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Docs get mediocre score on treatment of heart failure

A survey of 400 physicians found that thousands of heart failure patients are not receiving beta-blocker therapy, in spite of strong evidence that incorporating beta-blockers into a treatment plan increases survival and decreases the number of hospitalizations.

Survey respondents were asked to assign letter grades to questions on topics such as patient understanding of heart failure, compliance with the required lifestyle changes, physician satisfaction with available drug therapies, and the availability of education about treatment options. The nationwide survey, known as the Heart Failure Report Card, was conducted in conjunction with the Cardiovascular Institute of the University of Pittsburgh Medical Center (UPMC) Health System, with an educational grant from AstraZeneca.

The Heart Failure Report Card was developed in an attempt to understand the current beliefs and treatment patterns of physicians, according to Arthur Feldman, M.D., Ph.D., professor of medicine and director, Cardiovascular Institute of UPMC Health System, Pa. "The purpose of the survey was to try to obtain objective data about the perception of physicians regarding heart failure and to gain an understanding about their use of heart failure medications in their patients," explained Feldman. The survey was done, he continued, because both anecdotal reports and nondefinitive data indicate that beta-blocker usage was less than optimal.

Overall, heart failure diagnosis and treatment in the United States received the letter grade of C from the surveyed physicians. One of the most surprising findings was that although 87% of the physicians polled said that the benefits of beta-blocker therapy are clearly demonstrated in clinical trials, 62% of their patients are not receiving beta-blockers as part of their therapeutic regimen. Feldman sees this disparity as a complex problem. The first part of the issue is that patients must be educated about why they need to take (and pay for) yet another medication, when they may already be taking eight or nine other drugs.

Patient understanding of issues relevant to heart failure received the letter grade of D+. Respondents cited noncompliance with lifestyle changes and medications and a lack of understanding about what the medications do as the reasons for this abysmal grade. Feldman believes pharmacists can serve as an important educational resource for patients, by helping them understand the need for medication and what its benefits are and by encouraging them to become actively involved in their own care. Patients should be encouraged to exercise, watch their diet, avoid sodium, and weigh themselves regularly.

Pharmacists can make available pamphlets that explain heart failure and the required medications and lifestyle changes. Feldman reported that the Heart Failure Society of America is developing a series of patient information "modules" about heart failure. These educational modules cover topics such as exercise and heart failure medication and will be published throughout the year. The organization can be contacted at www.hfsa.org, and the patient information modules are available at www.abouthf.org. He hopes that by providing education from the bottom up—to patients, their families, and the general public—pharmacists can help patients better understand their condition, and patients will know to discuss beta-blocker therapy with their doctor.

Another problem is that beta-blocker dosage must be tailored to the individual patient. This requires up-titration of the dosage, necessitating frequent office visits. Feldman feels that, from the physicians' perspective, it is not desirable to have to make room in the office schedule for these patients, because the doctors are often not compensated or compensated on a very low scale for these visits. One way to overcome this problem is to care for these patients in a disease management setting. In this clinical situation, dosage adjustments are overseen by a nurse or nurse practitioner.

Pharmacists can help educate the healthcare team, particularly those clinicians not practicing at large medical centers, where information is not readily available, said Feldman. They can be attentive to the diagnosis and suggest beta-blocker therapy for persons who are on diuretics and ACE inhibitors for their heart failure.

According to Feldman, because pharmacists understand how to dose beta-blockers, if a physician contacts them about starting a patient on therapy, pharmacists can explain which drugs are approved and what the starting dose is. In this way, he concluded, pharmacists can be a key resource and an important part of the clinical team that is caring for a large patient population.

Charlotte LoBuono

Charlotte LoBuono. Docs get mediocre score on treatment of heart failure.

Drug Topics

2002;8:24.