Cor Vasa 2003, 44(10):481-485

Inadequate treatment of heart failure in Europe. Does clinical practice lag behind European guidelines? Does the Czech Republic lag behind Europe? Current status of treatment of heart failure in hospitals as documented by the Euro Heart Failure Survey, and in general practitioners as documented by the IMPROVEMENT of HF program

Jiří Widimský^1,*, Jindřich Špinar²

¹ Klinika kardiologie, Institut klinické a experimentální medicíny, Subkatedra kardiologie IPVZ, Praha

² II. interní klinika, Fakultní nemocnice u sv. Anny, Brno, Česká republika

Aim:
A comparison of European programs of analysis of heart failure management in hospitals (Euro Heart Failure Survey) and by general practitioners (IMPROVEMENT of HF) with the current status of chronic heart failure management by general practitioners in the Czech and Slovak Republics.

Methods:
In the IMPROVEMENT of HF project, general practitioners were randomly selected by a center based in Oxford, UK. The Euro Heart Failure Survey was organized by the European Society of Cardiology; the project was based on an analysis of data of patients who either died from heart failure, or were discharged from hospital departments of internal medicine or cardiology with the diagnosis of heart failure.

Results:
Either program included over 11,0000 patients both constitute the biggest databases of heart failure management in Europe. A comparison of both programs yielded surprising results. Shortcomings in the treatment of patients with heart failure, most importantly low rates of beta-blocker use and even lower rates of use of the combination of ACE inhibitor with beta-blocker can be seen both in hospitals and in general practitioner offices in either program. As little as 20% of patients in European hospitals were treated with beta-blockers; combination of ACE inhibitors and beta-blockers were used in as little as 17.2% of patients. Therapy with spironolactone in patients with NYHA Class III and IV heart failure is likewise inadequate. Target doses of ACE inhibitors are achieved in 50% of patients only.
The results of treatment by general practitioners in the Czech and Slovak Republics are consistent with European data (including the shortcomings).
Another analysis revealed that treatment of elderly patients aged ł 70 years is even less adequate than that of patients below 70 years of age. The standard of management in heart centers and in departments of cardiology was higher, yet patients were also significantly younger compared with those taken care of in departments of internal medicine.

Conclusions:
European programs of analysis of management of heart failure clearly indicate numerous shortcomings in clinical practice. It is surprising that the standard of treatment in hospitals in Europe is not superior to the standard of treatment by the general practitioner. Most importantly, beta-blocker use is absolutely inadequate. As it is, management of chronic heart failure in Europe is not consistent with the European Society of Cardiology's guidelines for the management of heart failure. The standard of management of heart failure by the general practitioner in the Czech and Slovak Republics is fully consistent with European standards, including the shortcomings.

Keywords: IMPROVEMENT of HF; Euro Heart Failure Survey; Current status of management of heart failure in Europe and the Czech Republic

Published: October 1, 2003  Show citation