Knowledge about heart failure in primary care: Need for strengthening of continuing medical education

Abstract

Heart failure (HF) is a common complication of cardiovascular diseases, and patients with HF remain largely under the care of primary care physicians (GPs). Therefore, the goal of the study presented was to assess the GPs' knowledge of chronic HF guidelines in regards to their professional experience. In 2008, during a nationwide educational project on HF management, 15 courses for GPs were conducted. Before the training, physicians filled out a standardized questionnaire about the diagnosis and treatment of HF. The answers were assessed in a three age-group of respondents: 24-39 years (n = 142), 40-55 years (n = 316), 56 years and above (n = 156). Of 614 physicians, 97% indicated echocardiography as obligatory diagnostic procedure in HF diagnosis. The oldest GPs more frequently pointed to the role of chest X-ray (63%, p < 0.001) and electrocardiography (32%, p < 0.001) in exclusion of systolic HF. There was a significant reverse relationship between physicians' age and their declarations in prescription of angiotensin II receptor blockers (p = 0.007; contingency coefficient, Cc= 0.13) and b-blockers (p = 0.01; Cc = 0.12) in patients with advanced HF (NYHA III-IV), and positive relation between application of spironolactone (p = 0.007; Cc = 0.13) and digitalis (p < 0.001; Cc = 0.16) in patients of NYHA class I-II. The new generation b-blockers (bisoprolol, carvedilol, nebivolol) were more frequently prescribed by the youngest physicians (respectively: 98%, 96%, 58%) compared to the oldest group (respectively: 88%, 87%, 50%; p < 0.05). The study revealed age of GPs to be inversely related to their knowledge of HF guidelines and potential therapeutic decisions in management of HF patients and support of the need of continuing medical education.