International journal of cardiology · 2014
Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Jankowska Ewa A, Kalicinska Elzbieta, Drozd Marcin, Kurian Beata, Banasiak Waldemar, Ponikowski Piotr
Аннотация
OBJECTIVE: We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland.
METHODS: All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF.
RESULTS: Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar.
CONCLUSION: In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations.
METHODS: All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF.
RESULTS: Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p<0.001). Hypertension (74% vs 66%), previous stroke and/or transient ischaemic attack (21% vs 16%), diabetes (40% vs 30%), and chronic obstructive pulmonary disease (14% vs 11%) were more common in outpatients of GPs (all p<0.001). GPs were less likely to prescribe β-blocker (95% vs 97%, p<0.01), mineralocorticoid receptor antagonist (MRA) (56% vs 64%, p<0.001), and loop diuretic (61% vs 64%, p<0.05) or use PCI (33% vs 44%, p<0.001), CABG (11% vs 16%, p<0.001), ICD (4% vs 10%, p<0.001), or CRT (1% vs 5%, p<0.001). Prescription of renin-angiotensin system inhibitors (94% vs 94%, p>0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar.
CONCLUSION: In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations.