title: The care for chronic heart failure by general practitioners. Results from a clinical audit in Italy.
abstract: BACKGROUND
  In Italian primary care, chronic heart failure (CHF) patients are mainly managed by general practitioners (GPs). However, there are few studies analysing CHF management challenges in primary care and identifying opportunities for improvement.
  
  
  OBJECTIVE
  To describe CHF care as implemented by GPs in the Veneto Region and to identify opportunities for improvement.
  
  
  METHODS
  In 2008, using an audit process, 114 Venetian GPs analysed their electronic health records, identified CHF patients and collected clinical and care related information: prevalence, co-morbidity, caring conditions, diagnostic and therapeutic management, and hospitalization. After two training sessions, data on pharmacotherapy were analysed again in 2009.
  
  
  RESULTS
  The prevalence of CHF was 1.2% (95% CI: 1.1-1.3%). Diagnostic echocardiography was used in 57% of cases. At baseline, the proportions of patients that used specific medication were: diuretics 88%; angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) 77%, beta-blockers 46% and anti-aldosterone agents 32%. After two training sessions, the use of ACE inhibitors/ARB and beta-blockers increased to 80% and 56%, respectively. Renal failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus and dementia were the most prevalent concomitant diseases, posing specific management problems. Half of the patients were generally visited at home; they were dependent on some kind of care given.
  
  
  CONCLUSIONS
  In Veneto a large number of CHF patients are mainly managed by GPs. Further improvements are necessary to meet standards of care with regard to diagnosis, medication, follow-up and home care. The care situation affected hospitalization and the quality of follow-up visits.
authors.affiliation: S.I.M.G. Società Italiana di Medicina Generale, Scuola Veneta di Medicina Generale, Padua, Italy. cancian.maurizio@simg.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cancian
authors.forename: Alessandro
authors.initials: A
authors.lastname: Battaggia
authors.forename: Mario
authors.initials: M
authors.lastname: Celebrano
authors.forename: Francesco
authors.initials: F
authors.lastname: Del Zotti
authors.forename: Bruno Franco
authors.initials: BF
authors.lastname: Novelletto
authors.forename: Raffaella
authors.initials: R
authors.lastname: Michieli
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.forename: Michele
authors.initials: M
authors.lastname: Pellizzari
authors.forename: Roberto
authors.initials: R
authors.lastname: Toffanin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000193:education / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics