Abstract
AimsTo assess whether a single training session for general practitioners (GPs) improves the evidence-based drug treatment of heart failure (HF) patients, especially of those with HF with reduced ejection fraction (HFrEF).Methods and resultsA cluster randomised controlled trial was performed for which patients with established HF were eligible. Primary care practices (PCPs) were randomised to care-as-usual or to the intervention group in which GPs received a half-day training session on HF management. Changes in HF medication, health status, hospitalisation and survival were compared between the two groups. Fifteen PCPs with 200 HF patients were randomised to the intervention group and 15 PCPs with 198 HF patients to the control group. Mean age was 76.9 (SD 10.8) years; 52.5% were female. On average, the patients had been diagnosed with HF 3.0 (SD 3.0) years previously. In total, 204 had HFrEF and 194 HF with preserved ejection fraction (HFpEF). In participants with HFrEF, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers decreased in 6 months in both groups [5.2%; (95% confidence interval (CI) 2.0–10.0)] and 5.6% (95% CI 2.8–13.4)], respectively [baseline-corrected odds ratio (OR) 1.07 (95% CI 0.55–2.08)], while beta-blocker use increased in both groups by 5.2% (95% CI 2.0–10.0) and 1.1% (95% CI 0.2–6.3), respectively [baseline-corrected OR 0.82 (95% CI 0.42–1.61)]. For health status, hospitalisations or survival after 12–28 months there were no significant differences between the two groups, also not when separately analysed for HFrEF and HFpEF.ConclusionA half-day training session for GPs does not improve drug treatment of HF in patients with established HF.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01487-x) contains supplementary material, which is available to authorized users.
Highlights
Heart failure (HF) is an increasing healthcare problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the healthcare team is considered optimal [1]
Of note is the fact that every individual in the Netherlands, except for patients in nursing homes and hospices, is registered with a single GP, independent of specialist care, and GPs routinely register all patient contacts in an individual electronic medical record (EMR) and keep record of all specialist letters, including hospital discharge letters
Among the 204 patients with HF with a reduced ejection fraction (HFrEF), the use of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) decreased by 5.2% in the intervention group and by 5.6% in the control group [baseline-corrected odds ratio (OR) 1.07], while beta-blocker use increased by 5.2% in the intervention group and 1.1% in the control group [baselinecorrected OR 0.82,]
Summary
Heart failure (HF) is an increasing healthcare problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the healthcare team is considered optimal [1]. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection fraction (HFrEF) with inhibition of the renin-angiotensin system and sympathetic nervous system [2, 3]. For patients with HF and a preserved ejection fraction (HFpEF), to date no drugs have been shown to clearly improve prognosis. Diuretics are helpful for fluid status management and reduce symptoms of fluid overload in HFpEF. Optimal blood pressure management is recommended and, in the case of tachycardia, optimal rate control or rhythm correction. Optimal management of comorbidities is important [3]. The search for novel treatment options for HFpEF patients is still ongoing [4,5,6]
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