title: Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy.
abstract: BACKGROUND
  Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care.
  
  
  OBJECTIVE
  To evaluate current drug therapy for CHF in adults with HF diagnosed according to ESC guidelines in the context of the EPICA study. Aetiological features and therapy relevant comorbidities were also analysed.
  
  
  METHODS
  EPICA was a community-based epidemiological study conducted in mainland Portugal. The study involved 365 primary care physicians, who evaluated 6300 primary care attendees aged over 25 years. CHF was diagnosed by clinical and echocardiography criteria according to ESC guidelines.
  
  
  RESULTS
  Total of 551 cases of CHF were identified, with a mean age of 65+/-9 years. The estimated overall prevalence of CHF in the Portuguese population was 4.4%; 1.3% with and 1.7% without left ventricular systolic dysfunction (LVSD). There are 6,280,792 people aged >25 years in Portugal, which extrapolates to 261,400 cases of heart failure. About 80% of patients had a history of hypertension, 39% had a history of coronary artery disease and 15% had atrial fibrillation. Only 58% of patients were on angiotensin-converting enzyme (ACE) inhibitors and 7% on beta-blockers. The type of ventricular dysfunction, age and presence of renal failure had little effect on prescription rates. Diuretics were prescribed in 78%. Thiazides were used more frequently in those with preserved systolic function and frusemide in those with left ventricular systolic dysfunction. Digoxin was prescribed more often to patients with than without left ventricular systolic dysfunction (34% vs. 17%; p=0.02). Long-acting nitrates were prescribed to 20% and amiodarone to 8% of patients.
  
  
  CONCLUSIONS
  The EPICA study, as in other studies in primary care in Europe, particularly the IMPROVEMENT study, suggests that greater efforts are required to improve training of primary care teams in the management of CHF.
authors.affiliation: Department of Medical Therapeutics, Medical Sciences School, New University of Lisbon, Portugal. fatima.ceia@sapo.pt
authors.forename: Fátima
authors.initials: F
authors.lastname: Ceia
authors.forename: Cândida
authors.initials: C
authors.lastname: Fonseca
authors.forename: Teresa
authors.initials: T
authors.lastname: Mota
authors.forename: Humberto
authors.initials: H
authors.lastname: Morais
authors.forename: Fernando
authors.initials: F
authors.lastname: Matias
authors.forename: Catarina
authors.initials: C
authors.lastname: Costa
authors.forename: António G
authors.initials: AG
authors.lastname: Oliveira
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011174:Portugal / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011320:Primary Health Care