Hungarian results of the IMPROVEMENT HF European survey on the everyday diagnostics and treatment of heart failure: Comparison of European and Hungarian data
Préda I., Cleland JGF., Cosin-Aguilar J., Cohen-Solal A., Dietz R., Follath F., Freemantel N., Gavazzi A., Hobbs R., Korewicki J., Madeira H., Swedberg K., Van Gilst W., Widimsky J.
The Working Group on Heart Failure of the European Society of Cardiology published guidelines on diagnosis and treatment of heart failure in 1995, 1997 and 2001. The IMPROVEMENT HF Study, examining a set of data obtained by 1363 family care physicians and 11.062 patients suffering in (or suspected of) heart failure, was primarily focused on a survey of the perception of the diagnostic signs and symptoms of heart failure and the real treatment of the patients suffering in heart failure. Hungary participated in the study with 98 familiy care physicians in 12 investigation centers. The mean age of the European patients was 70± 12 years, which was 66± 10 years in the cases of the Hungarian participants. The Hungarian patients had hypertension (60%), diabetes mellitus (28%) and previous myocardial infarction (40%), exceeding thus in all aspects the European mean values of the cohort. Both ECG and echocardiographic diagnostic examinations were extensively used in Hungary in diagnosing heart failure, and the recognition of diastolic and systolic left ventricular dysfunction signs is one of the best in Europe. Similarly, the functional classes of heart failure based on the New York Heart Accociation classification is also well known among the family practitioners in Hungary. The modern trends in the treatment of chronic heart failure, with a special regard to the angiotensine convertase enzyme inhibitors and beta receptor blockers were also wide spread during the study period (1999-2001) in Hungary. In spite of that, the mean daily therapeutic dose of angiotensine convertase enzyme blockers did not reach the required dose, only prindopril, bearing a long lasting therapeutic plasma level, approached the daily target dose. It is a special succes, that the Hungarian incidence of the combined angiotensine convertase inhibitor and beta receptor blokker therapy was the highest (44%) among the European countries. The International Study Group on Heart Failure of the Working Group of the European Society of Cardiology considers that the individual differences in perception and also in treatment in the European countries may be the consequence of the differtent structures in medical education and postgraduate teaching, and also of the differences in health care expenses. However, differences in the organization of health care may also be important.