Why are heart failure treatments underused?
We surveyed a random sample of 200 primary care physicians from France, Germany, Italy, the Netherlands, and Spain, and 250 from the United Kingdom to determine their perceptions of heart failure treatment. Most physicians thought angiotensin-converting enzyme (ACE) inhibitors were effective in relieving symptoms and reducing mortality in heart failure, but many also thought these agents carried substantial risk. Despite evidence of benefit, ACE inhibitors were prescribed in only 47% to 62% of patients. These data suggest treatment decisions were dominated by perceptions of treatment risk rather than benefit.