Heart Failure in Outpatients: Comorbidities and Management by Different Specialists. The EPISERVE Study

Abstract

The aim of the EPISERVE study was to investigate the clinical characteristics of heart failure in outpatients and its diagnostic and therapeutic management by cardiology, internal medicine and primary care specialists. The study involved 507 physicians working in primary care (n=181, 36%), cardiology (n=172, 34%) or internal medicine (n=154, 30%) who treated 2249 consecutive outpatients with heart failure between June and November 2005. The prevalence of heart failure was 2% in primary care, 17% in cardiology and 12% in internal medicine. Hypertension or coronary disease was the cause in more than 80% of cases. The prevalence of comorbidities was high: atrial fibrillation, 46%; diabetes, 38%; obesity, 64%; dyslipidemia, 60%; anemia, 27%; and renal failure, 7%. In 40% of cases, systolic function was preserved (i.e., left ventricular ejection fraction > or =45%). Echocardiographic and coronary angiographic studies were performed more frequently in patients seen in cardiology and in male patients. There were significant differences between men and women in pharmacologic treatment involving beta-blockers (55% vs. 44%, respectively; P< .001), diuretics (88% vs. 92%, respectively; P< .01) and statins (57% vs. 47%, respectively; P< .001). Only 20% of patients received the treatment recommended by clinical practice guidelines. The factors independently associated with appropriate treatment were being treated in cardiology, hypercholesterolemia, age and etiology. The varied approaches of different specialists, the smaller effort put into diagnosis and therapy in women, and the low percentage of patients treated according to guidelines make it essential that an educational and multidisciplinary strategy should be developed for managing outpatients with heart failure.