[Management of heart failure by French general practitioners in 2003]

The PRINCEPS study (Prise en charge des Insuffisants Cardiaques: Enquête chez les Patients Symptomatiques) was carried out by 1,717 general practitioners who reported their experience with 3,782 patients with cardiac failure treated by an angiotensin converting enzyme (ACE) inhibitor. This is the largest observational study carried out in general practice in France to date. The average age of the patients with cardiac failure was 71 years, with a majority of men (62%), many of whom were hypertensive (76%) and had other cardiovascular risk factors. The diagnosis of cardiac failure was made by the presence of effort dyspnoea (92%) and confirmed by a cardiologist in 81% of cases. Heart failure was rarely chronic (17%>5 years), usually related to hypertension (58%) and had required hospital admission in only 39% of patients. Finally, the patients were not very symptomatic (63% Class II of the NYHA Classification). Treatment included the obligatory ACE inhibitor at a high dosage (maximal dosage according the European Recommendations) in half the patients. The dosage prescribed was considered optimal in 3 out of 4 patients, and usually treated by the consulting cardiologist (81% of patients). It was higher in the young patients, less symptomatic, and in patients with heart failure due to hypertension. A treatment with betablockers (20%), diuretics (74%), digitalis (21%), was often associated with the ACE inhibitor. These results suggest that heart failure patients treated by general practitioners have hypertension as the main cause. The ACE inhibitors seem to be prescribed initially at high dosage for treating the hypertension, and the dosage is progressively decreased with time and aggravation of the cardiac failure.