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The Euro Heart Survey, a program launched in 1999, looked at how cardiologists and primary care physicians managed patients with heart failure. The Survey assessed more than 11,000 patients who received hospital and community care in 25 European countries. Current guidelines clearly mandate obtaining objective evidence for heart failure; when diagnosed, the aetiology underlying heart failure should be explored. Prof. F. Follath (Switzerland) reported that only 45% of primary care physicians said they would routinely request an echocardiogram for patients with suspected heart failure, ranging from 10% in the Netherlands to 73% in France. General practitioners obtained measures of left ventricular ejection fraction for fewer than half of patients with heart failure, and only 40% of general practitioners actually used the standard New York Heart Association classification of severity (IMPROVEMENT Trial). For treatment, current guidelines recommend ACE inhibitors and beta-blockers to lessen long-term morbidity and mortality for a majority of heart failure patients; spironolactone and angiotensin II antagonists are recognised to benefit selected patients. While diuretics and digoxin can lessen symptoms, there is no evidence that these drugs enhance survival. Prof. M. Komajda (France) reported for the Survey Programme that only diuretics were used consistently and widely throughout Europe (Figure 1). Although recommended as first-line therapy, ACE inhibitors were only prescribed to 60% of patients; when prescribed, these drugs were commonly given at 60% to 80% of the recommended doses. Beta-blockers were likewise underused—in spite of striking benefits attributed to this class of drugs. Figure 1. Percentage of European heart failure patients treated with
various drugs It is clear that many heart failure patients in Europe are not receiving recommended therapy for their condition, thus resulting in excessive mortality and morbidity. Prof. Follath summarised that practice gaps may result from limited availability of modern diagnostic tools, lack of understanding by physicians, or failure of practice guidelines to fully address all patients seen in practice (e.g., the very elderly and those with multimorbidity). |
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©2002 Failinghearts.com |
