Pilot survey of the diagnosis and management of heart failure in primary care: A Singaporean perspective

Abstract

Introduction: The diagnosis and management of congestive heart failure at the primary care level is difficult. Despite advances in medical therapy, namely angiotensin-converting enzyme inhibitors and β-blockers, congestive heart failure remains a common cause of hospital visits. The extent to which these advances have been implemented in primary care is uncertain. We therefore sought to assess current practice patterns of primary care physicians and identify obstacles to optimal diagnosis and management of congestive heart failure in Singapore. Materials and Methods: Telephone interviews of 100 primary care physicians using structured questionnaires. Results: Primary care physicians diagnose congestive heart failure based on the presence of breathlessness (92.5%), lung crackles (52.5%), peripheral oedema (55.0%) and findings on chest radiography (76.8%). Only 1 in 3 mentioned raised jugular venous pressure as a useful diagnostic sign. Echocardiography was not commonly obtained (5%), mainly due to inaccessibility. While many (47.5%) were aware of the importance of angiotensin-converting enzyme inhibitors, few (16.2%) knew of the impact of β-blockers on morbidity and mortality. Instead, diuretics were thought to be most important for prolonging survival in congestive heart failure (47.5%). The main obstacle to widespread angiotensin-converting enzyme inhibitors usage was dry cough. Patient compliance (57.5%) and cost (82.5%) were the main obstacles to optimising care. Conclusions: Local primary care physicians diagnose congestive heart failure using non-specific symptoms and signs. Obstacles to optimal congestive heart failure management were identified. We hope our results will lead to strategies to improve patient care.