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Awareness of indications for device therapy among a broad range of physicians: a survey study
- Source :
- EP Europace. 16:1580-1586
- Publication Year :
- 2014
- Publisher :
- Oxford University Press (OUP), 2014.
-
Abstract
- Aims Cardiac resynchronization therapy (CRT) and primary prophylactic implantable cardioverter-defibrillators (ICDs) are underutilized in heart failure (HF). This may originate from an unawareness of device benefits and indications among physicians responsible for HF care and referral. We aimed to describe the awareness of indications for device therapy in a generalized sample of Swedish physicians. Methods and results A randomly selected sample of Swedish physicians specializing in cardiology, internal medicine, and family medicine and interns (5% of eligible physicians, n = 519) was invited to fill in a 23-item survey, testing their awareness of indications for device therapy and, as comparison, pharmacological therapy. Acceptable awareness (AA) of CRT indication was predefined as recognizing that a left bundle branch block on ECG warrants further evaluation for CRT. Acceptable awareness of ICD indication was predefined as recognizing that ejection fraction ≤35% alone, without a history of ventricular tachycardia, is sufficient to warrant a primary prophylactic ICD. The response rate was 37% ( n = 168). Overall, 32% met AA of CRT indication, and significantly less (15%) met AA of ICD indication. Specialist certification in cardiology was the only significant predictor for AA [odds ratio (95% confidence interval): 37 (10–138)]. However, even among cardiologists, awareness of ICD indications was low (61% with AA). Guideline-recommended indications for pharmacological therapy were conceived significantly better ( P = 0.02) than device therapy [median (interquartile range) of correct answers: 50% (33–50) compared with 36% (14–57)]. Conclusions The study identified an important and substantial awareness gap in the medical community that may explain some of the previously reported low referral rates and utilization of device therapy in HF.
- Subjects :
- Adult
Male
Health Knowledge, Attitudes, Practice
medicine.medical_specialty
Referral
Attitude of Health Personnel
medicine.medical_treatment
Electric Countershock
Cardiac resynchronization therapy
Eligibility Determination
Cardiac Resynchronization Therapy
Interquartile range
Physicians
Surveys and Questionnaires
Physiology (medical)
medicine
Humans
Cardiac Resynchronization Therapy Devices
Practice Patterns, Physicians'
Referral and Consultation
Heart Failure
Sweden
Response rate (survey)
business.industry
Odds ratio
Awareness
Middle Aged
medicine.disease
Implantable cardioverter-defibrillator
Confidence interval
Defibrillators, Implantable
Primary Prevention
Death, Sudden, Cardiac
Health Care Surveys
Heart failure
Practice Guidelines as Topic
Emergency medicine
Female
Guideline Adherence
Medical emergency
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15322092 and 10995129
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- EP Europace
- Accession number :
- edsair.doi.dedup.....0901b033a8a4d527ee5f82429aeb8a3b