Perception of Nigerian internal medicine residents on the diagnosis and management of heart failure.
OBJECTIVE
To evaluate the perception of internal medicine residents on diagnosis and management of heart failure in Nigeria.


METHODS
A modified version of the Euro-F study questionnaire was administered to internal medicine residents (IMRs) from Nigeria who were attending the pre part I Fellowship examination of the Faculty of Internal Medicine of the National Postgraduate Medical College. Responses were compared with data from the Nigerian primary physicians (PCP) survey and the Euro-HF study.


RESULTS
The commonest symptoms used by the IMRs in heart failure diagnosis were exertional dyspnoea 68.85%(42), pedal oedema 63.93%(39) and orthopnoea 50.82%(31), while the signs included elevated jugular venous pressure 50.82%(31), basal crepitations 47.50%(29) and a gallop heart rhythm 39.34%(24). Categorisation using the Framingham criteria for diagnosis showed that 52% of the IMRs knew three or more major signs of heart failure. The IMRs use of investigations in diagnosing heart failure was fair to good and was significantly higher than results from the Euro-F study and the primary care physicians (PCPs) in Lagos study; echocardiogram, (p=0.007and <0.00001); electrocardiogram, (p= 0.0002 and p=0.001); chest x-ray (p=0.05 and 0.5) respectively. However the mean proportion of IMRs that would rely on investigation to make a diagnosis was significantly lower than in the Euro-F study (p=0.0001) and in the PCPs (p = 0.02). Although the mean proportion of the IMRs patients using ACE-inhibitors was significantly higher than in the Euro-F survey (p<0.001) and the PCPs (p <0.00001), majority (93.94%) of the IMRs were using less than half the trial doses for treatment. On the other hand, the knowledge of survival benefits with the use of b-blockers was very poor in the all the groups, p>0.05.


CONCLUSIONS
A substantial knowledge gap still exists among the IMRs as regards the diagnosis and management of heart failure and this need to be addressed by the trainers.
Mbakwem
A C
AC
Department of Medicine, College of Medicine, University of Lagos. PMB 12003 Idi Araba, Lagos. ambakwem@hotmail.com
Ajuluchukwu
J N A
JN
D001291:Attitude of Health Personnel; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003952:Diagnostic Imaging; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D009549:Nigeria
D002317:Cardiovascular Agents