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Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgments

The statistical evaluation by Michael Obermayer (GKM Gesellschaft für Therapieforschung mbH, München) is acknowledged. This study was sponsored by Pfizer.

Conflict of interest

Michael Böhm, Carsten Tschöpe, Ulrich Tebbe, Jost Henner Wirtz, Jan Lokies and Peter Bramlage have received research funding from a number of pharmaceutical companies interested in heart failure including the sponsor of the present study Pfizer Pharma GmbH, Berlin. Peter Bramlage was a paid consultant to Pfizer in connection with the development of this manuscript. Eva Turgonyi, Anke M. Strunz and Katharina Lins are employees of the sponsor.

Author information

Authors and Affiliations

  1. Klinikum Lippe-Detmold, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Röntgenstrasse 18, 32756, Detmold, Germany

    Ulrich Tebbe

  2. Medizinische Klinik II, Kardiologie und Pulmologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

    Carsten Tschöpe

  3. Kardiologische Gemeinschaftspraxis Dinslaken, Dinslaken, Germany

    Jost Henner Wirtz

  4. Gemeinschaftspraxis Eickhoff Lokies, Berlin, Germany

    Jan Lokies

  5. Pfizer Ltd., Tadworth, Surrey, UK

    Eva Turgonyi & Katharina Lins

  6. Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany

    Peter Bramlage

  7. Pfizer Pharma GmbH, Berlin, Germany

    Anke M. Strunz

  8. Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Homburg/Saar, Germany

    Michael Böhm

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  1. Ulrich Tebbe
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Correspondence to Peter Bramlage.

Appendix

Appendix

Steering Committee

Michael Böhm (Homburg/Saar), Carsten Tschöpe (Berlin), Ulrich Tebbe (Detmold), Jost Henner Wirtz (Dinslaken), Jan Lokies (Berlin), Peter Bramlage (Mahlow).

Investigators

Ulrich Tebbe (Detmold), Stefan Blankenberg (Hamburg), Stefan Störk (Würzburg), Bernd-Dieter Gonska (Karlsruhe), Günter Piske (Berlin), Gunter Stenzel (Riesa), Clemens Bauknecht (Rottweil), Heribert Brück (Erkelenz), Peter Bosiljanoff (München), Jens Taggeselle (Markkleeberg), Gunter Seidel (Detmold), Sinisa Miketic (Detmold), Torsten Figura (Rinteln), Susanne Backhaus (Buchholz), Dag-Alexander Keilhau (Hamburg), Jens Beermann (Wedel), Behrus Subin (Hamburg), Wilhelm Josef Mieseler (Höchberg), Claus Günthert (Höchberg), Michael Dobler (Karlstadt), Heinrich Bechtold (Schrozberg), Matthias Salefsky (Aschaffenburg), Ulrich Staedt (Speyer), Thomas Dieterle (Ettlingen), Sabine Raulin (Karlsruhe), Mustafa Durak (Heidelberg), Petra Lange-Braun (Berlin), Andreas Förster (Berlin), Rene Oliver (Berlin), Claudia Zemmrich (Berlin), Werner Rieker (Berlin), Heike Stenzel (Riesa), Peter Kindermann (Riesa), Jan Nimetschik (Gröditz), Petra Bauer (Bad Liebenwerda), Andreas Hagenow (Elsterwerda), Ottmar Banning (Waldmössing), Klaus Götz (Bad Dürrheim), Johannes Guhl (Villingen-Schwenningen), Karl Stuff (Donaueschingen), Helmut Hermanns (Erkelenz), Franz-Josef Geffers (Erkelenz), Ulrich Arendt (Mönchengladbach), Alexandra Haupt-Pichler (München), Cornelia Groos-März (München), Constanze Schmidt (Borna), Thomas Theuner (Markkleeberg), Astrid Meier (Markkleeberg), Cornelia Schlott (Zwenkau).

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Tebbe, U., Tschöpe, C., Wirtz, J.H. et al. Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF. Clin Res Cardiol 103, 665–673 (2014). https://doi.org/10.1007/s00392-014-0678-2

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  • DOI: https://doi.org/10.1007/s00392-014-0678-2

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