Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey
Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey
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DOI：
10.1016/s0140-6736(02)11601-1
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发表时间：
2002-11-23
期刊：
影响因子：
168.9
通讯作者：
Widimsky, J
中科院分区：
文献类型：
--
作者：
Cleland, JGF;Cohen-Solal, A;Widimsky, J
背景
心力衰竭是一种常见疾病，通常在初级医疗中进行治疗。本研究的目的是评估初级医疗医生认为心力衰竭应如何治疗，他们如何运用自己的知识，以及各国在实践中是否存在差异。
方法
该调查于1999年9月1日至2000年5月31日在15个欧洲心脏病学会（ESC）成员国进行。通过认知调查评估初级医疗医生对心力衰竭治疗的知识和认知，并通过实际实践调查评估具有代表性的患者样本是如何治疗的。
结果
1363名医生为11062名患者提供了数据，其中54%的患者年龄超过70岁，45%为女性。82%的患者进行过超声心动图检查，但其中只有51%显示左心室收缩功能障碍。缺血性心脏病、高血压、糖尿病、心房颤动和主要瓣膜疾病都很常见。医生对改善症状和预后给予大致相同的重视程度。大多数医生了解血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂的益处。60%的患者使用了ACE抑制剂，34%使用了β受体阻滞剂，但只有20%的患者联合使用了这两种药物。所使用的剂量约为ESC指南中建议目标剂量的50%。如果有收缩功能障碍的记录，与没有收缩功能障碍证据时相比，更有可能使用ACE抑制剂，而使用β受体阻滞剂的可能性更小。
解释
这项调查的结果表明，大多数心力衰竭患者都得到了适当的检查，尽管这一结果可能是由于住院率较高。然而，治疗似乎并非最佳，而且各国在实践中存在很大差异。医生的知识与他们所提供的治疗之间的不一致表明，需要改善心力衰竭的医疗护理组织。
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.