Cardiologistas de um hospital escola adotam as diretrizes para o tratamento da insuficiência cardíaca? / Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure?

RESUMO

OBJECTIVE: To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in functional classes II or III, use of spironolactone for patients in functional classes III or IV. METHODS: We analyzed the prescriptions of 199 patients. All these patients had ejection fraction (EF) <=0.50, their ages ranged from 25 to 86 years, and 142 were males. Cardiomyopathy was the most frequent diagnosis 67 (33.6 percent) patients had dilated cardiomyopathy, 65 (32.6 percent) had ischemic cardiomyopathy. RESULTS: Angiotensin-converting enzyme inhibitors were prescribed for 93 percent of the patients. 71.8 percent also had a prescription for digitalis, 86.9 percent for diuretics, 27.6 percent for spironolactone, 12 percent for beta-blockers, 37.2 percent for acetylsalicylic acid, 6.5 percent for calcium channel antagonists, and 12.5 percent for anticoagulants. In regard to vasodilators, 71 percent of the patients were using captopril (85.2mg/day), 20 percent enalapril (21.4mg/day), 3 percent hydralazine and nitrates. In 71.8 percent of the cases, the dosages prescribed were in accordance with those recommended in the large studies. CONCLUSION: Most patients were prescribed the same doses as those recommended in the large studies. Brazilian patients tolerate well the doses recommended in the studies, and that not using these doses may be a consequence of the physician's fear of prescribing them and not of the patient's intolerance