Abstract 180: The Effectiveness of a HF Training Program among Primary Care Physicians

Abstract

Background: Heart failure (HF) guidelines recommend beta-blockers (BB) to reduce morbidity and mortality. BB doses are often suboptimal, which do not provide maximum benefit for HF patients. Differences in BB management patterns may exist between family practice (FP) and internal medicine (IM) physicians due to differences in specialty interest and training. Objectives: 1) To determine the effectiveness of a one-day training intervention for primary care physicians (PCPs) designed to optimize BB titration for patients with systolic HF. 2) To compare BB titration rates of FP and IM physicians. We hypothesized the intervention would result in increased PCP BB titration rates for experimental patients, with a more significant benefit in the FP group. Methods: A prospective cohort study was conducted at a county hospital with low-income, underserved HF patients (mean age 54.1±13.1, males 70%, mean ejection fraction 28.2±9.8, mean serum creatinine 1.5±1.0) for up to 7 clinic visits. Twelve participating PCPs, including 5 FP and 7 IM physicians, received a one-day training intervention on HF management with a focus on BB titration. Medical records of control patients who received care 2 years prior to the intervention (n=54) were compared to experimental patients after the intervention (n=81). A linear mixed model examined differences in BB dose between the experimental and control groups and the FP and IM physicians. Results: No sociodemographic or clinical differences were noted between HF patients treated before or after the intervention or between IM and FP physicians (p>0.05). The test of the group by time interaction showed no difference between the experimental and control groups in linear change trajectories for BB dose change (t= -0.12, p=0.91). However, FP physicians showed a significant change in BB titration rates for experimental patients (p=0.04) when compared to IM physicians. Conclusions: There was no difference in BB titration rates between the experimental and control groups following a HF training intervention for PCPs, although the clinical reasons for restricting maximal dosage were not explored. Teaching interventions targeting FP physicians may benefit HF patients in achieving higher BB doses and should be examined further.