Gupta Milan, Bell Alan, Padarath Michelle, Ngui Daniel, Ezekowitz Justin
McMaster University, Department of Medicine, Hamilton, Ontario, Canada.
Canadian Collaborative Research Network, Brampton, Ontario, Canada.
CJC Open. 2020 Nov 16;3(3):361-366. doi: 10.1016/j.cjco.2020.11.008. eCollection 2021 Mar.
Heart failure (HF) with preserved ejection fraction (HFpEF) carries high morbidity and mortality. Compared with HF with reduced ejection fraction (HFrEF), HFpEF is difficult to diagnose, and lacks evidence-based treatments. In this survey we assessed perceptions of cardiologists, internists, and primary care physicians (PCPs) regarding HFpEF diagnosis and management.
In total, 159 cardiologists, 89 internists, and 200 PCPs from across Canada completed an online survey, with response rates of 14%-17%.
The perceived prevalence of HFpEF vs HFrEF was similar across physician types (58% HFrEF, 42% HFpEF). Thirty-seven percent of PCPs did not differentiate HF on the basis of ejection fraction. All physician types ranked symptom and mortality reduction as treatment priorities. Ninety-two percent of specialists believed that HFpEF is best comanaged by PCPs and specialists, whereas one-fifth of PCPs suggested PCP management alone. Compared with specialists, PCPs were more likely to underestimate HFpEF mortality and less aware of sex differences in the prevalence of HFpEF vs HFrEF (all < 0.001). Fewer PCPs use natriuretic peptides for diagnosis ( < 0.001). All physician types listed cost and availability as barriers to natriuretic peptide use. Ninety-one percent of PCPs incorrectly identified various therapies as effective for improving HFpEF outcomes. Most of all physicians expressed a strong desire to increase knowledge of diagnostic and treatment algorithms for HFpEF.
There are substantial knowledge gaps in the diagnosis and management of HFpEF, particularly among PCPs. Because of the prevalence of HFpEF in primary care, strategies are required to reduce these gaps.
射血分数保留的心力衰竭（HFpEF）具有较高的发病率和死亡率。与射血分数降低的心力衰竭（HFrEF）相比，HFpEF难以诊断，且缺乏循证治疗方法。在本次调查中，我们评估了心脏病专家、内科医生和初级保健医生（PCP）对HFpEF诊断和管理的看法。
来自加拿大各地的159名心脏病专家、89名内科医生和200名初级保健医生完成了一项在线调查，回复率为14%-17%。
不同类型医生认为的HFpEF与HFrEF的患病率相似（HFrEF为58%，HFpEF为42%）。37%的初级保健医生没有根据射血分数区分心力衰竭。所有类型的医生都将减轻症状和降低死亡率列为治疗重点。92%的专科医生认为HFpEF最好由初级保健医生和专科医生共同管理，而五分之一的初级保健医生建议仅由初级保健医生管理。与专科医生相比，初级保健医生更有可能低估HFpEF的死亡率，并且对HFpEF与HFrEF患病率的性别差异了解较少（均<0.001）。较少有初级保健医生使用利钠肽进行诊断（<0.001）。所有类型的医生都将成本和可及性列为使用利钠肽的障碍。91%的初级保健医生错误地认为各种疗法对改善HFpEF结局有效。大多数医生都强烈希望增加对HFpEF诊断和治疗算法的了解。
HFpEF的诊断和管理存在重大知识差距，尤其是在初级保健医生中。鉴于HFpEF在初级保健中的患病率，需要采取策略来缩小这些差距。
