Pilot survey of the diagnosis and management of heart failure in primary care: a Singaporean perspective.
BACKGROUND
The diagnosis and management of congestive heart failure at the primary care level is difficult. Despite advances in medical therapy, namely angiotensin-converting enzyme inhibitors and beta-blockers, congestive heart failure remains a common cause of hospital visits. The extent to which these advances have been implemented in primary care is uncertain. We therefore sought to assess current practice patterns of primary care physicians and identify obstacles to optimal diagnosis and management of congestive heart failure in Singapore.


METHODS
Telephone interviews of 100 primary care physicians using structured questionnaires.


RESULTS
Primary care physicians diagnose congestive heart failure based on the presence of breathlessness (92.5%), lung crackles (52.5%), peripheral oedema (55.0%) and findings on chest radiography (76.8%). Only 1 in 3 mentioned raised jugular venous pressure as a useful diagnostic sign. Echocardiography was not commonly obtained (5%), mainly due to inaccessibility. While many (47.5%) were aware of the importance of angiotensin-converting enzyme inhibitors, few (16.2%) knew of the impact of beta-blockers on morbidity and mortality. Instead, diuretics were thought to be most important for prolonging survival in congestive heart failure (47.5%). The main obstacle to widespread angiotensin-converting enzyme inhibitors usage was dry cough. Patient compliance (57.5%) and cost (82.5%) were the main obstacles to optimising care.


CONCLUSIONS
Local primary care physicians diagnose congestive heart failure using non-specific symptoms and signs. Obstacles to optimal congestive heart failure management were identified. We hope our results will lead to strategies to improve patient care.
Faculty of Medicine, National University of Singapore, Singapore.
S R
SR
Soon
R
R
Yong
Z H
ZH
Chew
J M J
JM
Lee
C S P
CS
Lam
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012846:Singapore