[Physicians' Adherence to Clinical Guidelines on the Chronic Heart Failure Diagnosis and Treatment: Changes Over 2 Years of the Document's Existence].

AIM: To study how physicians' commitment to the basic provisions of clinical guidelines (CGs) for the diagnosis and treatment of chronic heart failure (CHF) has changed over the two years of the document existence. MATERIAL AND METHODS: An anonymous survey was performed for 263 physicians (204 cardiologists, 46 internists and 13 other specialists) who were trained in advanced training programs in 2022. The questionnaire included questions regarding self-assessment of the respondents' professional knowledge, their attitude to the role of CGs in everyday practice and ideas about methods for treatment of CHF. RESULTS: Respondents gave 60.6 % correct answers to questions related to the treatment of CHF. More than 70% correct answers were given by 42.7% of cardiologists and 17.4% of internists. Compared to 2020, the proportion of cardiologists who gave more than 70 % correct answers increased significantly (p<0.05). CGs were considered mandatory by 26.2% and important or sometimes useful by 71.5% of respondents. Cardiologists considered CGs mandatory more frequently than internists (29.9 and 15.2 %, respectively; p=0.04). The mean number of correct answers was greater in the subgroup of respondents who considered CGs mandatory (p<0.001). More than 70% correct answers were given by only 43.8% of cardiologists, who considered themselves fully informed and able to advise colleagues on complex issues of diagnosis and treatment of CHF, and 40.6% of physicians who considered their knowledge acceptable for managing patients with CHF. CONCLUSION: The majority of physician consider CGs an important methodological document but only a little more than 25 % are aware that CGs are mandatory. Cardiologists are better informed than internists about the principal provisions of National Clinical Guidelines for the diagnosis and treatment of CHF, but the average level of physician knowledge remains low.

[Physicians' adherence to the guidelines on the chronic heart failure diagnosis and treatment].

Aim      To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect.   In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion      The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.