Survey of Primary Care Physicians Perception on Diagnosis and Management of Congestive Heart Failure in Lagos, Nigeria.

Abstract

Purpose: To evaluate the perception of primary care physicians on diagnosis and management of congestive cardiac failure in Lagos, Nigeria
Method: A slightly modified questionnaire used in the Euro-F study was distributed to primary care physicians in randomly selected hospitals in randomly selected local government in the Lagos metropolis.
Result: Response rate to the questionnaire was 50%. There was poor (25%) record keeping of heart failure patients among the group. The commonest symptoms used by the primary care physicians for diagnosis were pedal swelling (74%). The favored signs were pedal oedema (62%) and basal crepitations (39%). There was poor knowledge of symptoms when these were categorized using the Framingham criteria. Only 32% knew two major criteria and less than 50% knew three minor criteria. Majority of the diagnosis of heart failure was based on symptoms and signs, (62.91± 29.57), with minimal reliance on investigation, (12.58± 20.75). Commonest investigations performed were electrocardiogram, (75%) and chest X-ray (91%). The use of echocardiography was quite low in this study (16%). There was poor knowledge regarding ACE-inhibitor use, (32.82± 37.54) and adequate doses. The knowledge about the beneficial effects of ACE inhibitors on symptom relief (37%) and reduction in mortality (42%) was poor. The knowledge about the use of b-blockers in heart failure was also poor. Majority of the physicians favoured use of diuretics and cardiac glycosides. They had correct knowledge about their effects on symptom relief, diuretics, (80%) and cardiac glycosides (72%). They wrongly asserted that mortality is reduced with diuretics, (61%) and cardiac glycosides (65%).
Conclusion: There is poor knowledge among the primary care physicians as regards diagnosis and the management of congestive cardiac failure. Continuing medical education is therefore of paramount importance for these physicians in view of the importance of this disease entity and rapid emergence of new information in all aspects of heart failure.


Keywords: Primary care Physicians, Diagnosis, Management, Heart failure.

NQJHM Vol. 14 (2) 2004: pp. 130-135