[Knowledge of primary care physicians, cardiologists from cardiology clinics, internal and cardiology department physicians about chronic heart failure diagnosis and treatment].

UNLABELLED

Last studies have shown unsatisfactory diagnosis and treatment of chronic heart failure (CHF) patients. The aim of this study was to compare the knowledge of primary care physicians (PCP), cardiologists from cardiology clinics (CARC), internal and cardiology department physicians (INTD and CARD) about CHF diagnosis and treatment.

MATERIAL AND METHODS

A questionnaire consisting of 23 questions related to above issues was filled out by 153 physicians (64 PCP, 24 CARC, 44 INTD and 21 CARD) from the urban district. Similarly to other physicians, PCP suspected CHF on the ground of ankle oedema (88%), dyspnoea (75%) and basal pulmonary crepitations (44%). Most questioned doctors ordered a chest X-ray (58-86%) to establish the diagnosis. Echocardiography was underused by PCP (19%) in comparison to other doctors (68-86%). Under-utilization of angiotensin converting enzyme inhibitors (ACEI) (-68 to -79%; NS) and, especially, beta-blockers (-35% by PCP to -51% by CARD; p < 0.05) was observed. The recommended target dose of enalapril knew more CARD (52%) and INTD (45%) than PCP (25%) (p < 0.05 and p < 0.01, respectively). The appropriate target dose of carvedilol knew 3% of PCP, 8% of CARC, 9% of INTD and 14% of CARD (PCP vs. CARD; p < 0.01).

CONCLUSIONS

Most CHF patients from the urban region are diagnosed by PCP and other doctors on the basis of symptoms, signs and a chest X-ray. The misdiagnosis of CHF may depend on the small direct access of PCP to echocardiography. Under-utilization and under-dosing of ACEI and beta-blockers creates the necessity to introduce broad educational programs and some organisational changes (implementation of CHF clinics).