Nonpharmacologic Care by Heart Failure Experts

Background: Nonpharmacologic clinical management practices have not been studied widely in heart failure (HF). The purpose of this survey was to describe the practices of self-identified experts in HF to identify: topics with uniformity of practice (> or =75% agreement) and topics with variability in practice (no uniformity and 2 or more choices endorsed by >/=10% of respondents).

Methods And Results: An online survey of members of the Heart Failure Society of America (HFSA) actively engaged in clinical practice was conducted in Fall 2004. A total of 347 of the 1420 HFSA members in clinical practice (24.4%) responded to the survey. Of these, 321 completed the survey and 290 (90.3%) identified themselves as experts in HF. Areas in which there appears to be variability in practice include advising patients about: (1) sodium-restricted diet; (2) alcohol; (3) sexual activity; (4) increased swelling or weight gain, including use of a flexible diuretic regimen; and (5) palliative care. Providers vary in their treatment of risk factors and comorbid illnesses, the attention given to subtle losses of weight over time, beliefs about treatment adherence and ways to improve it, and opinions about the most important areas for patient education, and beliefs about health literacy.

Conclusion: Research on which to base advice for HF patients is greatly needed.