Differences between cardiologists and internists in the management of heart failure. Medical guidelines compared with every-day practice.

BACKGROUND

A marked progress in the treatment of chronic heart failure (CHF) took place during the last decade. Large, randomised studies documented the role of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in the reduction of mortality and morbidity in CHF.

AIM: To assess differences in the management of CHF patients between cardiologists and internists.

METHODS

Medical records of 433 patients with CHF, aged 38-98 years, hospitalised between October 2000 and May 2002 in an academic centre, were retrospectively analysed. Cardiologists treated 241 patients, and internists - 192 patients. In addition, 12 randomly selected physicians who treated CHF patients, filled-in a questionnaire concerning CHF treatment. Next, the answers were compared with the actual treatment, documented in patients medical files.

RESULTS

There were significant differences in the CHF treatment between cardiologists and internists. Cardiologists significantly more often prescribed ACE-I in NYHA class III patients (77% vs 58%, p=0.003), beta-blockers in all NYHA classes (80% vs 57%, p<0.001), loop diuretics in NYHA classes III and IV (76% vs 42%, p<0.001 and 91% vs 44%, p=0.005), and thiazides in NYHA class III patients (36% vs 11%, p<0.001). Internists more often used loop diuretics (37% vs 15%, p<0.001), digoxin (28% vs 7%, p<0.001) and aldosterone antagonists (24% vs 13%, p=0.022) in NYHA class II patients. All cardiologists and almost half of internists declared combined usage of ACE-I and beta-blockers at increasing dosages as the treatment was continued. The highest concordance between declared and actual medication concerned the concomitant use of ACE-I and beta-blockers.

CONCLUSIONS

Cardiologists used more often ACE-I and beta-blockers than internists in the treatment of CHF patients. A satisfactory knowledge of treatment guidelines was not associated with widespread usage of ACE-I and beta-blockers in every-day practice.