Under the Microscope: How is Patient Care for Heart Failure in the Czech Republic in Real Practice?

Purpose of the Survey and Methodology

It is still crucial for the prognosis of a patient with CHF to start optimal treatment in a timely manner. The results of clinical studies are reflected in the recommended guidelines—last year, for example, they led to the update of the previous 2021 guidelines. However, many patients still receive appropriate therapy with a delay, mainly due to the late diagnosis caused by the non-specific nature of CHF symptoms.

The survey among outpatient cardiologists and internists aimed to provide a more accurate view of the level of diagnosis and treatment of CHF in specialist offices. The online questionnaire included 9 questions. A total of 241 doctors, 80% of whom were cardiologists and 20% internists, completed it between May and September 2023. On average, they were caring for 1,447 patients at that time (1,490 for cardiologists, 1,262 for internists); 52% of the respondents were caring for more than 100 patients with heart failure.

Key Findings

Regardless of the specialty of the doctors involved in the survey, the largest group (38%) of their heart failure patients were those with HF with reduced ejection fraction (HFrEF). Close behind (37%) was the group of patients with HF with preserved EF (HFpEF). Among cardiologists, HFrEF patients predominated (41%), while among internists, HFpEF patients predominated (nearly 44%).

Pharmacotherapy for HFrEF, in line with the guidelines, stands on 4 pillars (angiotensin-converting enzyme inhibitors [ACEi] or angiotensin II AT₁ receptor antagonists/neprilysin inhibitors [ARNI], beta-blockers [BB], mineralocorticoid receptor antagonists [MRA], and sodium-glucose cotransporter 2 inhibitors [SGLT2i]). Of the HFrEF patients under the respondents' care, only 49.3% received it, more among cardiologists (51.5%) than internists (40.3%).

The Subgroup of Symptomatic Individuals without an HF Diagnosis

Among patients who had symptoms of heart failure but had not yet been diagnosed with it, the most common symptoms were: shortness of breath—on average 6.6% (with 59% being women), swelling—on average 4.4% (with 62% being women), and fatigue—on average 5.8% (with 62% being women).

On average, 6.4% of symptomatic individuals without an HF diagnosis had NT-proBNP values listed in their documentation, and part of them had elevated levels.

Regarding treatment strategies, these patients most frequently took ACEi or ARBs and hypolipidemic agents. Regardless of the doctor's specialty, they had an estimated glomerular filtration rate (eGFR) ≥ 90 ml/min.

Conclusion

The authors summarize their survey by noting that there is still a significant group of patients who show symptoms of heart failure but have not been diagnosed. This is despite the fact that some of these patients have elevated NT-proBNP levels. They also note that women predominate among those without a definitive diagnosis.

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Source: Málek F., Linhart A., Pudil R., Veselý J. Results of the survey “Diagnosis and Treatment of Patients with Heart Failure in Clinical Practice”. Vnitřní lékařství 2024; 70 (1): 28–34, doi: 10.36290/vnl.2024.005.