'You need to educate and uptitrate patients, and then they can be followed by a general practitioner.'
Source DR. SCHOU
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Findings Point to Lower Costs
The results from this study show that properly treated heart failure patients on an evidence-based regimen can be effectively managed by a primary care physician. That's a very powerful and important message. In the United States, heart failure management has become a big business. But every heart failure patient cannot be managed by a cardiologist because the number of patients is increasing too quickly. In the Danish study, general practitioners got the heart failure patients after they were stabilized, and the GPs were trained in how to adjust the patients' diuretic dosages.
These results do not discount a role for heart failure disease management. Disease management works. It is important to have a specific regimen for monitoring and treating heart failure patients. But the results show that it doesn't matter who does the monitoring and treating as long as they received training in how to do it.
The results also showed that we waste time and money if we measure B-type natriuretic peptide repeatedly in heart failure patients. BNP is good for making an initial diagnosis of heart failure, to distinguish heart failure from other disorders with similar symptoms. But once an initial measure is made and the diagnosis confirmed, more BNP measurements don't add anything further. Many U.S. heart failure patients undergo serial measurements despite the lack of good evidence that this helps. Current guidelines from the Heart Failure Society of America call for only measuring BNP initially in heart failure patients, especially when the initial diagnosis is uncertain based on clinical presentation (J. Card. Fail. 2010;16:e1-e194).
PRAKASH C. DEEDWANIA, M.D., is professor of medicine at the University of California, San Francisco, in Fresno. His comments were made in an interview. He reported having no disclosures.
