DIFFERENCES BETWEEN PRIMARY-CARE PHYSICIANS AND CARDIOLOGISTS IN MANAGEMENT OF CONGESTIVE-HEART-FAILURE - RELATION TO PRACTICE GUIDELINES

Objectives, This study was designed to characterize physician practice s in the management of congestive heart failure (CHF) and to determine whether these practices vary by specialty and how they relate to guid eline recommendations. Background. Congestive heart failure is respons ible for considerable mortality, morbidity and health care resource ut ilization, Although there have been important advances in the diagnost ic evaluation and treatment of CHF, little information is available on physician practices in this area. Methods. We surveyed physicians con cerning their management of patients with CHF, The results were analyz ed in multivariate models to determine the relation of diagnostic and treatment approaches to physician specialty, time since training, boar d certification and volume of patients with CHF, Surveys were sent to a sample of 2,250 family and general practitioners (FP/GPs), internist s and cardiologists. Responses were examined in relation to guidelines issued by the Agency for Health Care Policy and Research that had bee n released 9 months previously. Results. Significant differences were found between physician groups with regard to each of the major guidel ine recommendations, For example, routine evaluation of left ventricul ar function, a point of emphasis in the guideline, is performed by 87% of cardiologists, but by only 77% of internists and 63% of FP/GPs (p < 0.001 between groups), Angiotensin-converting enzyme inhibitors were used by cardiologists, internists and FP/GPs in 80%, 71% and 60% of p atients with mild to moderate CHF, respectively (p < 0.001 between gro ups), Larger differences were reported in the prescribed dosages of th ese drugs and their use in patients with renal dysfunction. Conclusion s. Cardiologists report practices more in conformity with published gu idelines for CHF than do internists and FP/GPs, Because of the large n umbers of patients with CHF and their substantial mortality, morbidity and cost of care, these differences may have a major impact on outcom es and health care costs. (C) 1997 by the American College of Cardiolo gy.