and adding these studies would have further weakened the moderate correlation as found in the meta analysis by Abdulla et al. Second, the authors do not mention the clinical setting of the studies they reviewed. The studies were all performed in an outpatient clinic setting, making the results difficult to generalize to the total CHF population. We recently studied a group of 120 CHF patients at time of discharge after admission for CHF (age 70 ± 12 years, 58% males, left ventricular ejection fraction 34% ± 14%, 41% ischemic aetiology of CHF). BNP was assessed and 6-minute walk test was performed on the day before discharge from the hospital. No correlation between BNP and functional status (6 minute walk test) was found (r = 0.005, P = 0.95) [4]. Therefore we argue that the clinical setting should be taken into account when conclusions are drawn about the correlation between BNP and functional status. As stated by the authors BNP is a very valuable marker in the management of CHF, but its plasma levels can change due to several variables like age, gender, renal function, use of medication, body weight. We want to stress the importance of the clinical setting, especially when evaluating the relationship between BNP and functional status.