Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in every‐day practice

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Abstract
Background: Data on diagnosis and management of heart failure in every‐day care are scarce. Aims: To compare general practitioners’ and cardiologists’ diagnostic work‐up and management of patients with (suspected) heart failure. Methods: In a cross‐sectional survey we studied a sample of 103 files of patients coded as heart failure in primary care (31 general practices), and 99 files of out‐patients coded as heart failure from 9 hospitals in the Netherlands. We defined patients as heart failure ‘GP patients’, when they were managed by a general practitioner without co‐treatment of a cardiologist. Results: Patients managed in general practice were older (mean age 79 years (S.D. 8.5) and more often female than ‘cardiology patients’ (mean age 64 years (S.D. 11.7)). Ischaemic heart disease (31 vs. 57%) was more prevalent in ‘cardiology patients’. Additional investigations such as chest radiography (51% vs. 84%), electrocardiography (39% vs. 100%), and (Doppler‐) echocardiography (12% vs. 97%) were performed more often in ‘cardiology patients’. Most patients received diuretics (85% vs.79%). Angiotensin converting enzyme inhibitors (40% vs. 76%), beta‐blockers (9% vs. 30%), spironolactone (11% vs. 32%), and angiotensin‐II‐antagonists (6% vs. 13%) were prescribed much more often to ‘cardiology patients’. Conclusion: General practitioners more often treat elderly, female patients with heart failure than cardiologists. General practitioners use less additional investigations and prescribe less potentially beneficial medication, compared to cardiologists. Population characteristics only partly explain these differences, suggesting that the physician's attitude has an important bearing on the uptake of treatment.