Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
Cardiol J. 2013;20(4):356-63. doi: 10.5603/CJ.2013.0093.
Heart failure (HF) is a common complication of cardiovascular diseases, and patients with HF remain largely under the care of primary care physicians (GPs). Therefore, the goal of the study presented was to assess the GPs' knowledge of chronic HF guidelines in regards to their professional experience.
In 2008, during a nationwide educational project on HF management, 15 courses for GPs were conducted. Before the training, physicians filled out a standardized questionnaire about the diagnosis and treatment of HF. The answers were assessed in a three age-group of respondents: 24-39 years (n = 142), 40-55 years (n = 316), 56 years and above (n = 156). Of 614 physicians, 97% indicated echocardiography as obligatory diagnostic procedure in HF diagnosis. The oldest GPs more frequently pointed to the role of chest X-ray (63%, p < 0.001) and electrocardiography (32%, p < 0.001) in exclusion of systolic HF. There was a significant reverse relationship between physicians' age and their declarations in prescription of angiotensin II receptor blockers (p = 0.007; contingency coefficient, Cc= 0.13) and b-blockers (p = 0.01; Cc = 0.12) in patients with advanced HF (NYHA III-IV), and positive relation between application of spironolactone (p = 0.007; Cc = 0.13) and digitalis (p < 0.001; Cc = 0.16) in patients of NYHA class I-II. The new generation b-blockers (bisoprolol, carvedilol, nebivolol) were more frequently prescribed by the youngest physicians (respectively: 98%, 96%, 58%) compared to the oldest group (respectively: 88%, 87%, 50%; p < 0.05).
The study revealed age of GPs to be inversely related to their knowledge of HF guidelines and potential therapeutic decisions in management of HF patients and support of the need of continuing medical education.
心力衰竭（HF）是心血管疾病的常见并发症，HF 患者主要仍由初级保健医生（全科医生）照顾。因此，本研究旨在评估全科医生对 HF 慢性指南的了解程度，以及他们的专业经验。
2008 年，在一项关于 HF 管理的全国性教育项目中，为全科医生举办了 15 次课程。培训前，医生填写了一份关于 HF 诊断和治疗的标准化问卷。答案按受访者的三个年龄组进行评估：24-39 岁（n = 142）、40-55 岁（n = 316）、56 岁及以上（n = 156）。在 614 名医生中，97%的人表示超声心动图是 HF 诊断的强制性诊断程序。最年长的全科医生更频繁地指出胸部 X 光（63%，p < 0.001）和心电图（32%，p < 0.001）在排除收缩性 HF 中的作用。医生的年龄与他们在处方血管紧张素 II 受体阻滞剂（p = 0.007；一致性系数，Cc = 0.13）和β-受体阻滞剂（p = 0.01；Cc = 0.12）时的声明之间存在显著的反向关系在患有晚期 HF（NYHA III-IV）的患者中，以及螺内酯（p = 0.007；Cc = 0.13）和地高辛（p < 0.001；Cc = 0.16）在 NYHA Ⅰ-Ⅱ级患者中的应用呈正相关。最年轻的医生（分别为 98%、96%、58%）比最年长的医生（分别为 88%、87%、50%；p < 0.05）更频繁地开新一代β-受体阻滞剂（比索洛尔、卡维地洛、奈必洛尔）。
该研究表明，全科医生的年龄与他们对 HF 指南的了解程度以及对 HF 患者管理和支持的潜在治疗决策呈负相关，这支持了继续医学教育的必要性。
