title: Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study.
abstract: OBJECTIVE
  To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors' characteristics are related to their decisions.
  
  
  METHODS
  Cross-sectional vignette study.
  
  
  METHODS
  Continuing Medical Education meeting.
  
  
  METHODS
  451 Dutch GPs.
  
  
  METHODS
  Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions.
  
  
  RESULTS
  Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated β-blocker treatment at a low-dose and 4% doubled the β-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued β-blocker therapy even when they considered prescribing a long-acting β2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the β-blocker in the up-titration phase.
  
  
  CONCLUSIONS
  GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a β-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions.
authors.affiliation: Department of Clinical Epidemiology, Division Julius Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Maartje H J
authors.initials: MH
authors.lastname: Swennen
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Alfred P E
authors.initials: AP
authors.lastname: Sachs
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
keywords: PRIMARY CARE
references.citation: BMJ. 2003 Jan 25;326(7382):196
references.pmid: 12543836
references.citation: JAMA. 2003 Feb 12;289(6):712-8
references.pmid: 12585949
references.citation: Med J Aust. 2004 Jul 19;181(2):78-81
references.pmid: 15257642
references.citation: Eur J Heart Fail. 2012 Aug;14(8):803-69
references.pmid: 22828712
references.citation: Circulation. 1994 Oct;90(4):1765-73
references.pmid: 7923660
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566
references.pmid: 16235327
references.citation: Arch Intern Med. 2010 Sep 13;170(16):1442-9
references.pmid: 20837830
references.citation: Neth J Med. 2007 May;65(5):167-77
references.pmid: 17519512
references.citation: Lancet. 2008 Oct 4;372(9645):1231-9
references.pmid: 18757089
references.citation: N Engl J Med. 2001 May 31;344(22):1659-67
references.pmid: 11386264
references.citation: Eur Heart J. 2008 Oct;29(19):2388-442
references.pmid: 18799522
references.citation: Fam Pract. 2009 Apr;26(2):145-53
references.pmid: 19153098
references.citation: Fam Med. 2006 Jul-Aug;38(7):511-7
references.pmid: 16823678
references.citation: N Engl J Med. 1996 May 23;334(21):1349-55
references.pmid: 8614419
references.citation: Lancet. 2010 Sep 11;376(9744):847-9
references.pmid: 20801501
references.citation: Eur Heart J. 2001 Sep;22(17):1527-60
references.pmid: 11492984
references.citation: N Engl J Med. 2007 Nov 29;357(22):2248-61
references.pmid: 17984166
references.citation: Eur J Heart Fail. 2007 Dec;9(12):1143-5
references.pmid: 17936067
references.citation: Am J Med Qual. 2005 May-Jun;20(3):151-7
references.pmid: 15951521
references.citation: Int J Clin Pract. 2009 Feb;63(2):226-32
references.pmid: 19196361
references.citation: BMC Health Serv Res. 2009 Jul 28;9:128
references.pmid: 19638231
references.citation: Eur Respir J. 2003 Jul;22(1):1-2
references.pmid: 12882441
references.citation: Lancet. 1999 Jun 12;353(9169):2001-7
references.pmid: 10376614
references.citation: Ann Intern Med. 2004 Nov 16;141(10):771-80
references.pmid: 15545677
references.citation: Med Care Res Rev. 2008 Apr;65(2):167-86
references.pmid: 18096718
references.citation: Lancet. 1997 Feb 8;349(9049):375-80
references.pmid: 9033462
references.citation: Lancet. 1999 Jan 2;353(9146):9-13
references.pmid: 10023943