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

Abstract

Background: 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.

Methods and results: In 2008, during a nationwide educational project on HF management,
15 courses for GPs were conducted. Before the training, physicians fi lled 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 signifi cant reverse relationship between physicians’ age and their declarations in prescription
of angiotensin II receptor blockers (p = 0.007; contingency coeffi cient, 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).

Conclusions: 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.