European Heart Journal Advance Access originally published online on May 27, 2008
European Heart Journal 2008 29(14):1739-1752; doi:10.1093/eurheartj/ehn196
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Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians
1 Sticares Cardiovascular Research Foundation, PO Box 882, 3160 AB Rhoon, The Netherlands
2 University of Glasgow, Glasgow, UK
3 Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
4 Hôpital Lariboisière, Paris, France
5 Hospital Universitario Gregorio Maranon, Madrid, Spain
6 Ospedale S. Giovanni-Addolorata, Rome, Italy
7 CHU Nancy Hôpital de Brabois, Nancy, France
8 Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
9 Institulul de Boli Cardiovasculare, ‘C.C.Iliescu’, Bucharest, Romania
10 National Institute of Cardiology, Warsaw, Poland
11 Karolinska University Hospital, Stockholm, Sweden
Received 20 December 2007; revised 9 April 2008; accepted 17 April 2008; online publish-ahead-of-print 27 May 2008.
* Corresponding author. Tel: +31 10 485 51 77, Fax: +31 10 485 48 33, Email: w.j.remme{at}sticares.org
See page 1706 for the editorial comment on this article (doi:10.1093/eurheartj/ehn256)
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 β-blocker in >50% of their patients (vs. 73% C, P < 0.0001). Also, only 5% PCP would always, and 35% often, prescribe a β-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 β-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, β-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.
Key Words: Heart failure • Awareness • Perception • Europe • Guidelines • Diagnosis • Treatment • Advice • Cardiologists • Internists • Geriatricians • Primary care physicians • ACE inhibition • β-Blockade • Aldosterone antagonists • Diuretics • Echocardiography • Heart failure nurses
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