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Updated: May 3, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure:
Ulrich Tebbe1, Carsten Tschöpe, Jost Henner Wirtz
1Klinikum Lippe-Detmold, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Röntgenstrasse 18, 32756, Detmold, Germany, ulrich.tebbe@klinikum-lippe.de.
Insights
Care for heart failure patients in Germany varies between hospital cardiologists, office cardiologists, and GPs. While basic treatments are consistent, advanced therapies like MRAs show differences, suggesting a need for improved guideline adherence across all care levels.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Practice
Background:
- Heart failure (HF) care in Germany involves hospital-based cardiologists (HBC), office-based cardiologists (OBC), and general practitioners (GPs).
- Understanding variations in patient profiles, diagnostic methods, and treatment strategies among these provider groups is crucial for optimizing HF management.
Purpose of the Study:
- To compare patient characteristics, diagnostic approaches, and therapeutic decisions for chronic heart failure (HF) across different healthcare providers in Germany.
- To identify potential disparities in evidence-based treatment adoption among hospital cardiologists, office-based cardiologists, and general practitioners.
Main Methods:
- A multi-center, cross-sectional, observational survey involving 48 physicians (5 HBCs, 26 OBCs, 18 GPs).
- Inclusion criteria for patients (n=384) were diagnosed HF with NYHA class ≥ II and/or left ventricular ejection fraction <50%.
Main Results:
- HBCs managed a higher proportion of HF patients (18.8%) compared to OBCs (13.9%) and GPs (6.7%).
- Echocardiogram availability was universal for HBCs and OBCs, but limited for GPs (16.7%). Patients seen by HBCs presented with more severe HF (NYHA class III/IV: 65.6%).
- While basic guideline-recommended medications (diuretics, RAS inhibitors, beta-blockers) were widely used across all groups, mineralocorticoid receptor antagonists (MRAs) were more frequently prescribed by OBCs (54.7%) than HBCs (43.8%) and GPs (31.0%). Ivabradine use was low overall, with OBCs showing higher utilization (11.0%). Implantable device therapies (CRT, ICD) and surgical interventions (CABG) showed no significant differences between provider groups.
Conclusions:
- Significant variations exist in the management of heart failure patients across different healthcare settings in Germany.
- Opportunities to improve HF patient care by promoting adherence to evidence-based guidelines and earlier adoption of recommended therapies across all provider levels.
Background:
In Germany, care for patients with chronic heart failure (HF) is provided by hospital-based cardiologists (HBC), office-based cardiologists (OBC) and general practitioners (GP). We aimed to compare patient characteristics, diagnostic approaches and therapeutic decisions.
Methods:
Multi-centre, cross-sectional, observational survey at 48 physicians. Patients (n = 384) were required to have previously diagnosed HF and NYHA class ≥ II and/or a left ventricular ejection fraction of <50 %. A total of 384 patients were included at 5 HBCs, 26 OBCs and 18 GPs.
Results:
A mean of 18.8 % of all patients at HBCs practices had heart failure, compared to a smaller proportion of 13.9 and 6.7 % at OBCs and GPs, respectively. Echo facility was available for all HBCs and OBCs, but for 16.7 % of GPs (p < 0.0001 for trend). Patients at HBCs had a higher NYHA class (65.6 % had class III/IV; p < 0.0001) compared to 36.8 % at OBCs and 39.3 % at GPs. Usage of three guideline-recommended pharmaceutical treatments was more than 80 %: diuretics (83.1 %), renin-angiotensin system blocking agents (91.4 %) and betablockers (90.1 %) with no differences between physician groups. Mineralocorticoid receptor antagonists (MRAs, overall 47.7 %) were more frequently prescribed by OBCs (54.7 %; p = 0.0007 for trend) than HBCs (43.8 %) and GPs (31.0 %). Ivabradin was not frequently used (11.0 % at OBCs, 4.9 % at HBCs and 0 % at GPs; p = 0.0163 for trend). The proportion of patients with CRT (8.6 %), ICD (23.5 %) and CABG (23.1 %) was not statistically different between groups.
Conclusion:
REFLECT-HF demonstrates that there are some differences in evidence-based treatment decisions between the three main health services (HBC, OBC and GP) providing care for patients with HF in Germany. Advocating adherence to guideline recommendations and earlier adoption of these evidence-based treatments across all levels of care might further improve patient care.
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