Practice Variability Across Disciplines Caring for Heart Failure with Preserved Ejection Fraction

Abstract

INTRODUCTION Heart failure with preserved ejection fraction (HFpEF) is often managed by non-cardiologists, but little is known about how their practice differs from that of cardiologists. We aimed to quantify differences in the diagnosis and treatment of HFpEF between these groups. Hypothesis We hypothesized that diagnosis and treatment practices for HFpEF would vary widely and differ between cardiologists and non-cardiologists, and that there would be relevant differences in approach to HFpEF and heart failure with reduced ejection fraction (HFrEF). Methods We anonymously surveyed cardiologists and non-cardiologists (Internal Medicine, Medicine/Pediatrics, Family Medicine, Geriatrics) on practices related to diagnosing and managing HFpEF at two academic centers (University of Michigan and Weill Cornell Medicine). Response data were compared using chi-squared analysis. Results Of 1,010 physicians surveyed, 245 completed a significant portion and 192 completed the entire survey. Among participants, 18% were cardiologists, 82% non-cardiologists, and 45% resident physicians. Survey data are shown in the Table . Over 90% of non-cardiologists reported caring for patients with HFpEF routinely. Most were unaware of HFpEF diagnostic guidelines, and commonly used ventricular diastolic dysfunction and natriuretic peptides to rule in or out a HFpEF diagnosis. Non-cardiologists were less likely than cardiologists to prescribe an aldosterone antagonist for HFpEF. Non-cardiologists were more likely to refer the majority of their HFrEF patients to cardiology (63%) compared to HFpEF (37%, p Conclusions Cardiologists and non-cardiologists vary significantly in the diagnosis and treatment of HFpEF. While imperfect guidelines must be clarified through further research, opportunity exists to improve diagnosis and processes of care.