European Heart Journal Advance Access first published online on May 27, 2008
This version published online on May 31, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn196
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.
* Corresponding author. Tel: +31 10 485 51 77, Fax: +31 10 485 48 33, Email: w.j.remme{at}sticares.org
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
The originally published version of this paper was incorrect. On p. 3, right column, the 5th sentence should have read ‘Significantly less I/G than C would prescribe a β-blocker...’ instead of ‘Significantly less I/G than C would not prescribe a β-blocker...’. The author apologizes that this error were not identified earlier.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Erdmann Safety and tolerability of beta-blockers: prejudices and reality Eur. Heart J. Suppl., March 1, 2009; 11(suppl_A): A21 - A25. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Swedberg What should we do about heart failure: challenges for 2009 Eur J Heart Fail, January 1, 2009; 11(1): 1 - 2. [Full Text] [PDF]
|
|
|
|
|
|
U. Dahlstrom, J. Hakansson, K. Swedberg, and A. Waldenstrom Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden Eur J Heart Fail, January 1, 2009; 11(1): 92 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. McMurray, M. Petrie, K. Swedberg, M. Komajda, S. Anker, and R. Gardner CHAPTER 23 Heart Failure ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Denvir and S. J. Leslie Best practice for chronic heart failure patients--writing guidelines is not enough Eur. Heart J., July 2, 2008; 29(14): 1706 - 1708. [Full Text] [PDF]
|
|