Cleland J G F, Cohen-Solal A, Aguilar J Cosin, Dietz R, Eastaugh J, Follath F, Freemantle N, Gavazzi A, van Gilst W H, Hobbs F D R, Korewicki J, Madeira H C, Preda I, Swedberg K, Widimsky J
Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK.
Lancet. 2002 Nov 23;360(9346):1631-9. doi: 10.1016/s0140-6736(02)11601-1.
Heart failure is a prevalent condition that is generally treated in primary care. The aim of this study was to assess how primary-care physicians think that heart failure should be managed, how they implement their knowledge, and whether differences exist in practice between countries.
The survey was undertaken in 15 countries that had membership of the European Society of Cardiology (ESC) between Sept 1, 1999, and May 31, 2000. Primary-care physicians' knowledge and perceptions about the management of heart failure were assessed with a perception survey and how a representative sample of patients was managed with an actual practice survey.
1363 physicians provided data for 11062 patients, of whom 54% were older than 70 years and 45% were women. 82% of patients had had an echocardiogram but only 51% of these showed left ventricular systolic dysfunction. Ischaemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, and major valve disease were all common. Physicians gave roughly equal priority to improvement of symptoms and prognosis. Most were aware of the benefits of ACE inhibitors and beta blockers. 60% of patients were prescribed ACE inhibitors, 34% beta blockers but only 20% received these drugs in combination. Doses given were about 50% of targets suggested in the ESC guidelines. If systolic dysfunction was documented, ACE inhibitors were more likely and beta blockers less likely to be prescribed than when there was no evidence of systolic dysfunction.
Results from this survey suggest that most patients with heart failure are appropriately investigated, although this finding might be as a result of high rates of hospital admissions. However, treatment seems to be less than optimum, and there are substantial variations in practice between countries. The inconsistencies between physicians' knowledge and the treatment that they deliver suggests that improved organisation of care for heart failure is required.
心力衰竭是一种常见疾病，通常在基层医疗中进行治疗。本研究的目的是评估基层医疗医生认为应如何管理心力衰竭，他们如何运用自己的知识，以及不同国家在实践中是否存在差异。
该调查于1999年9月1日至2000年5月31日在15个欧洲心脏病学会（ESC）成员国进行。通过认知调查评估基层医疗医生对心力衰竭管理的知识和认知，并通过实际实践调查评估对代表性患者样本的管理情况。
1363名医生提供了11062名患者的数据，其中54%年龄超过70岁，45%为女性。82%的患者进行了超声心动图检查，但其中只有51%显示左心室收缩功能障碍。缺血性心脏病、高血压、糖尿病、心房颤动和严重瓣膜疾病都很常见。医生对改善症状和预后给予大致相同的优先级。大多数人了解ACE抑制剂和β受体阻滞剂的益处。60%的患者被开具了ACE抑制剂，34%被开具了β受体阻滞剂，但只有20%的患者同时接受了这两种药物。给药剂量约为ESC指南建议目标的50%。如果记录到收缩功能障碍，与没有收缩功能障碍证据时相比，开具ACE抑制剂的可能性更大，开具β受体阻滞剂的可能性更小。
这项调查结果表明，大多数心力衰竭患者得到了适当的检查，尽管这一发现可能是由于住院率高所致。然而，治疗似乎并不理想，不同国家在实践中存在很大差异。医生的知识与他们提供的治疗之间的不一致表明，需要改善心力衰竭的护理组织。
