Awareness, Diagnostic Approaches, and Management of Heart Failure in Korea: A Nationwide Survey Comparing Primary Care Physicians and Cardiology Specialists

Figures

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  Figure 1. Perceptions of heart failure risk, prognosis, and economic burden. (A) Responses to the question “What do you think is the probability of developing heart failure in adults after age 40?” (B) Responses to the question “ What do you think is the correct one-year mortality rate for patients discharged after hospitalization due to worsening heart failure?” (C) Responses to the question “What do you think is the correct one-year readmission rate for patients discharged after hospitalization due to worsening heart failure?” (D) Responses to the question “If you are hospitalized for acute heart failure, what do you think is the average medical cost per hospitalization? (Including both the patient’s out-of-pocket payment and the insurance coverage)” HF = heart failure; PCP = primary care physician.

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  Figure 2. HF phenotype and Korean HF guideline awareness. (A) Responses to the question “How many percent of heart failure patients have preserved ejection fraction?” (B) Responses to the question “In 2016 and 2017, national guidelines for chronic and acute heart failure were developed and published. Are you aware of this?” (C) Responses to the question "Have you ever attended or read lectures on the heart failure guidelines?” HF = heart failure; HFpEF = heart failure with preserved ejection fraction; PCP = primary care physician.

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  Figure 3. Etiology and clinical presentation of HF. (A) Responses to the question “What are the three most common etiologies of heart failure among the patients you are currently treating?” (B) Responses to the question “What are the three most important symptoms and/or signs that you consider suggestive of heart failure?” HF = heart failure; PCP = primary care internal medicine physicians; JVP = jugular venous pressure.

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  Figure 4. Diagnostic investigations and approaches for HF. (A) Responses to the question “Which tests do you currently perform for the diagnosis of heart failure?” Comparison of diagnostic approaches for heart failure in PCPs (B) and cardiology specialists (C). HF = heart failure; PCP = primary care physician; ECG = electrocardiogram; BNP = brain natriuretic peptide; NT-proBNP = N-terminal pro-brain natriuretic peptide.

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  Figure 5. Frequency of prescribing medications for HFrEF patients. (A) PCPs and (B) cardiology specialists. HFrEF = heart failure with reduced ejection fraction; PCP = primary care physician; ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor-neprilysin inhibitor.

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  Figure 6. Choice of RAS blocker and beta-blocker agents for HFrEF patients. (A) Preferred RAS inhibitor class (ACE inhibitor vs. ARBs). (B) Preferred medicine among ACE inhibitors. (C) Preferred medicine among ARBs. (D) Preferred medicine among beta-blockers. RAS = renin-angiotensin system; HFrEF = heart failure with reduced ejection fraction; ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; PCP = primary care physician.

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  Figure 7. Barriers to GDMT and utilization of advanced HF therapies. (A) Barriers to ACE inhibitor prescription in HF patients. (B) Barriers to beta-blocker prescription in HF patients. (C) Barriers to diuretics prescription in HF patients. (D) Performance of device therapy and volume of advanced HF procedures per year. GDMT = guideline-directed medical therapy; HF = heart failure; ACE = angiotensin-converting enzyme; PCP = primary care physician; ICD = implantable cardioverter-defibrillator; CRT = cardiac resynchronization therapy; ECMO = extracorporeal membrane oxygenation; Tx = transplantation; LVAD = left ventricular assist device.