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[Perceptions of heart failure diagnosis and management: comparison between clinical cardiologists and family doctors]
Leandro Reis Tavares1, Luis Guilhermo Cocca Velarde, Verônica Alcoforado de Miranda
1Universidade Federal Fluminense e Projeto Médico da Família, FMS, Niterói, RJ. lreistavares@uol.com.br
Insights
Clinical cardiologists (CC) use more advanced diagnostic methods and medications for heart failure (HF) than family doctors (FD). This leads to better outcomes for HF patients, highlighting a gap in HF management strategies.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Heart failure (HF) diagnosis and management require specialized knowledge.
- Variations in clinical practice may exist between different medical specialties.
Purpose of the Study:
- To compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD).
Main Methods:
- A qualitative questionnaire, validated by the EURO-HF study, was administered to 54 FD and 62 CC.
- Data collected included HF diagnosis methods, diagnostic test utilization, and medication prescribing patterns.
Main Results:
- CC more frequently utilized echocardiograms and differentiated HF with preserved vs. systolic dysfunction (p < 0.001).
- CC prescribed beta-blockers, ACE inhibitors, and spironolactone more often than FD (p < 0.001), with higher and more appropriate dosages.
- Discrepancies were observed in HF classification methods and symptom recognition between the two groups.
Conclusions:
- Clinical cardiologists employ a more intensive diagnostic approach for HF.
- CC utilize medications more effectively in reducing HF morbidity and mortality compared to FD.
Objective:
To compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói.
Methods:
A qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality.
Results:
FD and CC reported that the most common signs and symptoms identified by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classification method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p < 0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p < 0.001). CC use beta-blockers (p < 0.001), angiotensin-converting enzyme inhibitors (p < 0.001) and spironolactone (p < 0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p < 0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature.
Conclusion:
CC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients.
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