Guidetti Federica, Giraldo Clara Inés Saldarriaga, Shchendrygina Anastasia, Kida Keisuke, Niederseer David, Basic Carmen, Rainer Peter P, Załęska-Kocięcka Marta, Ogola Elijah, Mohty Dania, Lanfranchi Giuseppina, Sari Novi Yanti, Einarsson Hafsteinn, Zurek Marzena, Ruschitzka Frank, Savarese Gianluigi, Mewton Nathan
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Pontificia Bolivariana, University of Antioquia, Cardiovid Clinic, Medellin, Colombia.
Eur J Heart Fail. 2025 Feb;27(2):198-208. doi: 10.1002/ejhf.3416. Epub 2024 Aug 21.
Heart failure (HF) with preserved ejection fraction (HFpEF) is characterized by growing incidence and poor outcomes. A large majority of HFpEF patients are cared by non-cardiologists. The availability of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as recommended therapy raises the importance of prompt and accurate identification and treatment of HFpEF across diverse healthcare settings. We evaluated HFpEF management across specialties through a survey targeting cardiologists, HF specialists, and non-cardiologists.
An independent web-based survey was distributed globally between May and July 2023. We performed a post-hoc analysis, comparing cardiologists, HF specialists, and non-cardiologists. A total of 1460 physicians (61% male, median age 41[34-49]) from 95 countries completed the survey; 20% were HF specialists, 65% cardiologists, and 15% non-cardiologists. Compared with HF specialists, non-cardiologists and cardiologists were less likely to use natriuretic peptides (p = 0.003) and HFpEF scores (p = 0.004) for diagnosis, and were also less likely to have access to or consider specific echocardiographic parameters (p < 0.001) for identifying HFpEF. Diastolic stress tests were used in less than 30% of the cases, regardless of the specialty (p = 1.12). Multidrug treatment strategies were similar across different specialties. While SGLT2i and diuretics were the preferred drugs, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors were the least frequently prescribed in all three groups. However, when constrained to choose one drug, the proportion of physicians favoring SGLT2i varied significantly among specialties (66% HF specialists, 52% cardiologists, 51% non-cardiologists). Additionally, 10% of non-cardiologists and 8% of cardiologists considered beta blocker the drug of choice for HFpEF.
Significant differences among specialty groups were observed in HFpEF management, particularly in the diagnostic work-up. Our results highlight a substantial risk of underdiagnosis and undertreatment of HFpEF patients, especially among non-HF specialists.
射血分数保留的心力衰竭（HFpEF）的特点是发病率不断上升且预后较差。绝大多数HFpEF患者由非心脏病专家护理。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）作为推荐治疗药物的应用，提高了在不同医疗环境中及时、准确识别和治疗HFpEF的重要性。我们通过针对心脏病专家、HF专科医生和非心脏病专家的调查，评估了各专业对HFpEF的管理情况。
2023年5月至7月在全球范围内开展了一项独立的基于网络的调查。我们进行了事后分析，比较心脏病专家、HF专科医生和非心脏病专家。来自95个国家的1460名医生（61%为男性，中位年龄41[34 - 49]岁）完成了调查；20%为HF专科医生，65%为心脏病专家，15%为非心脏病专家。与HF专科医生相比，非心脏病专家和心脏病专家在诊断时使用利钠肽（p = 0.003）和HFpEF评分（p = 0.004）的可能性较小，获取或考虑用于识别HFpEF的特定超声心动图参数的可能性也较小（p < 0.001）。无论专业如何，舒张期负荷试验在不到30%的病例中使用（p = 1.12）。不同专业的多药治疗策略相似。虽然SGLT2i和利尿剂是首选药物，但血管紧张素受体阻滞剂和血管紧张素受体脑啡肽酶抑制剂在所有三组中处方频率最低。然而，当只能选择一种药物时，各专业中倾向于使用SGLT2i的医生比例差异显著（66%的HF专科医生、52%的心脏病专家、51%的非心脏病专家）。此外，10%的非心脏病专家和8%的心脏病专家认为β受体阻滞剂是HFpEF的首选药物。
在HFpEF管理方面，各专业组之间存在显著差异，尤其是在诊断检查方面。我们的结果凸显了HFpEF患者，特别是非HF专科医生中，诊断不足和治疗不足的重大风险。
