ABSTRACT
The aim of this study was to assess how general physicians (GP) think that heart failure (HF) should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named "Improvement" already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a "perception survey", and later on how a representative sample of patients was managed, with an "actual practice survey". The electrocardiogram and the chest radiograph were recorded in most patients (approximately equal to 90%), but the echocardiogram only in 67% of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16% of the patient records. Likewise coronary angiogram was performed in 7% of patients. Only 23% of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43% of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9% received these drugs in combination. At the last interview, 50% had hypertension (blood pressure > or = 140/90) and 15% had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.
Subject(s)
Cardiac Output, Low/therapy , Clinical Competence , Physicians, Family/psychology , Adult , Aged , Argentina , Cardiac Output, Low/complications , Cardiac Output, Low/diagnosis , Electrocardiography , Female , Health Care Surveys , Humans , Male , Middle Aged , Risk Factors , Surveys and QuestionnairesABSTRACT
Los m¨¦dicos generales y el tratamiento de la insuficiencia card¨ªaca en una muestra de la poblaci¨®n argentina. El objetivo de este estudio fue evaluar c¨®mo los m¨¦dicos generales (MG) piensan que debe tratarse la insuficiencia card¨ªaca (IC) y c¨®mo ponen en pr¨¢ctica su conocimiento. Se realiz¨® en la ciudad de Buenos Aires y su ¨¢rea suburbana, con la colaboraci¨®n de 5 cardi¨®logos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicit¨® que guardasen las historias cl¨ªnicas de todos los pacientes que ellos hab¨ªan atendido con IC. Se obtuvieron los datos de 220 pacientes. La metodolog¨ªa fue similar a la utilizada en una iniciativa internacional llamada Improvement realizada en Europa. Se evalu¨® el conocimiento de los MG y su percepci¨®n sobre el manejo de la IC mediante una ¡°encuesta de percepci¨®n¡±, y c¨®mo una muestra representativa de pacientes fue tratada, a trav¨¦s de una ¡°encuesta sobre la pr¨¢ctica¡±. El lectrocardiograma y la radiograf¨ªa de t¨®rax se le pidieron a la mayor¨ªa de los pacientes (≅90%), pero el ecocardiograma se pidi¨® s¨®lo en el 67% de casos. Cuarenta por ciento de los pacientes ten¨ªan historia de infarto de miocardio y de angina de pecho, pero la ergometr¨ªa no fue considerada como una prueba de diagn¨®stico importante y s¨®lo se asent¨® en el 16% de las HC. Igualmente la cinecoronariograf¨ªa se realiz¨® en el 7% de pacientes. S¨®lo el 23% de los pacientes ten¨ªan una fracci¨®n de eyecci¨®n del ventr¨ªculo izquierdo documentada en sus HC. En la pr¨¢ctica, el 43% de pacientes estaban recibiendo un inhibidor de la ECA y una tercera parte betabloqueantes. S¨®lo 9% recibieron estas drogas combinadas. En la ¨²ltima entrevista, 50% ten¨ªan hipertensi¨®n arterial (¡Ý 140/ 90 mmHg) y en 15% no se hab¨ªa consignado este dato en las HC de los pacientes. Este estudio mostr¨® que el conocimiento y tratamiento de la IC en una muestra de MG, era menor que el ¨®ptimo.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cardiac Output, Low/diagnosis , Cardiac Output, Low/therapy , Physicians/psychology , Professional Practice/standards , Argentina , Cardiac Output, Low/complications , Electrocardiography , Health Care Surveys , Risk Factors , Surveys and QuestionnairesABSTRACT
Los m¿¬dicos generales y el tratamiento de la insuficiencia card¿¬aca en una muestra de la poblaci¿½n argentina. El objetivo de este estudio fue evaluar c¿½mo los m¿¬dicos generales (MG) piensan que debe tratarse la insuficiencia card¿¬aca (IC) y c¿½mo ponen en pr¿øctica su conocimiento. Se realiz¿½ en la ciudad de Buenos Aires y su ¿ørea suburbana, con la colaboraci¿½n de 5 cardi¿½logos, y de 29 MG que fueron seleccionados al azar, a los cuales se les solicit¿½ que guardasen las historias cl¿¬nicas de todos los pacientes que ellos hab¿¬an atendido con IC. Se obtuvieron los datos de 220 pacientes. La metodolog¿¬a fue similar a la utilizada en una iniciativa internacional llamada Improvement realizada en Europa. Se evalu¿½ el conocimiento de los MG y su percepci¿½n sobre el manejo de la IC mediante una íºencuesta de percepci¿½ní±, y c¿½mo una muestra representativa de pacientes fue tratada, a trav¿¬s de una íºencuesta sobre la pr¿øcticaí±. El lectrocardiograma y la radiograf¿¬a de t¿½rax se le pidieron a la mayor¿¬a de los pacientes (≅90%), pero el
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , RESEARCH SUPPORT, NON-U.S. GOVT , Physicians/psychology , Cardiac Output, Low/diagnosis , Cardiac Output, Low/therapy , Professional Practice/standards , Electrocardiography , Health Care Surveys , Argentina , Risk Factors , Surveys and Questionnaires , Cardiac Output, Low/complicationsABSTRACT
The aim of this study was to assess how general physicians (GP) think that heart failure (HF) should be managed and how they implement their knowledge. It was conducted in Buenos Aires City and suburban area, with the collaboration of 5 cardiologists, and 29 GP who were selected randomly, and were asked to keep a log of all patients they saw with HF. The methodology was similar to that employed in an international initiative named [quot ]Improvement[quot ] already performed in Europe. Data were obtained of 220 note patients. GP knowledge and perceptions about the management of HF were assessed initially with a [quot ]perception survey[quot ], and later on how a representative sample of patients was managed, with an [quot ]actual practice survey[quot ]. The electrocardiogram and the chest radiograph were recorded in most patients (approximately equal to 90
), but the echocardiogram only in 67
of cases. Forty percent of the patients had history of myocardial infarction and ischaemic heart disease, but exercise test was not considered as a potential diagnostic test and was recorded only in 16
of the patient records. Likewise coronary angiogram was performed in 7
of patients. Only 23
of the patients had a left ventricular ejection fraction test result documented in their charts. In practice, 43
of GP patients were receiving an ACE inhibitor and one third betablockers. Only 9
received these drugs in combination. At the last interview, 50
had hypertension (blood pressure > or = 140/90) and 15
had not recorded this data in patients notes. This study identified, in a random sample of GP of Buenos Aires City and suburbs, that management of HF was less than optimal.
