Clinical research study
Physician Attitudes Toward End-Stage Heart Failure: A National Survey

Preliminary data presented at the 9th annual meeting of the Heart Failure Society of America, Boca Raton, Florida, September 2005.
https://doi.org/10.1016/j.amjmed.2007.08.035Get rights and content

Abstract

Background

Despite recent improvements in medical therapies, heart failure remains a prevalent condition that places significant burdens on providers, patients, and families. However, there is a paucity of data published describing physician beliefs about heart failure management, especially in its advanced stages.

Methods

In order to better understand physician decision-making in end-stage heart failure, we used a stratified random sampling of physicians obtained from the Master File of the American Medical Association to survey cardiologists (n = 600), geriatricians (n = 250), and internists/family practitioners (n = 600).

Results

Response rate was 59.6% (highest among geriatricians). The vast majority (>90%) of respondents cited similarities between the clinical trajectory of end-stage heart failure and lung cancer or chronic obstructive pulmonary disease; however, only 15.7% stated that they could predict death at 6 months “most of the time” or “always.” Inpatient volume was a predictor of confidence in predicting mortality (odds ratio = 1.38, 95% confidence interval, 1.36-1.40). Less than one quarter of respondents formally measure quality of life. The experience with deactivation of implantable cardioverter defibrillators was limited: 59.8% of cardiologists, 88.0% of geriatricians, and 95.1% of internal medicine/family practice physicians have had 2 or fewer conversations with patients and families about this option.

Conclusions

Significant gaps in knowledge about and experience with end-stage heart failure exist among a large proportion of physicians. The growing prevalence and highly symptomatic nature of heart failure highlight the need to further evaluate and improve the way in which care is delivered to patients dying from the disease.

Section snippets

Instrument Development

Based on a literature review, information generated in focus groups, and cognitive interviews, we conducted a pilot study of internists, family practice physicians, geriatricians, and cardiologists (n = 68, response rate 38%) selected at random from the American Medical Association Master File of Physicians (www.ama-assn.org/ama/pub/category/2673.html) to examine item response and several data collection strategies. Subsequently, a random stratified sample of 1450 physicians (cardiology: 600;

Characteristics of Physician Responders

Physician characteristics are provided in Table 1. A total of 734 respondents were available for analysis, with representation from cardiologists (n = 292), internists/family practice (n = 291), and geriatricians (n = 151); the majority were male (74%). The median year of medical school graduation was 1980 for cardiologists, 1985 for geriatricians, and 1986 for internal medicine/family practice physicians.

Most respondents were primarily office-based (cardiologists 60.0%, geriatricians 61.5%, and

Discussion

End-stage heart failure is increasingly common, as the prevalence of the disease increases and the population continues to age. Despite significant advances in medical therapy and initiatives to improve compliance with evidence-based approaches, mortality remains high. Further, the increased use of implantable defibrillators may be responsible for an increase in the population potentially at risk for dying from progressive pump dysfunction rather than sudden arrhythmic death.35, 36

Acknowledgments

The authors thank the staff of the Center for Survey Research at the University of Massachusetts. We acknowledge with thanks Drs. Robert Rakel, W.R. Hazzard, and Eugene Braunwald, who provided supporting letters that accompanied the surveys.

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    Dr. Hauptman was funded by National Institutes of Health (NIH) grant RO1 AG 021515.

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