Poor communication impairs optimal care of patients with heart failure and erectile dysfunction

Heart failure (HF) and erectile dysfunction (ED) share numerous risk factors and pathogenetic mechanisms, resulting in a high prevalence of ED among male patients with HF. This questionnaire-based study aimed to better understand the patient's journey from a patient perspective and that of healthcare professionals (HCPs) regarding communication, education and treatment of ED as a recognized comorbid condition.

Two independent online surveys were conducted between November 2021 and January 2022 in Germany. Analysis of the first patient-targeting survey comprised 927 male patients with HF. As part of this survey, 176 patients with HF and comorbid ED provided further information about their experiences and ED-related communication with HCPs. The second online survey collected the perspectives of 78 physicians including general practitioners (GPs), cardiologists and internists throughout Germany.

The average age of participating male patients with HF was 55 years. Both patients and HCPs considered sexual life as an important aspect of patients' quality of life (QoL). Fifty-six per cent of all patients with HF rated their sexual life as important, and 43% were unsatisfied with it. Patients' suffering due to ED was reported as moderate to severe by nearly all HCPs (92%) and patients themselves (82%). A communication gap and perceived imbalance in education were identified, with 27% of patients reporting consultations about ED, while 58% of HCPs claimed to proactively address the issue of ED during counselling. Thirty-nine per cent of HCPs felt that their patients were uncomfortable talking about ED, but only 7% of patients reported discomfort. As a possible result, 69% of male HF patients with ED felt left alone, and 74% stated that they would like to talk to an HCP. Due to inadequate education together with patients not considering their HF doctor as a contact for ED management, as few as 20% of patients with ED receive prescription drugs for ED management. HCPs reported that 32% of their patients are non-compliant with HF medication due to ED, highlighting the importance of sexual health for patients' QoL.

The results of our surveys suggest that most of the male HF patients may be receiving incomplete ED management also affecting HF treatment, most likely due to impaired communication with their HCPs with barriers from both sides. HCPs giving patients advice on this topic are urgently needed to improve patients' QoL, reduce patient suffering and avoid discontinuation of HF medications for fear of side effects.