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Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care
Willem J Remme1, John J V McMurray, F D Richard Hobbs
1Sticares Cardiovascular Research Foundation, PO Box 882, 3160 AB Rhoon, The Netherlands. w.j.remme@sticares.org
Insights
Cardiologists demonstrate better adherence to heart failure (HF) management guidelines than internists, geriatricians, and primary care physicians. Educational initiatives are needed to improve HF care among non-specialists.
Area of Science:
- Cardiology
- Internal Medicine
- Geriatrics
- Primary Care
Background:
- Heart failure (HF) management guidelines exist to optimize patient outcomes.
- Awareness and adherence to these recommendations may vary across different medical specialties.
Purpose of the Study:
- To assess the awareness of HF management recommendations among cardiologists, internists/geriatricians, and primary care physicians in Europe.
- To identify disparities in the application of HF diagnosis and treatment strategies across these physician groups.
Main Methods:
- A survey was conducted among 2041 cardiologists, 1881 internists/geriatricians, and 2965 primary care physicians across nine European countries.
- A 32-item questionnaire assessed knowledge and practice patterns related to the diagnosis and treatment of HF (left ventricular ejection fraction <40%).
Main Results:
- Cardiologists showed higher utilization of echocardiography and echo-Doppler for diagnosis compared to internists/geriatricians.
- Internists/geriatricians and primary care physicians demonstrated lower rates of prescribing guideline-recommended medications like angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers at target doses.
- A significant proportion of primary care physicians and internists/geriatricians relied on signs and symptoms for HF diagnosis and were less likely to initiate beta-blockers or add spironolactone in specific HF scenarios.
Conclusions:
- Adherence to guideline-recommended HF management strategies is suboptimal across all surveyed physician groups.
- Internists, geriatricians, and primary care physicians exhibit significantly lower adherence compared to cardiologists.
- There is a clear need for targeted educational programs to enhance the understanding and implementation of evidence-based HF care among non-specialist physicians.
Aims:
To assess awareness of heart failure (HF) management recommendations in Europe among cardiologists (C), internists and geriatricians (I/G), and primary care physicians (PCPs).
Methods And Results:
The Study group on HF Awareness and Perception in Europe (SHAPE) surveyed randomly selected C (2041), I/G (1881), and PCP (2965) in France, Germany, Italy, the Netherlands, Poland, Romania, Spain, Sweden, and the UK. Each physician completed a 32-item questionnaire about the diagnosis and treatment of HF (left ventricular ejection fraction <40%). This report provides an analysis of HF awareness among C, I/G, and PCP. Seventy-one per cent I/G and 92% C use echocardiography, and 43% I/G and 82% C use echo-Doppler as a routine diagnostic test (both P < 0.0001). In contrast, 75% PCP use signs and symptoms to diagnose HF. Fewer I/G would use an angiotensin-converting enzyme (ACE)-inhibitor in >90% of their patients (64 vs. 82% C, P < 0.0001), whereas only 47% PCP would routinely prescribe an ACE-inhibitor. Worsening HF was considered a risk of ACE-inhibitor therapy by 35% PCP. I/G and PCP consistently do not prescribe target ACE-inhibitor doses (P < 0.0001 vs. C). Only 39% I/G would use a beta-blocker in >50% of their patients (vs. 73% C, P < 0.0001). Also, only 5% PCP would always, and 35% often, prescribe a beta-blocker and reach target doses in only 7-29%. Moreover, 34% PCP and 26% I/G vs. 11% C (P < 0.0001) do not start a beta-blocker in patients with mild HF, who are already on an ACE-inhibitor and are on diuretic. In mild, stable HF, 39% PCP and 18% I/G would only prescribe diuretics, vs. 7% C (P < 0.0001). In patients with worsening HF in sinus rhythm and on an optimal ACE-inhibitor, beta-blockade and diuretics, significantly more C would add spironolactone, but I/G would more often add digoxin.
Conclusion:
Although each physician group lacks complete adherence to guideline-recommended management strategies, these are used significantly less well by I, G, and PCPs, indicating the need for education of these essential healthcare providers.
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