title: Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF.
abstract: BACKGROUND
  In Germany, care for patients with chronic heart failure (HF) is provided by hospital-based cardiologists (HBC), office-based cardiologists (OBC) and general practitioners (GP). We aimed to compare patient characteristics, diagnostic approaches and therapeutic decisions.
  
  
  METHODS
  Multi-centre, cross-sectional, observational survey at 48 physicians. Patients (n = 384) were required to have previously diagnosed HF and NYHA class ≥ II and/or a left ventricular ejection fraction of <50 %. A total of 384 patients were included at 5 HBCs, 26 OBCs and 18 GPs.
  
  
  RESULTS
  A mean of 18.8 % of all patients at HBCs practices had heart failure, compared to a smaller proportion of 13.9 and 6.7 % at OBCs and GPs, respectively. Echo facility was available for all HBCs and OBCs, but for 16.7 % of GPs (p < 0.0001 for trend). Patients at HBCs had a higher NYHA class (65.6 % had class III/IV; p < 0.0001) compared to 36.8 % at OBCs and 39.3 % at GPs. Usage of three guideline-recommended pharmaceutical treatments was more than 80 %: diuretics (83.1 %), renin-angiotensin system blocking agents (91.4 %) and betablockers (90.1 %) with no differences between physician groups. Mineralocorticoid receptor antagonists (MRAs, overall 47.7 %) were more frequently prescribed by OBCs (54.7 %; p = 0.0007 for trend) than HBCs (43.8 %) and GPs (31.0 %). Ivabradin was not frequently used (11.0 % at OBCs, 4.9 % at HBCs and 0 % at GPs; p = 0.0163 for trend). The proportion of patients with CRT (8.6 %), ICD (23.5 %) and CABG (23.1 %) was not statistically different between groups.
  
  
  CONCLUSIONS
  REFLECT-HF demonstrates that there are some differences in evidence-based treatment decisions between the three main health services (HBC, OBC and GP) providing care for patients with HF in Germany. Advocating adherence to guideline recommendations and earlier adoption of these evidence-based treatments across all levels of care might further improve patient care.
authors.affiliation: Klinikum Lippe-Detmold, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Röntgenstrasse 18, 32756, Detmold, Germany, ulrich.tebbe@klinikum-lippe.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tebbe
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
authors.forename: Jost Henner
authors.initials: JH
authors.lastname: Wirtz
authors.forename: Jan
authors.initials: J
authors.lastname: Lokies
authors.forename: Eva
authors.initials: E
authors.lastname: Turgonyi
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.forename: Anke M
authors.initials: AM
authors.lastname: Strunz
authors.forename: Katharina
authors.initials: K
authors.lastname: Lins
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy