[Knowledge of primary care physicians, cardiologists from cardiology clinics, internal and cardiology department physicians about chronic heart failure diagnosis and treatment].
Last studies have shown unsatisfactory diagnosis and treatment of chronic heart failure (CHF) patients. The aim of this study was to compare the knowledge of primary care physicians (PCP), cardiologists from cardiology clinics (CARC), internal and cardiology department physicians (INTD and CARD) about CHF diagnosis and treatment.


METHODS
A questionnaire consisting of 23 questions related to above issues was filled out by 153 physicians (64 PCP, 24 CARC, 44 INTD and 21 CARD) from the urban district. Similarly to other physicians, PCP suspected CHF on the ground of ankle oedema (88%), dyspnoea (75%) and basal pulmonary crepitations (44%). Most questioned doctors ordered a chest X-ray (58-86%) to establish the diagnosis. Echocardiography was underused by PCP (19%) in comparison to other doctors (68-86%). Under-utilization of angiotensin converting enzyme inhibitors (ACEI) (-68 to -79%; NS) and, especially, beta-blockers (-35% by PCP to -51% by CARD; p < 0.05) was observed. The recommended target dose of enalapril knew more CARD (52%) and INTD (45%) than PCP (25%) (p < 0.05 and p < 0.01, respectively). The appropriate target dose of carvedilol knew 3% of PCP, 8% of CARC, 9% of INTD and 14% of CARD (PCP vs. CARD; p < 0.01).


CONCLUSIONS
Most CHF patients from the urban region are diagnosed by PCP and other doctors on the basis of symptoms, signs and a chest X-ray. The misdiagnosis of CHF may depend on the small direct access of PCP to echocardiography. Under-utilization and under-dosing of ACEI and beta-blockers creates the necessity to introduce broad educational programs and some organisational changes (implementation of CHF clinics).
Wierzchowiecki
Michał
M
II Klinika Kardiologii Katedry Kardiologii AM w Poznaniu. kardio2@am.poznan.pl
Poprawski
Kajetan
K
Nowicka
Anna
A
Kandziora
Magdalena
M
Piatkowska
Anna
A
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D002309:Cardiology / Q000706:statistics & numerical data*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004232:Diuretics / Q000008:administration & dosage; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004452:Echocardiography / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy*; D006748:Hospital Departments / Q000706:statistics & numerical data; D020445:Hospitalists / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011044:Poland; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D004232:Diuretics