Article type
Year
Abstract
Background: One of the aims of evidence-based medicine is to systematically link a disease to a corresponding therapeutic objective(s) and treatment. In chronic heart failure one example of a therapeutic objective assessed in numerous clinical trials on ACE inhibitors is the decrease in the risk of death and hospitalization. A survey was performed in 1999 to investigate the treatments used in chronic heart failure in France. The results presented will be limited to the description of the therapeutic objectives for the use of ACE inhibitors reported by the cardiologists.
Methods: A retrospective transversal survey involved 700 French cardiologists and 4 patients with cardiomyopathy per cardiologist, over a period of 7 consecutive days. One of the questions asked for the reason(s) for the prescription of ACE inhibitors (i.e. which therapeutic objective was considered by the physician for this therapy).
Results: From the 1717 questionnaires completed, only 3% were considered as having given "appropriate" therapeutic objectives, such as an increase in life expectancy, a decrease in dyspnea or reduction in number of hospitalizations. Some of the cardiologists gave a mixture of clinical and pathophysiological therapeutic objectives (e.g. improvement of some haemodynamic parameters). The remaining 97% of the answers were considered as "non appropriate" because these dealt with the disease itself (heart failure, additional hypertension or myocardial infarction or diabetes) and / or its etiology (ischemic or non ischemic) or its severity (functional status).
Discussion and conclusions: Although the wording of the question avoided the direct use of the words "therapeutic objective", the percentage of the cardiologists who seem to understand the concept of therapeutic objective is extremely low. In therapeutics, clinical endpoints do not seem to be widely taken into account, and in our sample, pathophysiological reasoning seems to still be largely considered as sufficient justification for the basis of the prescription.
Methods: A retrospective transversal survey involved 700 French cardiologists and 4 patients with cardiomyopathy per cardiologist, over a period of 7 consecutive days. One of the questions asked for the reason(s) for the prescription of ACE inhibitors (i.e. which therapeutic objective was considered by the physician for this therapy).
Results: From the 1717 questionnaires completed, only 3% were considered as having given "appropriate" therapeutic objectives, such as an increase in life expectancy, a decrease in dyspnea or reduction in number of hospitalizations. Some of the cardiologists gave a mixture of clinical and pathophysiological therapeutic objectives (e.g. improvement of some haemodynamic parameters). The remaining 97% of the answers were considered as "non appropriate" because these dealt with the disease itself (heart failure, additional hypertension or myocardial infarction or diabetes) and / or its etiology (ischemic or non ischemic) or its severity (functional status).
Discussion and conclusions: Although the wording of the question avoided the direct use of the words "therapeutic objective", the percentage of the cardiologists who seem to understand the concept of therapeutic objective is extremely low. In therapeutics, clinical endpoints do not seem to be widely taken into account, and in our sample, pathophysiological reasoning seems to still be largely considered as sufficient justification for the basis of the prescription.