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Differences between primary care physicians and cardiologists in management of congestive heart failure: relation to
M E Edep1, N B Shah, I M Tateo
1Department of Medicine, University of California, San Francisco, USA.
Insights
Physician practices for managing congestive heart failure (CHF) differ significantly by specialty, with cardiologists adhering more closely to guidelines than internists and general practitioners. These variations impact patient outcomes and healthcare costs.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Practice Guidelines
Background:
- Congestive heart failure (CHF) significantly contributes to mortality, morbidity, and healthcare utilization.
- Despite advances in CHF diagnosis and treatment, physician management practices are not well-documented.
Purpose of the Study:
- To characterize physician practices in managing congestive heart failure (CHF).
- To determine variations in CHF management practices among different medical specialties.
- To assess the alignment of physician practices with established guideline recommendations.
Main Methods:
- A survey was conducted among 2,250 family/general practitioners, internists, and cardiologists regarding their CHF patient management.
- Practices were analyzed using multivariate models to identify relationships with physician specialty, experience, board certification, and patient volume.
- Responses were compared against guidelines from the Agency for Health Care Policy and Research.
Main Results:
- Significant differences in adherence to CHF guideline recommendations were observed across specialties.
- Routine evaluation of left ventricular function was more common among cardiologists (87%) than internists (77%) and FP/GPs (63%).
- Use of angiotensin-converting enzyme inhibitors for mild to moderate CHF varied: cardiologists (80%), internists (71%), and FP/GPs (60%).
Conclusions:
- Cardiologists' reported practices align more closely with published CHF guidelines compared to internists and FP/GPs.
- Discrepancies in CHF management practices among specialties may significantly influence patient outcomes and healthcare expenditures.
- Further research is needed to address practice variations and optimize CHF care delivery.
Objectives:
This study was designed to characterize physician practices in the management of congestive heart failure (CHF) and to determine whether these practices vary by specialty and how they relate to guideline recommendations.
Background:
Congestive heart failure is responsible for considerable mortality, morbidity and health care resource utilization. Although there have been important advances in the diagnostic evaluation and treatment of CHF, little information is available on physician practices in this area.
Methods:
We surveyed physicians concerning their management of patients with CHF. The results were analyzed in multivariate models to determine the relation of diagnostic and treatment approaches to physician specialty, time since training, board certification and volume of patients with CHF. Surveys were sent to a sample of 2,250 family and general practitioners (FP/GPs), internists and cardiologists. Responses were examined in relation to guidelines issued by the Agency for Health Care Policy and Research that had been released 9 months previously.
Results:
Significant differences were found between physician groups with regard to each of the major guideline recommendations. For example, routine evaluation of left ventricular function, a point of emphasis in the guideline, is performed by 87% of cardiologists, but by only 77% of internists and 63% of FP/GPs (p < 0.001 between groups). Angiotensin-converting enzyme inhibitors were used by cardiologists, internists and FP/GPs in 80%, 71% and 60% of patients with mild to moderate CHF, respectively (p < 0.001 between groups). Larger differences were reported in the prescribed dosages of these drugs and their use in patients with renal dysfunction.
Conclusions:
Cardiologists report practices more in conformity with published guidelines for CHF than do internists and FP/GPs. Because of the large numbers of patients with CHF and their substantial mortality, morbidity and cost of care, these differences may have a major impact on outcomes and health care costs.