The basics of heart failure management: are they being ignored?

Background: Advances have been made in the medical management of congestive heart failure. However, there is concern that these changes may not be tra nsmitted to the heart failure population in the community. Other impediment s to improved prognosis, such as failure to apply non-pharmacological strat egies and poor patient comprehension may also be prevalent in the community . Aims: The purpose of this study was to assess physician practice and pati ent knowledge in a heart failure population admitted to a University Hospit al in Ireland. Methods: Patients admitted with a primary diagnosis of heart failure were studied. Estimation of ejection fraction was used to subdivid e the population into heart failure with impaired and normal systolic funct ion. Patients' course in hospital was noted with reference to management by cardiology or internal medicine, use of angiotensin-converting enzyme inhi bition therapy and digoxin and application of dietary and rehabilitative se rvices. Patient knowledge was assessed by questionnaire. Results: Eighty pa tients were included in this study. Two-thirds of the population had impair ed systolic function. The majority of patients were managed by internal med icine physicians, and this population was older and more likely to have nor mal systolic function. Prescription of converting enzyme inhibitor therapy was more frequently used in cardiology-managed patients (96 vs. 70%, P < 0. 05). Neither group applied dietary or rehabilitative advice to a significan t level. Patient comprehension was poor, especially with regard to understa nding of medicine and the value of weight measurement. Conclusion: The abov e data demonstrate a lack of use of rehabilitative and dietary services and poor patient knowledge. These deficiencies may play a role in determining outlook and may impede the expected improvement in prognosis that has been witnessed in large randomised studies. (C) 2000 European Society of Cardiol ogy. All rights reserved.