The Study Group on Heart Failure Awareness and Perception in Europe (SHAPE) presented the survey at the Heart Failure 2003 meeting in Strasbourg. Led by Prof Willem Remme (Sticares Cardiovascular Research Institute, Rotterdam, the Netherlands), the survey included almost 3000 primary care physicians from nine European countries.
Results of the survey showed that GPs fail to follow treatment guidelines, with just over 50% starting heart failure treatment with an ACE inhibitor, as recommended. The remainder said they preferred to start treatment with a diuretic, which has not been shown to improve survival. Moreover, 35% of GPs thought that ACE inhibitors could worsen heart failure and 86% thought beta-blockers could worsen the condition.
Also, 56% would not prescribe aldosterone antagonists. Even when GPs do prescribe these therapies, they were found to not be prescribing the optimal dosage. These findings are inline with the recently published MITRA-PLUS study, which found that of 14,608 consecutive patients with St elevation acute myocardial infarction, 4.7% received acute therapy with ramipril, 39.0% received other ACE inhibitor therapy, and 56.3% received no ACE inhibitor therapy.
The SHAPE survey also showed that GPs are not using the correct tests to diagnose heart failure, with 75% relying solely on signs and symptoms, despite recommendations from guidelines to also use echocardiography and measurement of natriuretic peptides. Most GPs were able to identify the most common symptoms of heart failure, namely breathlessness on exertion (85%), nocturnal dyspnea (70%), and swollen ankles (66%), although as few as 39% identified fatigue as a common symptom.
"There is an urgent need to educate primary care physicians on the appropriate diagnosis and management of heart failure. This will have a positive impact on the prevention, survival and quality of life of heart failure patients," Remme concluded.
Reference
Heartwire news, 26th June 2003.