Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey.
BACKGROUND
The medical management of heart failure (HF) in clinical practice varies considerably by country and by medical specialty.


OBJECTIVE
To assess the treatment of HF patients admitted to Internal Medicine departments, and to evaluate out-patient management prior to admission, by specialty.


METHODS
Prospective cross-sectional multi-centre survey.


METHODS
Of 55 randomly selected Spanish hospitals, 51 agreed to participate. All patients (n = 2145) consecutively admitted for decompensated HF to the Departments of Internal Medicine of these hospitals, over 5 months, were included. Twenty variables were analysed, including aspects relating to out-patient management prior to admission.


RESULTS
Mean +/- SD age was 77.2 +/- 10.5 years, 57.3% were female, 47% had systolic dysfunction. Prescriptions at discharge: loop diuretics 85.6%, spironolactone 29.8%, ACEIs 65.8%, beta-blockers 8.7%, cardiac glycosides 39%. At admission, 86% already had a diagnosis of HF. Of these, 53% (older patients and more women) were being treated on an out-patient basis by primary care physicians. Primary care physicians requested fewer echocardiograms than internists (38% vs. 69%, p<0.001) and prescribed fewer drugs (ACEIs 40% vs. 54%, p<0.001; spironolactone 15% vs. 23%, p<0.05; beta-blockers 6% vs. 13%, p<0.01). The internists treated more incapacitated patients than the cardiologists (p<0.001), prescribed more high-dose ACEIs (20% vs. 13%, p<0.01) and spironolactone (26% vs. 20%, p<0.05), and fewer anticoagulants (32% vs. 39%, p<0.05).


CONCLUSIONS
Patients admitted to medical departments with HF are different to those found in clinical trials. Their management is currently suboptimal. Differences in treatment between internists and cardiologists appear to be accounted for by differences in the patients they treat.
Román-Sánchez
P
P
Hospital General de Requena, Paraje Casablanca s/n, 46340 Valencia, Spain. gilroman@terra.es
Conthe
P
P
García-Alegría
J
J
Forteza-Rey
J
J
Montero
M
M
Montoto
C
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D002301:Cardiac Glycosides / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D002301:Cardiac Glycosides; D002316:Cardiotonic Agents; D004232:Diuretics; D009566:Nitrates; D013148:Spironolactone; D004077:Digoxin