Physicians’ adherence to the guidelines on the chronic heart failure diagnosis and treatment

Abstract

Aim To evaluate the physician’s knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect. In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.

Knowledge and Practices regarding Guideline-directed Medical Therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) among Physicians in Beijing, China: a Cross- sectional Study

“…Interventions such as guideline dissemination and education have been shown to improve adherence to cardiovascular disease guidelines [24]. We suggest that the provision of suitable training might improve physicians' knowledge of GDMT for HFrEF, in agreement with a previous report that recommended training programs focusing on the use of medications such as RAS inhibitors and beta-blockers, dosing principles, and the indications for ICD placement [21]. The provision of training programs is particularly important given that nearly half of the physicians surveyed in this study reported not taking a proactive approach to learning about GDMT for HFrEF and given that more than half of the respondents saw only a small number of patients with HFrEF each month, limiting their clinical experience.…”

“…Additionally, less than half of the respondents were aware of the indications for CRT or ICD use in patients with HFrEF, in agreement with a previous study [21], implying that these treatments may be underused in eligible patients in China. Indeed, the China Heart Failure study showed that ACEIs/ARBs, beta-blockers and MRAs were utilized in only 27%, 25.6% and 26.6%, respectively, of patients with HF at admission to hospital, while ICDs, CRT and other devices were utilized in only 0.3% of patients hospitalized for HF [22].…”

Problematic issues and development of classifications of the main parameters of quality and adherence to pharmacotherapy. Part II: physician adherence to clinical guidelines and official drug labels

“…В то же время, как и в отношении приверженности больных, отсутствуют утвержденные терминология и методология определения приверженности/неприверженности врачей [10]. В целом ряде российских и зарубежных исследований была продемонстрирована недостаточная приверженность врачей положениям современных КР, выявлены нерациональные, ошибочные назначения ЛП при лечении пациентов с ХНИЗ [11][12][13][14][15][16].…”