title: Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians.
abstract: OBJECTIVE
  To assess awareness of heart failure (HF) management recommendations in Europe among cardiologists (C), internists and geriatricians (I/G), and primary care physicians (PCPs).
  
  
  RESULTS
  The Study group on HF Awareness and Perception in Europe (SHAPE) surveyed randomly selected C (2041), I/G (1881), and PCP (2965) in France, Germany, Italy, the Netherlands, Poland, Romania, Spain, Sweden, and the UK. Each physician completed a 32-item questionnaire about the diagnosis and treatment of HF (left ventricular ejection fraction <40%). This report provides an analysis of HF awareness among C, I/G, and PCP. Seventy-one per cent I/G and 92% C use echocardiography, and 43% I/G and 82% C use echo-Doppler as a routine diagnostic test (both P < 0.0001). In contrast, 75% PCP use signs and symptoms to diagnose HF. Fewer I/G would use an angiotensin-converting enzyme (ACE)-inhibitor in >90% of their patients (64 vs. 82% C, P < 0.0001), whereas only 47% PCP would routinely prescribe an ACE-inhibitor. Worsening HF was considered a risk of ACE-inhibitor therapy by 35% PCP. I/G and PCP consistently do not prescribe target ACE-inhibitor doses (P < 0.0001 vs. C). Only 39% I/G would use a beta-blocker in >50% of their patients (vs. 73% C, P < 0.0001). Also, only 5% PCP would always, and 35% often, prescribe a beta-blocker and reach target doses in only 7-29%. Moreover, 34% PCP and 26% I/G vs. 11% C (P < 0.0001) do not start a beta-blocker in patients with mild HF, who are already on an ACE-inhibitor and are on diuretic. In mild, stable HF, 39% PCP and 18% I/G would only prescribe diuretics, vs. 7% C (P < 0.0001). In patients with worsening HF in sinus rhythm and on an optimal ACE-inhibitor, beta-blockade and diuretics, significantly more C would add spironolactone, but I/G would more often add digoxin.
  
  
  CONCLUSIONS
  Although each physician group lacks complete adherence to guideline-recommended management strategies, these are used significantly less well by I, G, and PCPs, indicating the need for education of these essential healthcare providers.
authors.affiliation: Sticares Cardiovascular Research Foundation, PO Box 882, 3160 AB Rhoon, The Netherlands. w.j.remme@sticares.org
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Remme
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: José
authors.initials: J
authors.lastname: Lopez-Sendon
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rauch
authors.forename: Karen
authors.initials: K
authors.lastname: Keukelaar
authors.forename: Cezar
authors.initials: C
authors.lastname: Macarie
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: Charles
authors.initials: C
authors.lastname: Cline
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D002983:Clinical Competence; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data; D004363:Drug Utilization; D005060:Europe; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008511:Medicine; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D013038:Specialization
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors