Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF
- 295 Downloads
In Germany, care for patients with chronic heart failure (HF) is provided by hospital-based cardiologists (HBC), office-based cardiologists (OBC) and general practitioners (GP). We aimed to compare patient characteristics, diagnostic approaches and therapeutic decisions.
Multi-centre, cross-sectional, observational survey at 48 physicians. Patients (n = 384) were required to have previously diagnosed HF and NYHA class ≥ II and/or a left ventricular ejection fraction of <50 %. A total of 384 patients were included at 5 HBCs, 26 OBCs and 18 GPs.
A mean of 18.8 % of all patients at HBCs practices had heart failure, compared to a smaller proportion of 13.9 and 6.7 % at OBCs and GPs, respectively. Echo facility was available for all HBCs and OBCs, but for 16.7 % of GPs (p < 0.0001 for trend). Patients at HBCs had a higher NYHA class (65.6 % had class III/IV; p < 0.0001) compared to 36.8 % at OBCs and 39.3 % at GPs. Usage of three guideline-recommended pharmaceutical treatments was more than 80 %: diuretics (83.1 %), renin–angiotensin system blocking agents (91.4 %) and betablockers (90.1 %) with no differences between physician groups. Mineralocorticoid receptor antagonists (MRAs, overall 47.7 %) were more frequently prescribed by OBCs (54.7 %; p = 0.0007 for trend) than HBCs (43.8 %) and GPs (31.0 %). Ivabradin was not frequently used (11.0 % at OBCs, 4.9 % at HBCs and 0 % at GPs; p = 0.0163 for trend). The proportion of patients with CRT (8.6 %), ICD (23.5 %) and CABG (23.1 %) was not statistically different between groups.
REFLECT-HF demonstrates that there are some differences in evidence-based treatment decisions between the three main health services (HBC, OBC and GP) providing care for patients with HF in Germany. Advocating adherence to guideline recommendations and earlier adoption of these evidence-based treatments across all levels of care might further improve patient care.
KeywordsHeart failure General practitioners Cardiologists Mineralocorticoid receptor antagonists Echocardiography Elderly
- 10.Franke J, Zugck C, Wolter JS, Frankenstein L, Hochadel M, Ehlermann P, Winkler R, Nelles M et al (2012) A decade of developments in chronic heart failure treatment: a comparison of therapy and outcome in a secondary and tertiary hospital setting. Clin Res Cardiol 101:1–10PubMedCrossRefGoogle Scholar
- 11.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847PubMedCrossRefGoogle Scholar
- 12.Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2009) National guideline chronic heart failure—Long version. http://www.versorgungsleitlinien.de/themen/herzinsuffizienz/pdf/nvl_hi_lang.pdf
- 13.DEGAM. Guideline No. 9: heart failure. http://leitlinien.degam.de/uploads/media/Langfassung_Herzinsuffizienz_1_E002BIndex.pdf
- 14.Ehlers APF, Götting S (2007) The accountability requirements of section 13550 of the cardiocomplex EBM. http://www.bnk.de/uploads/media/0703_262.pdf
- 15.Kassenärztliche Bundesvereinigung (2013) Physician group EBM. http://www.kbv.de/8170.html
- 26.Bohm M, Borer J, Ford I, Gonzalez-Juanatey JR, Komajda M, Lopez-Sendon J, Reil JC, Swedberg K et al (2013) Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study. Clin Res Cardiol 102:11–22PubMedCrossRefGoogle Scholar
- 31.Jost A, Rauch B, Hochadel M, Winkler R, Schneider S, Jacobs M, Kilkowski C, Kilkowski A et al (2005) Beta-blocker treatment of chronic systolic heart failure improves prognosis even in patients meeting one or more exclusion criteria of the MERIT-HF study. Eur Heart J 26:2689–2697PubMedCrossRefGoogle Scholar