Abstract 5911: Prescribing Barriers to Heart Failure Management in Primary Care
Heart failure (HF) guidelines support the use of ACE-inhibitors and Beta-blockers, however their use may not be optimal in the primary care setting. The CHAMP-C study was a cluster randomized trial assessing a primary care based HF management strategy. The results showed improved prescribing practices for the use of ACE-inhibitors and beta-blockers in stable community dwelling HF patients following the study intervention. We assessed the hypothesis that there are barriers to optimizing ACE-inhibitors and Beta-blockers in HF management by family physicians (FPs) participating in the CHAMP-C Study. A standardized survey of 53 FPs (n=53) from the CHAMP-C study was conducted at baseline. FPs were asked whether they were aware of and had read the Canadian Cardiovascular Society guidelines. FPs were asked whether they felt comfortable increasing the doses of ACE-inhibitors and Beta-blockers and, if not, the reasons why. FPs were asked whether they felt that increased HF specialist support could help them to better manage HF. FPs were mostly male (81%), 62% had graduated before 1985 and the average size of the practices was 2058 (SD=625). Preliminary results show that 50% of FPs were aware of the guidelines and 39% had read them. 89% of physicians were comfortable increasing the dose of ACE-inhibitors, but were unclear of the rationale and evidence for titrating up to maximum tolerated dose. 61% of physicians felt uncomfortable introducing beta-blockers and 65% felt uncomfortable increasing the dose. FPs reported ambivalence due previous practice suggesting contraindications to use of beta-blockers in HF therapy. 94% of FPs indicated that they felt that increased opportunities for interaction with a HF specialist would help improve HF management. In conclusion, although guidelines are distributed to FPs, this study shows that many remain uncomfortable introducing and titrating recommended therapies. These findings support increased interactions between HF specialists and primary care physicians.