Kocabaş Umut, Özçalık Emre, Kıvrak Tarık, Altın Cihan, Türk Uğur Önsel
Department of Cardiology, Başkent University Izmir Hospital, Izmir, Türkiye.
Department of Cardiology, Fırat University, Faculty of Medicine, Elazığ, Türkiye.
Turk Kardiyol Dern Ars. 2024 Dec;52(8):581-589. doi: 10.5543/tkda.2024.32050.
Integrating heart failure (HF) guideline recommendations into clinical practice takes time and is often suboptimal in real-life settings. Physician-related factors may be significant barriers to the adoption of these guidelines. This survey aims to assess the current opinions of cardiologists practicing in Türkiye regarding the management of heart failure with reduced ejection fraction (HFrEF).
The survey comprised 22 questions and was published on the SurveyMonkey platform.
A total of 177 cardiologists (mean age: 39.5 years; 73.3% male) participated in the survey. Of these, 38.7% worked in a training and research hospital, and 10.2% were specialists in HF. The threshold EF value to define HFrEF was ≤ 40% for 80.1% of the cardiologists. While 52.6% of physicians considered angiotensin receptor-neprilysin inhibitor (ARNi) treatment the most effective medication for HF, 62.7% would initiate HF treatment with an angiotensin-converting enzyme inhibitor (ACEi) instead of ARNi due to reimbursement and cost issues. More than half of the cardiologists (52.3%) stated that adding another class of HF medication is more important than up-titrating those already prescribed. Although 69.5% of the study participants indicated prescribing all four classes of HF medications during the initial hospitalization is feasible, most cardiologists preferred a sequential approach starting with ACEi/ARNi, followed by beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2i).
This survey highlights significant discrepancies between guideline recommendations and the real-life clinical practice of cardiologists in Türkiye. These results suggest that there is a need for organized action by healthcare providers to improve the implementation of guideline recommendations.
将心力衰竭（HF）指南建议纳入临床实践需要时间，且在现实生活环境中往往不尽人意。与医生相关的因素可能是采用这些指南的重大障碍。本调查旨在评估在土耳其执业的心脏病专家对射血分数降低的心力衰竭（HFrEF）管理的当前看法。
该调查包括22个问题，并在SurveyMonkey平台上发布。
共有177名心脏病专家（平均年龄：39.5岁；73.3%为男性）参与了调查。其中，38.7%在培训和研究医院工作，10.2%是HF方面的专家。80.1%的心脏病专家将定义HFrEF的射血分数（EF）阈值设定为≤40%。虽然52.6%的医生认为血管紧张素受体脑啡肽酶抑制剂（ARNi）治疗是治疗HF最有效的药物，但由于报销和成本问题，62.7%的医生会先用血管紧张素转换酶抑制剂（ACEi）而非ARNi启动HF治疗。超过一半的心脏病专家（52.3%）表示，添加另一类HF药物比增加已开药物的剂量更重要。尽管69.5%的研究参与者表示在初次住院期间开具所有四类HF药物是可行的，但大多数心脏病专家更喜欢采用序贯方法，从ACEi/ARNi开始，接着是β受体阻滞剂、盐皮质激素受体拮抗剂（MRA）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）。
本次调查突出了土耳其心脏病专家的指南建议与现实生活临床实践之间的重大差异。这些结果表明，医疗保健提供者需要采取有组织的行动，以改善指南建议的实施情况。
