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QJM Advance Access published online on January 17, 2005
QJM, doi:10.1093/qjmed/hci019
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QJM © Association of Physicians 2005; all rights reserved.
Received June 22, 2004
Revised November 2, 2004

Original Papers

Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey

P. Román-Sánchez 1*, P. Conthe 2, J. García-Alegría 3, J. Forteza-Rey 4, M. Montero 5, and C. Montoto 2

1 Department of Internal Medicine, Requena General Hospital, Valencia, Spain
2 Department of Internal Medicine, Gregorio Marañon Hospital, Madrid, Spain
3 Department of Internal Medicine, Costa del Sol Foundation Hospital, Málaga, Spain
4 Department of Internal Medicine, Son Dureta Hospital, Palma de Mallorca, Spain
5 Reina Sofía Hospital, Córdoba, Spain

* To whom correspondence should be addressed.
P. Román-Sánchez, E-mail: gilroman{at}terra.es


  Abstract

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.


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