Specialty-Based Variability in Diagnosing and Managing Heart Failure With Preserved Ejection Fraction

• Published in: Mayo Clinic proceedings Vol. 95; no. 4; pp. 669 - 675
• Main Authors: Saxon, David T., Kennel, Peter J., Guyer, Heidi M., Goyal, Parag, Hummel, Scott L., Konerman, Matthew C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-04-2020; Frontline Medical Communications Inc; Elsevier Limited
• Subjects: Aldosterone; Analysis; Angiotensin; Angiotensin-converting enzyme inhibitors; Biomarkers; Cardiology; Care and treatment; Congestive heart failure; Diagnosis; Ejection fraction; Enzymes; Family medicine; Geriatrics; Heart; Heart failure; Hospitalists; Internal medicine; Medical centers; Medical diagnosis; Medical referrals; Medicine; Morbidity; Mortality; Patients; Pediatrics; Peptides; Peptidyl-dipeptidase A; Physicians; Primary care; Ultrasonic imaging; Ventricle; Michigan; HFpEF; TTE; BNP; HFrEF
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2019.09.026

To quantify differences in the diagnosis and treatment of heart failure with preserved ejection fraction (HFpEF) between cardiologists and noncardiologists, who often diagnose and manage HFpEF.
Cardiologists and noncardiologists (internal medicine, medicine/pediatrics, family medicine, geriatrics) were anonymously surveyed between January 16, 2018, and March 2, 2018, regarding practices related to diagnosing and managing HFpEF at the University of Michigan and Weill Cornell Medical Center. Response data were compared using χ2 analysis.
Of 1010 physicians surveyed, 211 completed a significant portion of the survey: 32 cardiologists and 179 noncardiologists. Most noncardiologists were unaware of HFpEF diagnostic guidelines and commonly used left ventricular diastolic dysfunction and natriuretic peptides to diagnose HFpEF. Noncardiologists (32.3%, n=52) were less likely than cardiologists (64.5%, n= 20) to prescribe an aldosterone antagonist for HFpEF (P=.001). Both groups reported similar use of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and exercise programs. Noncardiologists were more likely to refer patients with HFrEF to cardiology (63.1%, n=111) compared with patients with HFpEF (33.5%, n=59; P<.001). Noncardiologists were more likely to discuss prognosis and goals of care with patients with HFrEF (84.4%, n=151) than with patients with HFpEF (65.9%, n=118; P<.001).
Cardiologists and noncardiologists vary significantly in their HFpEF diagnosis and treatment practices. As diagnostic criteria continue to be evaluated for HFpEF, dissemination of these guidelines to noncardiologists, with an emphasis on the morbidity and mortality associated with HFpEF, is imperative.