Document Detail

Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey.
MedLine Citation:
PMID:  15655095     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The medical management of heart failure (HF) in clinical practice varies considerably by country and by medical specialty. AIM: To assess the treatment of HF patients admitted to Internal Medicine departments, and to evaluate out-patient management prior to admission, by specialty. DESIGN: Prospective cross-sectional multi-centre survey. METHODS: Of 55 randomly selected Spanish hospitals, 51 agreed to participate. All patients (n = 2145) consecutively admitted for decompensated HF to the Departments of Internal Medicine of these hospitals, over 5 months, were included. Twenty variables were analysed, including aspects relating to out-patient management prior to admission. RESULTS: Mean +/- SD age was 77.2 +/- 10.5 years, 57.3% were female, 47% had systolic dysfunction. Prescriptions at discharge: loop diuretics 85.6%, spironolactone 29.8%, ACEIs 65.8%, beta-blockers 8.7%, cardiac glycosides 39%. At admission, 86% already had a diagnosis of HF. Of these, 53% (older patients and more women) were being treated on an out-patient basis by primary care physicians. Primary care physicians requested fewer echocardiograms than internists (38% vs. 69%, p<0.001) and prescribed fewer drugs (ACEIs 40% vs. 54%, p<0.001; spironolactone 15% vs. 23%, p<0.05; beta-blockers 6% vs. 13%, p<0.01). The internists treated more incapacitated patients than the cardiologists (p<0.001), prescribed more high-dose ACEIs (20% vs. 13%, p<0.01) and spironolactone (26% vs. 20%, p<0.05), and fewer anticoagulants (32% vs. 39%, p<0.05). DISCUSSION: Patients admitted to medical departments with HF are different to those found in clinical trials. Their management is currently suboptimal. Differences in treatment between internists and cardiologists appear to be accounted for by differences in the patients they treat.
P Román-Sánchez; P Conthe; J García-Alegría; J Forteza-Rey; M Montero; C Montoto
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2005-01-17
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  98     ISSN:  1460-2725     ISO Abbreviation:  QJM     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-26     Completed Date:  2005-04-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  127-38     Citation Subset:  IM    
Hospital General de Requena, Paraje Casablanca s/n, 46340 Valencia, Spain.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Aged, 80 and over
Ambulatory Care / methods
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anticoagulants / therapeutic use
Cardiac Glycosides / therapeutic use
Cardiotonic Agents / therapeutic use
Cross-Sectional Studies
Digoxin / therapeutic use
Diuretics / therapeutic use
Heart Failure / complications,  drug therapy*,  physiopathology
Middle Aged
Nitrates / therapeutic use
Prospective Studies
Spironolactone / therapeutic use
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Anticoagulants; 0/Cardiac Glycosides; 0/Cardiotonic Agents; 0/Diuretics; 0/Nitrates; 20830-75-5/Digoxin; 52-01-7/Spironolactone

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