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Published on: July 12, 2024
[European study of ambulatory management of heart failure by cardiologists]
María J Salvador1, Alain Sebaoun, Frank Sonntag
1mjsalvador@idexeus.es
Insights
This study of 1252 heart failure outpatients across three countries found significant differences in causes like hypertension and ischemic heart disease. Beta-blocker use remains suboptimal despite increased ACE inhibitor prescription.
Area of Science:
- Cardiology and Internal Medicine
- Epidemiology of Chronic Diseases
Context:
- Heart failure (HF) represents a significant global health burden, necessitating understanding of its clinical characteristics and management.
- Outpatient cardiology settings are crucial for managing chronic conditions like HF.
- Cross-cultural comparisons in healthcare practices can reveal disparities and areas for improvement.
Purpose:
- To examine the clinical characteristics and management strategies for 1252 outpatients diagnosed with heart failure.
- To compare the reported etiologies and treatment patterns of heart failure across Spain, France, and Germany.
- To assess the utilization of key medications, including diuretics, ACE inhibitors, and beta-blockers, in heart failure management.
Summary:
- A cross-sectional study involving 465 cardiologists surveyed 1252 heart failure outpatients on a single day in April 2001.
- Significant international variations were observed in the prevalence of hypertension and ischemic heart disease as causes of heart failure.
- While ACE inhibitor use showed a slight increase, beta-blocker underutilization persisted, with 52.3% of patients not receiving this class of medication.
Impact:
- Highlights the substantial utilization of medical resources for heart failure management.
- Underscores the need for standardized heart failure treatment protocols, particularly regarding beta-blocker prescription, across different healthcare systems.
- Provides valuable data for public health initiatives aimed at optimizing heart failure care and reducing healthcare costs.
Introduction And Objectives:
This cross-sectional study examined the overall clinical characteristics and management of 1252 outpatients with heart failure in 3 countries (Spain, France and Germany).
Material And Method:
A standardized questionnaire was used to record demographic, diagnostic, clinical and treatment data for all patients seen on one day (26 April 2001) by 465 outpatient cardiologists.
Results:
Men accounted for 62.1% of the patients in the population, and mean age of the patients was 68.3 years. In the twelve months prior to the study 78% of the patients consulted their physician at least once because of heart failure, and 36.2% had hospital admissions. Differences between the three countries were observed in reported causes of heart failure (alone or in combination) such as ischemic heart disease (France 40.7%, Germany 41.3%, Spain 26%, P<.0001) and hypertension (France 10.7%, Germany 16.7%, Spain 43.6%, P<.0001). How-ever the proportion of patients with prior myocardial infarction was very similar (France 63.7%, Germany 69.5%, Spain 65%, P=NS). Diuretics were not prescribed in 19.7% of the patients, ACE inhibitors were not prescribed in 27.9%, and beta blockers were not prescribed in 52.3%.
Conclusions:
The study provides further information on the consumption of large amounts of medical resources because of heart failure. The reported etiologies differed between countries. However, the proportion of patients with prior myocardial infarction was very similar. Treatment with ACE inhibitors and beta blockers was slightly more common than previously reported, although beta blockers continue to be underused.
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