Changes over time in attitudes towards the management of older patients with heart failure by general practitioners: a qualitative study

Laura Moscova (1) , Fabien Leblanc (1) , Jacques Cittee (1) , Julien Le Breton (1, 2) , Sophie Vallot (1, 3) , Julie Fabre (4, 3) , Tan-Trung Phan (1) , Vincent Renard (1, 2) , Emilie Ferrat (1, 2)

1 UPEC Médecine - Université Paris-Est Créteil Val-de-Marne - Faculté de médecine
2 U955 Inserm - UPEC - IMRB - CEPIA/"Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health" [Créteil]
3 IMRB - Institut Mondor de Recherche Biomédicale
4 HSM - Hydrosciences Montpellier

Background Underdiagnosis and undertreatment of chronic heart failure (CHF) are common in older patients, who are usually treated by general practitioners (GPs). In 2007, the French ICAGE study explored GPs’ attitudes to the management of this condition in older patients. Objectives To explore changes over time in GPs’ attitudes towards the management of CHF in patients aged ≥75 and to identify barriers to optimal management. Methods In 2015, we performed a qualitative study of 20 French GPs via semi-structured interviews and a thematic content analysis. The results were compared with the findings of a 2007 study. Results In 2015, the perceived barriers to diagnosis were the same as in 2007. Echocardiography was still the preferred diagnostic method but the GPs relied on the cardiologist to confirm the diagnosis. Many GPs were still unaware of the different types of CHF. In contrast, they reported greater knowledge of decompensation factors and the ultrasound criteria for CHF. They also prescribed a brain natriuretic peptide assay more frequently. Angiotensin-converting enzyme inhibitors and beta blockers were more strongly perceived to be core treatments. Few GPs initiated drug treatments and optimized dosages. Although patient education was never mentioned, the importance of multidisciplinary care was emphasized. Conclusion Our results evidenced a small recent improvement in the management of older patients with CHF. Appropriate guidelines and training for GPs, patient education and multidisciplinary collaboration might further improve the care given to this population.

Mots clés: aging; cardiovascular disorders; continuity of care; managed care; primary care; quality of care

Domaines: Gériatrie et gérontologie; Cardiologie et système cardiovasculaire; Santé publique et épidémiologie

Laura Moscova, Fabien Leblanc, Jacques Cittee, Julien Le Breton, Sophie Vallot, et al.. Changes over time in attitudes towards the management of older patients with heart failure by general practitioners: a qualitative study. Family Practice, 2020, ⟨10.1093/fampra/cmz033⟩. ⟨hal-03244310⟩