title: Current treatment of chronic heart failure in primary care; still room for improvement.
abstract: RATIONAL AND AIMS: In recent years, guidelines for treatment of patients with chronic heart failure (CHF) have been updated. Insight in current pharmacological and non-pharmacological treatment of CHF in primary care, which was non-optimal in earlier studies, is limited. We aim to describe current pharmacological and non-pharmacological treatment of CHF in primary care.
  
  
  METHODS
  In this cross-sectional observational study, we included a representative sample of 357 patients diagnosed with CHF from 42 primary care practices in the Netherlands. We combined medical record data with data from patient and doctor questionnaires.
  
  
  RESULTS
  Mean age of patients was 75.7 years (SD 10.2), 53% were male, and 73% of patients had mild heart failure (New York Heart Association class I or II). 76.5% of patients received diuretics. Angiotensin-converting enzyme inhibitors were prescribed in 40.6% and angiotensin-II receptor blockers in 20.7%; beta-blockers were prescribed to 54.6%, while 24.9% received spironolactone. Patients with more severe heart failure had a lower probability of being treated according to guideline recommendations. Relevant lifestyle advice was given to 40-60% of the patients, depending on the specific lifestyle advice.
  
  
  CONCLUSIONS
  Implementation of evidence-based pharmacotherapy for heart failure in primary care has improved since clinical guidelines have been updated; especially with respect to prescription of beta-blockers. However, there still seems ample room for improvement, as in the case for providing lifestyle advice.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. marije.bosch@monash.edu
authors.forename: Marije
authors.initials: M
authors.lastname: Bosch
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: J Carel
authors.initials: JC
authors.lastname: Bakx
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D019370:Observation; D011320:Primary Health Care; D011785:Quality Assurance, Health Care