Variations in family physicians' and cardiologists care for patients with heart failure

Background Improved understanding of the reasons for underuse of diagnostic tests and treatments For congestive heart failure (CHF) may be helpful for designing future interventions to improve quality of care. Methods To determine differences between family physicians' and cardiologis ts' practice styles for diagnosis and treatment of CHF, a random sample of family physicians-and cardiologists were surveyed-with standardized case sc enarios. Results Survey respondents were 182 family physicians and 163 cardiologists . Family physicians were less likely than cardiologists to rate measurement of left ventricular ejection fraction as "very important" for patients wit h new CHF, less likely to order an echocardiogram or test for ischemia, and much less likely to identify diastolic dysfunction as a cause of CHF. Fami ly physicians were more likely to prescribe digoxin when it was not indicat ed (diastolic dysfunction) and less likely to prescribe digoxin and an angi otensin-converting enzyme (ACE) inhibitor when they were indicated (moderat ely to severely reduced left ventricular ejection fraction). Family physici ans expressed more concern over the risks of ACE inhibitors in patients wit h blood pressure of 100/70 mm Hg or serum creatinine of 2.0 mg/dL and were less likely to prescribe an ACE inhibitor in these settings. Family physici ans overestimated the risks of warfarin use For atrial fibrillation and wer e therefore less likely to prescribe warfarin. Conclusions Family physicians appear to have less understanding of CHF path ophysiology (ie, systolic versus diastolic dysfunction) and how treatment d iffers according to the underlying disease process. Overestimation of the r isk of ACE inhibitor and warfarin use may result in underprescribing these medications.