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Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in

Frans H Rutten1, Diederick E Grobbee, Arno W Hoes

  • 1Utrecht Heart Failure Organisation (UHFO), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Stratenum 6.101, 3508 AB Utrecht, The Netherlands. f.h.rutten@med.uu.nl

European Journal of Heart Failure
|June 12, 2003
PubMed

Insights

General practitioners (GPs) manage older, female heart failure patients, using fewer diagnostic tests and prescribing less recommended medication compared to cardiologists. Physician approach significantly impacts treatment uptake.

Area of Science:

  • Cardiology
  • General Practice
  • Health Services Research

Background:

  • Data on the diagnosis and management of heart failure in everyday care settings are limited.
  • Understanding practice patterns in primary care is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare the diagnostic work-up and management strategies for patients with suspected or confirmed heart failure between general practitioners and cardiologists.
  • To identify potential disparities in care based on physician specialty.

Main Methods:

  • A cross-sectional survey analyzed 103 patient files managed by general practitioners (GPs) and 99 patient files from cardiology out-patient clinics in the Netherlands.
  • Patients were categorized as 'GP patients' if managed solely by a GP without cardiologist co-treatment.

Main Results:

  • GP patients were older (mean age 79) and more frequently female than cardiology patients (mean age 64).
  • Cardiology patients had higher rates of ischemic heart disease and received more diagnostic investigations (e.g., echocardiography) and potentially beneficial medications (e.g., ACE inhibitors, beta-blockers).
  • While diuretics were commonly prescribed in both groups, significant differences existed in the use of other guideline-recommended heart failure therapies.

Conclusions:

  • General practitioners predominantly manage older, female heart failure patients, often with less intensive diagnostic work-up and medication compared to cardiologists.
  • Differences in patient demographics partially explain the variations in care, suggesting physician attitudes play a significant role in treatment decisions.
  • Further research is needed to address practice variations and optimize heart failure management in primary care.
Abstract

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