title: [Heart failure in primary care in Italy: analysis of management and needs by general practitioners].
abstract: BACKGROUND
  Heart failure (HF) is a major clinical problem and a challenge for healthcare systems. Primary care physicians (PCPs) play an important role in the clinical management of HF patients. The aim of the present investigation was to evaluate the behaviors and problems of Italian PCPs in managing patients with HF.
  
  
  METHODS
  Clinical behaviors and perceived obstacles were evaluated through the administration of a modified version of the Euro-HF questionnaire to a nationwide sample of 385 PCPs.
  
  
  RESULTS
  Out of 389 042 persons entitled to receive their medical assistance, all PCPs declared to care 9263 patients with HF (prevalence of HF 2.4%, 24 HF patients/PCP). HF was diagnosed either by symptoms only (14% of cases), or by analysis of symptoms plus signs (57%), by combining the evidence of cardiac dysfunction by echocardiography to the assessment of symptoms and signs (12%) or by adding consultation by a cardiologist to the clinical assessment in the PCP office (17%). Forty-two percent of the PCPs participating in the survey had a free access to echocardiography whereas measurement of natriuretic peptide serum levels was freely available to 14% of PCPs. Pharmacological therapy for HF prescribed by the PCPs included in this survey included: diuretics (91%), inhibitors of the renin-angiotensin system (87%), digitalis (34%), beta-blockers (33%), aldosterone antagonists (23%). Drugs considered to potentially leading to major side effects were: digitalis (51%), beta-blockers (48%) and diuretics (47%), much less angiotensin-converting enzyme-inhibitors (17%) and aldosterone antagonists (14%). Consultation with a cardiologist for starting beta-blocker treatment was judged mandatory by 57% of PCPs. Management of HF patients was considered sufficient by 70% of PCPs. Improvement in the access to echocardiography, laboratory data and consultation with a specialist were the priorities indicated by PCPs for optimizing the management of HF patients.
  
  
  CONCLUSIONS
  PCPs have a suboptimal approach to the diagnostic evaluation of HF patients and to implementation and management of beta-blocker therapy. These behaviors derive from a difficult access to echocardiography, laboratory parameters and consultation with a cardiologist.
authors.affiliation: Dipartimento di Cardiologia, Ospedale San Martino, ASL1, Belluno.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Donatella
authors.initials: D
authors.lastname: Del Sindaco
authors.forename: Nadia
authors.initials: N
authors.lastname: Aspromontes
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Misuraca
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000704:Analysis of Variance; D004452:Echocardiography / Q000706:statistics & numerical data; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D045265:Natriuretic Peptides / Q000097:blood; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D000319:Adrenergic beta-Antagonists; D045265:Natriuretic Peptides; D049993:Sodium Chloride Symporter Inhibitors