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[Treatment of heart failure: guidelines compared to clinical practice]
Sławomir Stawicki1, Mariusz Jasik, Marek Roik
1I Katedra i Klinika Kardiologii AM w Warszawie.
Insights
Cardiologists and gastroenterologists show variations in managing heart failure (HF), with differing adherence to European Society of Cardiology (ESC) guidelines. Prescribing patterns for angiotensin-converting-enzyme inhibitors (ACE-I) and beta-blockers (BB) varied between departments, impacting HF treatment consistency.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Practice Guidelines
Context:
- Heart failure (HF) management has evolved significantly, with angiotensin-converting-enzyme inhibitors (ACE-I) reducing morbidity and mortality.
- Assessing specialist knowledge and adherence to European Society of Cardiology (ESC) guidelines is crucial for optimizing HF patient care.
Purpose:
- To evaluate how cardiology and gastroenterology specialists manage heart failure (HF).
- To compare specialist knowledge with actual clinical practice and adherence to ESC recommendations.
- To identify practice variations between cardiology and gastroenterology departments in HF management.
Summary:
- A study involving questionnaires and medical record analysis of 345 patients (aged 38-98) assessed HF management by cardiologists and gastroenterologists.
- Angiotensin-converting-enzyme inhibitors (ACE-I) were widely prescribed across NYHA classes, with variations between departments.
- Beta-blockers (BB) were used similarly across classes, more frequently in cardiology. Digoxin, diuretics, and aldosterone receptor blockers increased with NYHA class severity.
- Highest compliance was observed for the combined use of beta-blockers (BB) and angiotensin-converting-enzyme inhibitors (ACE-I).
Impact:
- Highlights discrepancies in heart failure (HF) management between cardiology and gastroenterology specialists.
- Identifies areas for improved adherence to European Society of Cardiology (ESC) guidelines in clinical practice.
- Provides insights into the real-world implementation of evidence-based HF therapies.
Unlabelled:
Last decade brought great development in the treatment of patients with heart failure (HF). General use of angiotensin-converting-enzyme inhibitors (ACE-I) in patients with asymptomatic left ventricular dysfunction or with HF significantly reduced morbidity and mortality. The aim of this study was to assess how the specialists from Cardiology Department and Gastroenterology Department think that heart failure should be managed, how they implement their knowledge and if it is consistent with the recommendation of European Society of Cardiology (ESC) and whether differences exists in practice between specialists. In the first phase the specialists, cardiologists and diabetologists, answered the questions about the management of different stages of HF. In second phase we analysed medical documentation of 345 patients aged between 38 and 98 years, hospitalised in Cardiology and Gastroenterology Departments from October 2000 to February 2002 by reason of coronary artery disease, hypertension and dilated cardiomyopathy. In the third phase we compared the knowledge of heart failure management from questionnaire and its implementation, the compliance with ESC recommendation and finally whether differences in clinical practice exist between cardiologist and diabetologists.
Results:
ACE-I were prescribed in all NYHA classes of HF. In over 50% patients in II NYHA class to 94% in IV NYHA class in Cardiology Department. Differences between the Departments in prescribing of ACE-I were observed. Beta-blockers (BB) were used with the same frequency in all NYHA classes, more often in Cardiology Department. Frequency of the administration of digoxin, diuretics, aldosterone receptor blocker was increasing starting with II NYHA class. The highest compliance between declarations from questionnaire and clinical practice concerned the use of BB and ACE-I combination.