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SURVEY SHOWS STRENGTHS, WEAKNESSES OF HEART FAILURE CARE; CARE IS GENERALLY GOOD, YET SOME PROVIDER EDUCATION IS NEEDED

 /ADVANCE/ NEW YORK, Sept. 29 /PRNewswire/ -- At a time when the number of hospitalizations and deaths due to heart failure are rising, it appears that some physicians may not be offering their patients optimal treatment, according to a new survey released today at an American Medical Association media briefing.
 "We may have a potential information gap," said Michael J. Horan, M.D., Sc.M., director of the Division of Heart and Vascular Diseases at the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Md.
 Heart failure is the inability of the heart to keep up its work load of pumping blood to the lungs and to the rest of the body. Congestive heart failure (CHF) affects over 3 million Americans; more than 50 percent of whom die within five years of diagnosis. Each year, there are 400,000 new cases of CHF and more than 300,000 related deaths. While death rates due to other coronary diseases have decreased, experts expect to see more CHF patients as the nation's population ages.
 The phone survey assessed the practice patterns and knowledge of CHF management and diagnosis of specialists and primary care physicians who treat patients with congestive heart failure; it included 257 cardiologists, 132 internal medicine specialists (IMs), and 119 general practitioners/family practitioners (GPs/FPs). Horan presented the results at the briefing.
 "Physicians in general appear to be on the right track," he said. "For example, the majority of physicians responding were aware of the benefits of using ACE inhibitors to treat CHF." Angiotensin-converting enzyme inhibitors are vasodilators, drugs which widen blood vessels, making it easier for a weakened heart to pump blood.
 He said, however, that cardiologists rely more heavily on ACE inhibitors than IMs and GPs/FPs (90 percent, 87 percent and 84 percent, respectively), particularly when treating patients who have had heart attacks. Additionally, IMs and GPs/FPs tended toward similar treatment approaches for all their CHF patients, while cardiologists individualized treatment for each patient.
 He noted, however, that 17 percent of all physicians reported using calcium channel blockers with their CHF patients. "We now know you should not use a calcium channel blocker in most cases," he said. "If you're a patient with CHF, and your physician has you on a calcium channel blocker, you want to ask him or her about it."
 In the diagnosis of CHF, cardiologists reported using more echocardiograms while IMs and GPs/FPs tended to rely more on chest X-rays for their diagnosis. Cardiologists used echocardiograms 87 percent of the time and chest X-rays 66 percent of the time. IMs used X-rays 80 percent of the time and echocardiograms 75 percent of the time; for GPs/FPs, it was 80 percent and 62 percent, respectively.
 While chest X-rays are important, Horan said they are unable to provide some information necessary to treat CHF. "If you're seriously going to treat heart failure, you need to get a handle on ejection fraction," the amount of blood the heart squeezes out when pumping, he said. Chest X-rays cannot determine ejection fraction, while echocardiograms can. He added that some other tests can also assess ejection fraction, and the choice of test depends on a given patient's condition.
 Horan said the differences in the way these various physicians diagnosed and treated CHF and the fact that the syndrome is not completely understood necessitates "a more aggressive biomedical research effort." He added, however, that new information needed to be made available in "user friendly ways" and that the information needed to be disseminated as widely as possible.
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 /NOTE TO EDITORS: Michael J. Horan, M.D., Sc.M., of NHLBI, can be reached at the NHLBI press office at 301-496-4236/
 /CONTACT: Paul Tarini of AMA, 312-464-5945/


CO: American Medical Association ST: New York IN: HEA SU:

SH-TW -- NY014 -- 6709 09/29/93 09:58 EDT
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