Cardiology

May 2014

FocusCardiology

Cardiomyopathy

Volume 43, No.5, May 2014 Pages 253-253

Janice Charles

Allan J Pollack

Graeme C Miller

Cardiomyopathy is a disease that causes the heart muscle to become weak and ineffective, reducing the heart’s ability to pump blood through the body and possibly leading to heart failure.1 The rate at which cardiomyopathy was recorded by general practitioner (GP) participants in the BEACH program has not changed significantly since 2000. On average, it was managed at 0.9 per 1000 encounters between April 2000 and March 2013, a total of 1175 times over that period. In 9 out of 10 cases, GPs used the general term cardiomyopathy, whereas in the other 10% this was specified as hypertrophic, congestive, secondary or restrictive.

Male patients were three times more likely than female patients, and patients aged ≥45 years were seven times more likely than younger patients to have cardiomyopathy managed (Figure 1). The most common other problems managed with cardiomyopathy were diabetes, atrial fibrillation and hypertension.

Figure 1. Cardiomyopathy: Rate per 1000 encounters (95%CI)

Figure 1. Cardiomyopathy: Rate per 1000 encounters (95%CI)

Management of cardiomyopathy

There were 115 medications recorded per 100 cardiomyopathy problems, which is a higher rate than average for all encounters in BEACH (69 per 100 problems). Frusemide and carvedilol were each recorded at a rate of 17 per 100 cardiomyopathy problems managed. Other treatments were recorded at a rate of 21 per 100 cardiomyopathy problems managed, lower than the average rate of 35 per 100 total problems. They comprised clinical treatments, almost all of which were counselling or advice and procedures, the most common of which were INR tests at point of care. Referrals were provided at a rate of 11 per 100 cardiomyopathy problems and most were to cardiologists. Pathology tests were ordered often (40 per 100 cardiomyopathy problems), but imaging orders were infrequent (Table 1). Cardiomyopathy is one of the less commonly managed problems in general practice and the management rate has remained steady over the past 13 years.

Table 1. Treatments for cardiomyopathy
TreatmentNumber of treatmentsRate per 100 cardiomyopathy problemsProportion of each treatment type (%)

Medications
Frusemide
Carvedilol
Warfarin
Perindopril
Ramipril

1351
202
194
116
87
82

115.0
17.2
16.5
9.9
7.4
7.0

100.0
15.0
14.4
8.6
6.4
6.1

Other treatments
Advice medication
Counselling
INR tests

251
41
40
22

21.4
3.5
3.4
1.9

100.0
16.3
15.9
8.8

Referrals
Cardiologist

131
112

11.1
9.5

100.0
85.5

Pathology tests
EUC
Full blood count
Coagulation

471
89
72
71

40.1
7.6
6.1
6.0

100.0
18.9
15.3
15.1

Imaging
Echocardiography

45
29

3.8
2.5

100.0
64.4

Acknowledgements

The authors thank the GP participants in the BEACH program, and all members of the BEACH team. Funding contributors to BEACH from April 2000 to March 2013: Australian Government Department of Health and Ageing; AstraZeneca Pty Ltd (Australia); CSL Biotherapies Pty Ltd; Merck, Sharp and Dohme (Australia) Pty Ltd; National Prescribing Service; Novartis Pharmaceuticals Australia Pty Ltd; Pfizer Australia Pty Ltd; Abbott Australasia Pty Ltd; Janssen-Cilag Pty Ltd; Sanofi-Aventis Australia Pty Ltd; GlaxoSmithKline Australia Pty Ltd; Bayer Australia Ltd; Wyeth Australia Pty Ltd; and Roche Products Pty Ltd. BEACH is approved by the Human Research Ethics Committee of the University of Sydney. Authors

Competing interests: None.
Provenance and peer review: Commissioned; not peer reviewed.

References

  1. National Institutes of Health. What is cardiomyopathy? Available at www.nhlbi.nih.gov/ health/health-topics/topics/cm/ [Accessed 11 April 2014].

Correspondence afp@racgp.org.au

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Article Series

BEACH

Type

Focus

2014