Inter-specialty differences and knowledge gaps in acute and advanced heart failure care

Heart failure (HF) is a major public health challenge with high morbidity and mortality despite advances in therapy. Optimal care requires coordination among general practitioners (GPs), hospital internists, and HF specialists. This study assessed knowledge on epidemiology, diagnosis, and management of chronic, acute and advanced HF among physicians involved in HF care in Switzerland, with a focus on inter-specialty differences.

A cross-sectional online survey was conducted between January and March 2025 among GPs attending a national congress, hospital internists at a tertiary hospital, and members of the Swiss Society of Cardiology HF Working Group.

Of 130 participants (59 GPs, 38 hospitalists, 33 HF specialists; median age 44 years, 50 % female), HF specialists reported the highest self-rated competence for managing HF. Most participants were aware of undetected HF prevalence and sex disparities in care. GPs often underestimated, whereas HF specialists overestimated the HF prevalence in elderly diabetic patients. For acute HF, most chose loop diuretics as initial treatment, but hospitalists (61 %) had the highest dosing accuracy. Only 31 % correctly recognized elevated lactate as a hallmark of cardiogenic shock, with GPs scoring lowest. HF specialists were most likely to endorse intensive GDMT uptitration and cardiac rehabilitation. Recognition of advanced HF criteria and optimal referral for advanced therapies was higher among HF specialists than GPs (79 % vs. 44 %).

Substantial inter-specialty differences exist in HF knowledge, particularly in epidemiology, acute HF management, and referral for advanced HF. Targeted interdisciplinary education may improve guideline adherence and patient outcomes.