Do Doan-Loi, Truong Thanh Huong, Kim Ngoc-Thanh
Department of Cardiology, Hanoi Medical University, Hanoi, Viet Nam.
Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Viet Nam.
BMJ Open. 2025 Jan 6;15(1):e090658. doi: 10.1136/bmjopen-2024-090658.
This study aimed to determine doctors' level of adherence to the natriuretic peptide testing guideline and to identify the factors influencing their adherence.
Cross-sectional study.
Web-based survey.
Full-time doctors involved in heart failure (HF) treatment in Vietnam.
Doctors using natriuretic peptide testing for diagnosis, differential diagnosis, treatment assessment and prognosis of patients with HF were classified as adhering to the guidelines. We assessed the practice of natriuretic peptide testing and stratified the doctors based on their professional qualifications. Univariate and multivariate logistic regression analyses were used to estimate the Odds Ratio (ORs) and 95% CIs for associations between guideline adherence and selected covariates.
Over half of the participants adhered to the natriuretic peptide testing guidelines (57.4%). Cardiologists adhered more closely to the guidelines than other professionals; they had approximately four times higher odds of adherence than other doctors (univariate model, OR: 3.88, 95% CI: 2.56 to 5.89, p<0.001; multivariate model, OR: 4.24, 95% CI: 2.64 to 6.82, p<0.001). Cardiologists also had significantly higher rates of using natriuretic peptide testing for diagnosis (93.8% vs 84.1%, p<0.002), differential diagnosis (71.4% vs 53.5%, p<0.001), treatment assessment (87% vs 64.2%, p<0.001) and prognosis (68.2% vs 50.4%, p<0.001) than other professionals. More years of professional experience correlated with higher guideline adherence (<2 years was used as a reference point; >5 to <10 years, OR: 2.59, 95% CI: 1.45 to 4.60, p<0.001; ≥10 years, OR: 2.30, 95% CI: 1.30 to 4.09, p<0.004).
The level of adherence to natriuretic peptide testing guidelines among doctors treating patients with HF varies across Vietnam. Targeted interventions are needed to enhance understanding and proficiency, especially among non-cardiologists and those with limited experience. A dedicated fact sheet focusing on natriuretic peptide testing in HF management, separate from the existing guidelines, could bridge this gap.
本研究旨在确定医生对利钠肽检测指南的遵循程度，并找出影响其遵循的因素。
横断面研究。
基于网络的调查。
越南参与心力衰竭（HF）治疗的全职医生。
将使用利钠肽检测对HF患者进行诊断、鉴别诊断、治疗评估和预后判断的医生归类为遵循指南。我们评估了利钠肽检测的实践情况，并根据医生的专业资格对其进行分层。采用单因素和多因素逻辑回归分析来估计指南遵循与选定协变量之间关联的优势比（OR）和95%置信区间（CI）。
超过一半的参与者遵循利钠肽检测指南（57.4%）。心脏病专家比其他专业人员更严格地遵循指南；他们遵循指南的几率比其他医生高约四倍（单因素模型，OR：3.88，95%CI：2.56至5.89，p<0.001；多因素模型，OR：4.24，95%CI：2.64至6.82，p<0.001）。心脏病专家在使用利钠肽检测进行诊断（93.8%对84.1%，p<0.002）、鉴别诊断（71.4%对53.5%，p<0.001）、治疗评估（87%对64.2%，p<0.001）和预后判断（68.2%对50.4%，p<0.001）方面的比例也显著高于其他专业人员。更多年的专业经验与更高的指南遵循度相关（以<2年为参考点；>5至<10年，OR：2.59，95%CI：1.45至4.60，p<0.001；≥10年，OR：2.30，95%CI：1.30至4.09，p<0.004）。
越南治疗HF患者的医生对利钠肽检测指南的遵循程度各不相同。需要有针对性的干预措施来提高理解和熟练程度，特别是在非心脏病专家和经验有限的医生中。一份专门针对HF管理中利钠肽检测的情况说明书，与现有指南分开，可以弥补这一差距。
