General Physicians and Heart Failure

The aim of this study was to assess how general physicians (GP) think that heart failure (HF) should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named “Improvement” already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a “perception survey”, and later on how a representative sample of patients was managed, with an “actual practice survey”. The electrocardiogram and the chest radiograph were recorded in most patients (≅90%), but the echocardiogram only in 67% of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16% of the patient records. Likewise coronary angiogram was performed in 7% of patients. Only 23% of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43% of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9% received these drugs in combination. At the last interview, 50% had hypertension (blood pressure ≥ 140/90) and 15% had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.