ABSTRACT
To evaluate the knowledge of primary care physicians on the diagnosis and treatment of heart failure. A cross-sectional study was conducted during March 2009. An English form self-administered questionnaire was used. Out of 458 questionnaires distributed to all physicians working in primary health care in Kuwait during the study period 320 questionnaires were complete. The questionnaire consists of 22 questions to gather primary care physicians. Socio-demographic characteristics, type of practice and primary care physicians' knowledge of heart failure [including etiology, symptom and sign, diagnostic procedures and treatment. The response rate of completed questionnaires was 69.9%. Male subjects constituted 65.5% of all participants. More than two-thirds of the subjects were of 30-49 years of age [72.5%] over three-quarters of primary care physicians were general practitioners and 69.4% of primary care physicians, were working in general practitioner clinic. 59.4% of primary care physicians were having a disease register than would enable them to identify heart failure patients and 63.1% were participating in audit of prescribing for heart failure. Most participants thought that early diagnosis and management of heart failure improve quality of life and mortality [99.1%] and [96.9%] respectively. Majority of primary care physicians diagnosed heart failure on symptoms and signs alone [63.4%] without formal investigation or referral. Primary care physicians described the most frequent signs or symptoms of heart failure is oedema or breathlessness. Many primary care physicians arrange a chest X-ray [96.6%] and electrocardiography [91.6%] to establish the diagnosis and some arrange an echocardiogram [30.6%]. Only 28.5% described that the best diagnostic test of heart failure is echocardiography. 83.4% of participants claimed to prescribe for most of their patients with heart failure loop diuretics followed by Angiotensin converting enzyme inhibitor [76.2%] and cardiac glycosides [57.5%]. The vast majority of primary care physicians believed that there was strong evidence of reduced mortality in heart failure patients when using Angiotensin converting enzyme inhibitors. About two third of primary care physicians consider that beta blocker carry side effects in heart failure and should be cautiously use in heart failure. Although symptoms of heart failure are not sufficiently specific for diagnosing patients with heart failure, many primary care physicians in Kuwait treat people with suspected heart failure on the basic of symptoms and sings alone. Echocardigraphy is underused which may hamper the accuracy of heart failure. Angiotensin converting enzyme inhibitors and beta-blockers are also underused. These findings demonstrate that knowledge about diagnosis and treatment of heart failure is insufficient among primary care physicians and indicate the need for educational and systematic changes, including a wider access to echocardiography