Buradasınız

Kalp yetersizliği tedavi kılavuzlarına uymada kardiyologlar ile iç hastalıkları uzmanları arasındaki farklılıklar

The differences between cardiologists and internal medicıine physicians in adherence to heart failure guidelines

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
There are now a number of guidelines outlining the diagnosis and management of patients with chronic heart failure. The extend to which these guidelines are used and the effects on patient outcomes are not well known. This study was done to examine the implementation of a heart failure guideline among cardiologist and internal medicine physicians in a state hospital setting. Treatment protocols of 256 patients (cardiology :148 patients and internal medicine: 108 patients) hospitalized for heart failure treatment in İsparta State Hospital were examined. Cardiologists had used more ACEi (%79 vs. %69, p<0.05) and spironolactone (%57 vs. %22, p<0.05) than internal medicine physicians. On the other hand internal medicine physicians had used more aspirin (%55 vs. %26, p<0.05) than cardiologists. Our findings has demonstrated that implementation of treatment protocols in heart failure guideline remains inadequade.
Abstract (Original Language): 
Günümüzde kronik kalp yetmezliğinin teşhis ve tedavisini ele alan çok sayıda kılavuz bulunmaktadır. Klinik uygulamada hangi düzeyde bu kılavuzlara uyulduğu ve bunun hasta prognozuna etkisi bilinmemektedir. Bu çalışma, bir devlet hastanesi düzeyinde kardiyolog ve iç hastalıkları uzmanlarının kalp yetmezliği kılavuzlarındaki önerileri ne ölçüde uyguladıklarını araştırmak amacıyla yapıldı. İsparta Devlet Hastanesi'nde kalp yetmezliği tanısıyla yatan 256 hastanın (Kardiyoloji Kliniğinde 148, İç Hastalıkları Kliniğindel08 hasta) tedavi protokolleri incelendi. Kardiyologlar anjiyotensin konverting enzim inhibitörlerini (ACEi) (%79'a karşın %69, p<0.05) ve spironolakton'u (%57'e karşın %22, p<0.05) iç hastalıkları uzmanlarından daha fazla kullanmışlardı. Buna karşılık, iç hastalıkları uzmanları daha fazla aspirin kullanmışlardı (%45'e karşın %26, p<0.05). Bulgularımız, kalp yetmezliği kılavuzundaki tedavi protokollerine uyumun yetersiz olduğunu göstermektedir.
32-34

REFERENCES

References: 

1. Anderson G. Implementing pratice guidelines. Can Med Assoc J 1993; 148: 735-753.
2. Lomas J, Anderson GM, Domnick - Pierre K, Vayda E, Enkin MW, Hannah WJ. Do practice guidelines guide pratice? The effect ofa consensus statement on the pratice ofphysicions. N Engl J Med 1989; 321: 1306-1311.
3. Lee TH, Pearson SD, Johnson PA, Garcia TB, Weisberg MC, Guadagnoli E. Failure ofinformation as an intervetion to modifiy clinical management; a time -series trial in patients with acute chest pain. Ann Intern Med 1995; 122: 434-437.
4. Hunt S, Baker DW, Chin MH, Cinguegrani MP, Feldman AM, Francis GS et al. ACC/AHA guidelines for the evaluation and management ofchronic heart failure in the adult: J Am Coll Cardiol 2001; 38: 2101¬2113.
5. Task Force for the diagnosis and treatment ofchronic heart failure, European Society of Cardiology. Guidelines for the diagnosis and treatment ofchronic heart failure. Eur Heart J 2001; 22: 1527-1560.
6. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results ofthe Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) N Eng J Med 1987; 316: 1429-35.
7. The SOLVD investigators. Effect of enalapril on survial in patients with reduced left venticular ejection fractions and congestive heart failure. N Engl J Med 1991; 325:
293-302.
8. CIBIS-II investigators and Committees. The Cardiac insufficiency Bisoprolol Study II (CIBIS-II); a randomised trial. Lancet 1999; 353: 9-13.
9. Merit - HF Study Group. Effect ofmetoprolol CR/XL in chronic heart failure; Metoprolol CR/XL Randomised intervation trial in congestive heart failure (MERİT-HF). Lancet 1999; 353: 2001-7.
10. Packer M, Bristow, MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM et al. The effect ofcarvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J. Med 1996; 334: 1349-55.
11. Packer M, Coats Aj. Fowler MB, Katus HA, Krum H, Mahaesi P et al. Effect ofcarvedilol on survival in severe chronic heart failure. N Engl J Med. 2001; 344:
1651-8.
12. Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldoctone Evaluation Study. N Engl J Med. 1999; 341: 709-17.
13. Clarke KW, Gray D, Hampton JR. Evidence of inadequate investigation and treatment on patients with heart failure. Br Heart J 1994; 71: 584-7.
14. Whelldon NM, Mc Donald TM, Flucker CJ. Echocardiography in chronic heart failure in community. QuardJMed 1993; 86: 17-23.
15. Horan M, Barrett F, Molqueen M, Maurer B, Quiglay P, Mc Donald KM. The basics ofheart failure monogement are they being ignored? Eur J Heart Fail 2000;2: 101-105.
16. Mc Kee SP, Leslie SF, Le Maitre JP, Webb DJ, Denva MA. Management of chronic heart failure due to systolic lefts verticular dysfunction by cardiologist and non cardiologist physicians. Eur J Heart Fail 2003; 5:
549-555.
17. Cabona MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abbout PA. Why don't physicions follow clinical pratice guidelines? A framework for improvement. JAMA 1999; 282: 1458-1465.

Thank you for copying data from http://www.arastirmax.com