Survey of Views on the Diagnosis andTreatment of Cardiac Failure Held by General Practitioners in the Czech and Slovak Republicin 1999.Part 1 of the IMPROVEMENT of HF Programme

Overview

The programme IMPROVEMENT of HF is an international European study in which 15countries participate and which is implemented under the auspices of the working groups forcardiac failure of the European Cardiological Society. The objective of the programme is toassess the contemporary state of diagnosis and treatment of chronic heart failure in clinicalpractice of general practitioners in Europe. The objective of part one of the programme was toassess views of general practitioners on the diagnosis and treatment of heart failure. Theauthors present the views of a random sample of 94 general practitioners from different areasin the Czech and Slovak Republic.The functional classification of heart failure according to NYHA was known by 94.7% doctorsbut only 46.6% use it in their practice. Only 39.4% general practitioners request echocardio-graphy when heart failure is suspected. The collaboration of GPs and cardiologists will have tobe extended in this sense. Objective evidence of systolic dysfunction by echocardiography iscrucial for a correct diagnosis. Left ventricular systolic and diastolic dysfunction is differenti-ated by 40.4% doctors, most frequently on the basis of the chest X-ray. Spirometry is not muchused.From the survey of views regarding treatment of heart failure the dominant position of ACEinhibitors does not ensue as the number of positive answers was less than half as comparedwith the number of replies on the use of diuretics. ACE inhibitors should be used in thetreatment of chronic heart failure in all patients except contraindications, because contrary todigoxin, they improve markedly the patient’s prognosis and retard the progression of leftventricular systolic dysfunction. The relatively infrequent use of beta-blockers in the treatmentof heart failure is understandable as only recent major prospective studies proved the impor-tance of this treatment for the life prognosis. In patients after myocardial infarction only 59.6%physicians use beta-blockers. In patients after myocardial infarction beta-blockers reduce theoverall mortality due to re-infarctions and the mortality due to sudden death. This situationmust be also improved. A favourable surprise was the use of digoxin only in selected patientswith heart failure. The highest percentage of general practitioners uses digoxin mainly inpatients with atrial fibrillation or as a drug of third choice. Hospital doctors start most oftentreatment with beta-blockers and antagonists of angiotensin II receptors. General practitionersstart most often treatment with diuretics.The results of this first part of the study IMPROVEMENT of HF must be considered onlya survey of views regarding diagnosis and treatment of heart failure, not an indicator of currentpractice which will be discussed in part 2 of the IMPROVEMENT programme.

Key words:
cardiac failure - diagnosis - treatment - IMPROVEMENT.