Baudry Guillaume, Girerd Nicolas, Cikes Maja, Crespo-Leiro Maria Generosa, Damman Kevin, Delmas Clément, Adamopoulos Stamatis, Nalbantgil Sanem, Lim Hoong Sern, Ruschitzka Frank, Metra Marco, Gustafsson Finn
Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.
REICATRA, Université de Lorraine, Vandoeuvre-les-Nancy, France.
Eur J Heart Fail. 2025 Jun;27(6):1126-1135. doi: 10.1002/ejhf.3530. Epub 2024 Nov 19.
Management of advanced heart failure (HF) remains challenging despite specific sections in the 2021 European Society of Cardiology/Heart Failure Association (ESC/HFA) guidelines, with delays in referrals exacerbating the issue. This study aimed to evaluate the awareness and implementation of these guidelines among cardiologists and identify barriers to effective referral.
From June to October 2023, an online survey was disseminated through the ESC mailing list, targeting cardiologists across Europe. The survey investigated four areas: guideline awareness, healthcare network organization, clinical case management, and perceptions of mechanical circulatory support (MCS) outcomes. Respondents were categorized into heart failure cardiologists (HFCs), general cardiologists (GCs), and other participants (OPs). Among 497 respondents, 25% were heart HFCs, 40% were GCs, and 35% were OPs. A total of 84% of HFCs reported a high level of guideline knowledge, compared to 57% of GCs and 62% of OPs (p < 0.001). Additionally, 76% of HFCs 'regularly or always' used ESC/HFA criteria to identify advanced HF, compared to 44% of GCs and 48% of OPs (p < 0.001). Correct responses regarding the recommendation class for heart transplantation were 84%, 55%, and 60% (p < 0.0001), and for MCS as a bridge to transplantation, 69%, 65%, and 55% (p = 0.018) among HFCs, GCs, and OPs, respectively. Referring patients with severe HF to a tertiary centre team was found to be 'very difficult' or 'difficult' by 8.4% of HFCs, 19.6% of GCs, and 18.2% of OPs (p = 0.0005).
The study highlights significant disparities in knowledge and application of advanced HF guidelines among cardiologists, revealing an opportunity for educational initiatives. The difficulty in referring patients to tertiary centres underscores the need to improve the referral pathway for advanced HF patients.
尽管2021年欧洲心脏病学会/心力衰竭协会（ESC/HFA）指南中有特定章节，但晚期心力衰竭（HF）的管理仍然具有挑战性，转诊延迟使问题更加严重。本研究旨在评估心脏病专家对这些指南的知晓情况和实施情况，并确定有效转诊的障碍。
2023年6月至10月，通过ESC邮件列表开展了一项在线调查，目标是欧洲各地的心脏病专家。该调查研究了四个领域：指南知晓情况、医疗网络组织、临床病例管理以及对机械循环支持（MCS）结果的看法。受访者分为心力衰竭心脏病专家（HFC）、普通心脏病专家（GC）和其他参与者（OP）。在497名受访者中，25%是HFC，40%是GC，35%是OP。共有84%的HFC报告对指南知识掌握程度高，而GC为57%，OP为62%（p<0.001）。此外，76%的HFC“经常或总是”使用ESC/HFA标准来识别晚期HF，而GC为44%，OP为48%（p<0.001）。HFC、GC和OP中关于心脏移植推荐类别的正确回答分别为84%、55%和60%（p<0.0001），关于MCS作为移植桥梁的正确回答分别为69%、65%和55%（p=0.018）。8.4%的HFC、19.6%的GC和18.2%的OP认为将重度HF患者转诊至三级中心团队“非常困难”或“困难”（p=0.0005）。
该研究突出了心脏病专家在晚期HF指南知识和应用方面的显著差异，揭示了开展教育活动的机会。将患者转诊至三级中心的困难凸显了改善晚期HF患者转诊途径的必要性。
