QJM Advance Access originally published online on January 17, 2005
QJM 2005 98(2):127-138; doi:10.1093/qjmed/hci019
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QJM vol. 98 no. 2 © Association of Physicians 2005; all rights reserved.
Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey
From the Departments of Internal Medicine, 1Requena General Hospital, Valencia, 2Gregorio Marañon Hospital, Madrid, 3Costa del Sol Foundation Hospital, Málaga, 4Son Dureta Hospital, Palma de Mallorca, and 5Reina Sofía Hospital, Córdoba, Spain
Received 22 June 2004 and in revised form 2 November 2004
Background: The medical management of heart failure (HF) in clinical practice varies considerably by country and by medical specialty.
Aim: To assess the treatment of HF patients admitted to Internal Medicine departments, and to evaluate out-patient management prior to admission, by specialty.
Design: Prospective cross-sectional multi-centre survey.
Methods: Of 55 randomly selected Spanish hospitals, 51 agreed to participate. All patients (n = 2145) consecutively admitted for decompensated HF to the Departments of Internal Medicine of these hospitals, over 5 months, were included. Twenty variables were analysed, including aspects relating to out-patient management prior to admission.
Results: Mean ± SD age was 77.2 ± 10.5 years, 57.3% were female, 47% had systolic dysfunction. Prescriptions at discharge: loop diuretics 85.6%, spironolactone 29.8%, ACEIs 65.8%, beta-blockers 8.7%, cardiac glycosides 39%. At admission, 86% already had a diagnosis of HF. Of these, 53% (older patients and more women) were being treated on an out-patient basis by primary care physicians. Primary care physicians requested fewer echocardiograms than internists (38% vs. 69%, p<0.001) and prescribed fewer drugs (ACEIs 40% vs. 54%, p<0.001; spironolactone 15% vs. 23%, p<0.05; beta-blockers 6% vs. 13%, p<0.01). The internists treated more incapacitated patients than the cardiologists (p<0.001), prescribed more high-dose ACEIs (20% vs. 13%, p<0.01) and spironolactone (26% vs. 20%, p<0.05), and fewer anticoagulants (32% vs. 39%, p<0.05).
Discussion: Patients admitted to medical departments with HF are different to those found in clinical trials. Their management is currently suboptimal. Differences in treatment between internists and cardiologists appear to be accounted for by differences in the patients they treat.
Address correspondence to Dr P. Román-Sánchez, Hospital General de Requena, Paraje Casablanca s/n, 46340 Valencia, Spain. e-mail: gilroman{at}terra.es