Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey

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Item Type:	Article
Title:	Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey
Creators Name:	Cleland, J.G.F., Cohen-Solal, A., Aguilar, J.C., Dietz, R., Eastaugh, J., Follath, F., Freemantle, N., Gavazzi, A., van Gilst, W.H., Hobbs, F.D.R., Korewicki, J., Madeira, H.C., Preda, I., Swedberg, K. and Widimsky, J.
Abstract:	BACKGROUND: Heart failure is a prevalent condition that is generally treated in primary care. The aim of this study was to assess how primary-care physicians think that heart failure should be managed, how they implement their knowledge, and whether differences exist in practice between countries. METHODS: The survey was undertaken in 15 countries that had membership of the European Society of Cardiology (ESC) between Sept 1, 1999, and May 31, 2000. Primary-care physicians' knowledge and perceptions about the management of heart failure were assessed with a perception survey and how a representative sample of patients was managed with an actual practice survey. FINDINGS: 1363 physicians provided data for 11062 patients, of whom 54% were older than 70 years and 45% were women. 82% of patients had had an echocardiogram but only 51% of these showed left ventricular systolic dysfunction. Ischaemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, and major valve disease were all common. Physicians gave roughly equal priority to improvement of symptoms and prognosis. Most were aware of the benefits of ACE inhibitors and {beta} blockers. 60% of patients were prescribed ACE inhibitors, 34% beta blockers but only 20% received these drugs in combination. Doses given were about 50% of targets suggested in the ESC guidelines. If systolic dysfunction was documented, ACE inhibitors were more likely and {beta} blockers less likely to be prescribed than when there was no evidence of systolic dysfunction. INTERPRETATION: Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required.
Keywords:	Attitude of Health Personnel, Cardiotonic Agents, Data Collection, Europe, Heart Failure, Physician's Practice Patterns, Primary Health Care
Source:	Lancet
ISSN:	0140-6736
Publisher:	Lancet
Volume:	360
Number:	9346
Page Range:	1631-1639
Date:	23 November 2002
Official Publication:	https://doi.org/10.1016/S0140-6736(02)11601-1
PubMed:	View item in PubMed

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