Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Department of Medicine, Weill Cornell Medicine, New York, NY.
Mayo Clin Proc. 2020 Apr;95(4):669-675. doi: 10.1016/j.mayocp.2019.09.026.
To quantify differences in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF) between cardiologists and noncardiologists, who often diagnose and manage HFpEF.
Cardiologists and noncardiologists (internal medicine, medicine/pediatrics, family medicine, geriatrics) were anonymously surveyed between January 16, 2018, and March 2, 2018, regarding practices related to diagnosing and managing HFpEF at the University of Michigan and Weill Cornell Medical Center. Response data were compared using χ analysis.
Of 1010 physicians surveyed, 211 completed a significant portion of the survey: 32 cardiologists and 179 noncardiologists. Most noncardiologists were unaware of HFpEF diagnostic guidelines and commonly used left ventricular diastolic dysfunction and natriuretic peptides to diagnose HFpEF. Noncardiologists (32.3%, n=52) were less likely than cardiologists (64.5%, n= 20) to prescribe an aldosterone antagonist for HFpEF (P=.001). Both groups reported similar use of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and exercise programs. Noncardiologists were more likely to refer patients with HFrEF to cardiology (63.1%, n=111) compared with patients with HFpEF (33.5%, n=59; P<.001). Noncardiologists were more likely to discuss prognosis and goals of care with patients with HFrEF (84.4%, n=151) than with patients with HFpEF (65.9%, n=118; P<.001).
Cardiologists and noncardiologists vary significantly in their HFpEF diagnosis and treatment practices. As diagnostic criteria continue to be evaluated for HFpEF, dissemination of these guidelines to noncardiologists, with an emphasis on the morbidity and mortality associated with HFpEF, is imperative.
量化心脏病专家和非心脏病专家（内科、内科/儿科、家庭医学、老年医学）在诊断和治疗射血分数保留型心力衰竭（HFpEF）方面的差异，因为他们经常诊断和管理 HFpEF。
2018 年 1 月 16 日至 2018 年 3 月 2 日，密歇根大学和威尔康奈尔医学中心对心脏病专家和非心脏病专家（内科、内科/儿科、家庭医学、老年医学）进行了匿名调查，内容涉及 HFpEF 的诊断和管理实践。使用卡方检验比较应答数据。
在接受调查的 1010 名医生中，有 211 名医生完成了调查的重要部分：32 名心脏病专家和 179 名非心脏病专家。大多数非心脏病专家不了解 HFpEF 诊断指南，常用左心室舒张功能障碍和利钠肽来诊断 HFpEF。非心脏病专家（32.3%，n=52）比心脏病专家（64.5%，n=20）更不可能为 HFpEF 开醛固酮拮抗剂（P=.001）。两组报告的β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和运动方案的使用情况相似。与 HFpEF 患者（33.5%，n=59；P<.001）相比，非心脏病专家更倾向于将 HFrEF 患者转介给心脏病专家（63.1%，n=111）。与 HFpEF 患者（65.9%，n=118；P<.001）相比，非心脏病专家更倾向于与 HFrEF 患者讨论预后和治疗目标。
心脏病专家和非心脏病专家在 HFpEF 的诊断和治疗实践方面存在显著差异。随着 HFpEF 的诊断标准不断得到评估，向非心脏病专家传播这些指南，强调 HFpEF 相关的发病率和死亡率至关重要。
