Differences between cardiologists and internists in the management of heart failure. Medical guidelines compared with every-day practice.
BACKGROUND
A marked progress in the treatment of chronic heart failure (CHF) took place during the last decade. Large, randomised studies documented the role of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in the reduction of mortality and morbidity in CHF.


OBJECTIVE
To assess differences in the management of CHF patients between cardiologists and internists.


METHODS
Medical records of 433 patients with CHF, aged 38-98 years, hospitalised between October 2000 and May 2002 in an academic centre, were retrospectively analysed. Cardiologists treated 241 patients, and internists - 192 patients. In addition, 12 randomly selected physicians who treated CHF patients, filled-in a questionnaire concerning CHF treatment. Next, the answers were compared with the actual treatment, documented in patients medical files.


RESULTS
There were significant differences in the CHF treatment between cardiologists and internists. Cardiologists significantly more often prescribed ACE-I in NYHA class III patients (77% vs 58%, p=0.003), beta-blockers in all NYHA classes (80% vs 57%, p<0.001), loop diuretics in NYHA classes III and IV (76% vs 42%, p<0.001 and 91% vs 44%, p=0.005), and thiazides in NYHA class III patients (36% vs 11%, p<0.001). Internists more often used loop diuretics (37% vs 15%, p<0.001), digoxin (28% vs 7%, p<0.001) and aldosterone antagonists (24% vs 13%, p=0.022) in NYHA class II patients. All cardiologists and almost half of internists declared combined usage of ACE-I and beta-blockers at increasing dosages as the treatment was continued. The highest concordance between declared and actual medication concerned the concomitant use of ACE-I and beta-blockers.


CONCLUSIONS
Cardiologists used more often ACE-I and beta-blockers than internists in the treatment of CHF patients. A satisfactory knowledge of treatment guidelines was not associated with widespread usage of ACE-I and beta-blockers in every-day practice.
Stawicki
Sławomir
S
Department of Cardiology, Medical Academy, Warsaw, Poland.
Roik
Marek
M
Jasik
Mariusz
M
Kosior
Dariusz
D
Scisło
Piotr
P
Kochanowski
Janusz
J
Dembe
Krzysztof
K
Steckiewicz
Roman
R
Karnafel
Waldemar
W
Opolski
Grzegorz
G
D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology / Q000706:statistics & numerical data; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D018674:Adrenergic Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors