A review of heart failure services has found wide variations between the performance of primary care trusts.

The Healthcare Commission said it was 'worrying' that 26 PCTs were judged to be weak for their overall level of service. These PCTs will now have to produce an improvement plan.

In the assessment of progress made against the 2003 national service framework for coronary heart disease, the commission reported substantial progress.

But there remained a mixed picture among PCTs, for example the 'considerable variation' in identifying people with heart failure in primary care. The total number was 140,000 below the watchdog's expectations.

The findings preceded the launch this week of a government consultation into the future of stroke services.

The consultation proposes that acute stroke patients should be treated by ambulance services as a category-A response, 75 per cent of which must be attended to in eight minutes.

National director for heart disease and stroke Professor Roger Boyle, who is leading the consultation, said: 'Services may need to be reorganised within trusts or local areas to ensure patients receive faster care.

'By redesigning services so that people can be given the newest treatments in specialist centres, including clot-busting drugs, 1,000 people who have a stroke a year could regain independence rather than die or be left dependent on others.'