Key result
GP heart failure training improves six-minute walk distance by ~28 meters despite unchanged medication uptake.
Why the study?
Does training general practitioners in optimizing drug treatment improve medication use and functionality in newly detected heart failure patients?
RCT (n=92)
Cluster randomized
Yes
Does training general practitioners in optimizing drug treatment improve medication use and functionality in newly detected heart failure patients?
A half-day training program for general practitioners on heart failure medication optimization did not increase medication uptake but was associated with improved functional capacity and more HF-related GP visits.
Half-day GP training did not increase HF medication uptake; leaves open whether modest walking-distance gains merit larger trials before practice change.
OBJECTIVE: To assess the effect of training general practitioners (GPs) in the optimization of drug treatment for newly detected heart failure (HF). DESIGN: Cluster randomized trial comparing the training programme to care as usual. PARTICIPANTS: Community-dwelling older persons with a new HF diagnosis after diagnostic work-up. METHODS: Thirty GPs were randomized to care as usual or the training. Sixteen GPs of the latter group received a half-day training on optimizing HF medication in HF patients with a reduced (HFrEF), or with a preserved ejection fraction (HFpEF). At baseline and after six months of follow-up, the 46 HF patients in the intervention group and the 46 cases in the care as usual group were assessed on medication use, functionality, health status, and health care visits. RESULTS: After 6months, uptake of HF medication and health status were similar in the two groups. Interestingly, patients in the intervention group had a longer walking distance with the six-minute walk test than those in the care as usual group (mean difference in all-type HF 28.0 (95% CI 2.9 to 53.1) meters; HFpEF patients 28.2 (95% CI 8.8 to 47.5) meters and HFrEF patients 55.9 (95% CI -16.3 to 128.1) meters). They also had more HF-related GP visits (RR 1.8, 95% CI 1.3 to 2.5) and fewer visits to the cardiologist (RR 0.6, 95% CI 0.3 to 1.1). CONCLUSIONS: Training GPs in optimization of drug treatment of newly detected HFrEF and HFpEF did not clearly increase HF medication, but resulted in improvement in walking distance.
No takes yet. Share an insight, caveat, or question.
Riet et al. (2016) conducted an RCT in Newly detected heart failure (n=92). Training general practitioners in optimization of drug treatment vs. Care as usual was evaluated on Six-minute walk test distance (MD 28.0, 95% CI 2.9 to 53.1). Training general practitioners in heart failure drug optimization did not increase medication uptake but improved patient six-minute walk distance (mean difference 28.0 meters; 95% CI 2.9-53.1).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: