Related Experiment Video

Updated: Aug 8, 2026

Workflow and Framework for Collecting and Implementing Point-of-Care Ultrasound Data in the Management of Heart Failure Patients
03:47

Workflow and Framework for Collecting and Implementing Point-of-Care Ultrasound Data in the Management of Heart Failure Patients

Published on: July 12, 2024

Compliance by referring physicians with recommendations on heart failure therapy from a tertiary center

Hans Peter Brunner-La Rocca1, J Capraro, W Kiowsk

  • 1Division of Cardiology, University Hospital, Zurich and Clinic of Cardiology, University Hospital, Basel, Switzerland. brunnerh@uhbs.ch

Journal of Cardiovascular Pharmacology and Therapeutics
|May 17, 2006
PubMed

Insights

Physicians often underdosed heart failure medications like ACE inhibitors/ARBs and beta-blockers, with lower adherence to complex medication changes. Simple, one-step recommendations improved adherence to guideline-directed medical therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Internal Medicine

Background:

  • General practitioners' adherence to heart failure specialist recommendations was investigated.
  • The study assessed medication use and physician compliance with expert guidelines.

Purpose of the Study:

  • To evaluate the adherence of referring physicians to heart failure specialist recommendations regarding medication.
  • To determine if general practitioners follow expert advice on heart failure pharmacotherapy.

Main Methods:

  • A cohort of 193 stable heart failure patients (ejection fraction ≤40%) was analyzed.
  • Physician adherence to specialist recommendations on medication (ACE inhibitors/ARBs, beta-blockers, spironolactone) was recorded over 1906 visits.
  • Medication doses and changes were compared to target recommendations.

Main Results:

  • High initial use of ACE inhibitors/ARBs (96%); beta-blocker and spironolactone use increased post-2001.
  • Suboptimal dosing was common for ACE inhibitors/ARBs (55% of target) and beta-blockers (29% of target).
  • Physician adherence was lower for initiating/up-titrating ACE inhibitors/ARBs (62%) and beta-blockers (48%) compared to spironolactone (78%).
  • Single-step recommendations showed higher adherence (63-70%) than multiple-step recommendations (25-48%).
  • No significant difference in adherence was observed between general practitioners and cardiologists.

Conclusions:

  • While beneficial heart failure medications were widely prescribed, doses were often below recommended targets.
  • Physician adherence to medication change recommendations, especially complex ones, was insufficient.
  • Simplified, single-step recommendations and direct prescribing during clinic visits may improve adherence and optimize heart failure management.
Abstract

Related Concept Videos

Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
Mitral Regurgitation IV: Nursing Management01:28

Mitral Regurgitation IV: Nursing Management

Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...