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Survey results

Surveys conducted by the Council for Cardiology Practice

Private Practice Cardiology in Europe (2012)

The ESC Council for Cardiology Practice (CCP) performed an internet-based survey on private practice cardiology in Europe in late autumn 2012.
We received 1329 answers of which, for the purposes of the survey, we excluded 191 responses from participants not working in practice, 176 responses from non-ESC member or non-Affiliate countries and 85 answers that were incomplete.

876 practicing cardiologists from 52 ESC Member or Affiliate countries completed the survey.



Country participation

As seen in Table 1 the country with the highest participation rate was Italy (114 participants). Russia, Greece, Spain and Ukraine were also among the top 5 countries.

It is of interest to note that many eastern European countries without representation in our Council* were among the most active in the survey:  Russia, Ukraine, Romania, Poland and Bulgaria.

The mean age of responders was 48 and 28 % of them were female.  The percentage of female cardiologists varies much between countries with more female cardiologists in practice in Eastern Europe (see Table 1).

* We would like to remind our readers that is easy for a country to become a member of CCP. Please contact councils@escardio.org for information.

Percentage of working time spent in practice

The practicing cardiologists represent  a group with wide experience:  61% of participants had more than 10 years of practice after having received their cardiology certification. 

The proportion of work done in the cardiology practice and in hospitals varies:  38% reported that they worked at least 90% of their time in office practice whereas 31 % spent less than 50% of their working time in their practice.

This also differs between countries (as shown in Table & Graph 2) depending on differences in the organization of specialized health care. In some countries most cardiologists work part time in their office and part time in non-academic or in university hospitals whereas in many countries this combination is more uncommon or regulatorily forbidden.

Patients average age and main disease category

The participating cardiologists were requested to characterize the patients who consulted on the day of the survey by age and by main disease category.

  • The mean age of patients seen that day was 57 years
  • 53% were male
  • 28 % were aged 70 and above.

As shown in Table & Graph 3 the five most frequent symptom/disease groups were evaluation of chest pain, hypertension,  known coronary artery disease and atrial fibrillation.

Diagnostic procedures

A total of 534 cardiologists also gave information about the diagnostic procedures performed on the survey day.

As shown in Table & Graph 4 the vast majority performs standard out-patients procedures like ECG, Exercise ECG, Transthoracic Echo, Holter ECG and ambulatory BP monitoring. 

More specialized procedures like Stress ECHO, Cardiopulmonary Exercise testing, Tilt Table Testing and Body Box testing were done by a significant proportion.

This shows that the practicing cardiologists in many countries perform advanced procedures often thought of as belonging to hospital based cardiology.

New echocardiographic techniques

Newer echocardiographic techniques are also being adopted by practicing cardiologists:

  • Use of TDI to obtain E/e’ was reported by 2/3 of the participants
  • 2-D speckle strain was used by one in four participants
  • 3-D echo was used by one in five participants

ESC Congresses

Continued medical education is of prime importance and we also asked whether they had attended the last ESC congresses. Of the 867 cardiologists 35% had attended either ESC Congress 2011 or ESC Congress 2012.

The cost of congress, travel and accommodation was:

  • sponsored totally by industry for 50% of the participants
  • sponsored partly by industry for 12%
  • paid on their own budget for 34%
  • funded by their employer/hospital for 4%. 

Conclusion

This survey has brought important information regarding European cardiologists working in out-of hospital offices.  In a future “borderless” Europe also regarding cardiology practice, such information is crucial to describe similarities and differences between the ESC countries regarding cardiology office practice.

The ESC Council of Cardiology Practice will continue to develop targeted surveys to describe the working conditions and the work done by practicing cardiologists. 


Table 1. Number of answers to the survey by country

 

AnswersFemale AnswersFemale

Italy

114 23%

Georgia

 9 22%

Russia

85 55%

Sweden

 9 33%

Greece

 65 15%

Armenia

 8 50%

Spain

 51 12%

Latvia

 8 75%

Ukraine

 40 53%

Switzerland

 8 13%

Romania

 39 62%

Slovakia

 7 14%

Poland

 35 29%

Finland

 6 17%

Germany

 33 9%

Kosovo

 5 0

Belgium

 30 13%

Macedonia,F.Y.R

 5 20%

Portugal

 29 34%

Slovenia

 5 40%

France

 28 11%

Albania

 4 67%

Bulgaria

 23 39%

Azerbaijan

 4 5%

Egypt

 22 23%

Belarus

 4 50%

Austria

 19 10%

Kazakhstan

 4 25%

Czech Rep.

 16 25%

Iceland

 3 0

Turkey

 15 7%

Ireland

 3 0

Netherlands

 14 14%

Lebanon

 3 0

Norway

 14 0

Syria

 3 0

Serbia

 14 43%

Estonia

 2 100%

Hungary

 13 8%

Libya

 2 0

United Kingdom

 13 15%

Algeria

1 0

Bosnia and Herzegovina

 12 17%

Denmark

1 0

Israel

 12 17%

Luxembourg

1 0

Lithuania

 12 75%

Moldova

1 0

Cyprus

 11 18%

Morocco

1 0
       Total answers  876  



Table 2. Percentage of working time spent in practice

 % time spent % time spent % time spent
Norway

95%

Hungary

68%

Austria

59%

Netherlands

90%

Bulgaria

66%

Spain

58%

Germany

85%

Ukraine

65%

Israel

54%

France

79%

Romania

64%

Lithuania

47%

Czech Rep.

77%

Italy

63%

Poland

35%

Greece

70%

Egypt

60%

       
Russia 

69%

Portugal

59%

   


Graph Working time spent in practice

 

 

 

 

 

 

 

 

 

 

 

 

Table 3. Main symptom/disease groups for patients seen on the day of survey

 Number of patients 
Chest pain evaluation

1548

14,3%

Evaluation for hypertension

1523

14,0%

Known CAD, evaluation

1303

12,0%

Atrial Fibrillation

 992

9,1%

Palpitation (not AF) 

 820

7,6%

Control of known heart failure 

 735

6,8%

Asymptomatic CAD risk evaluation 

 673

6,2%

Evaluation of dyspnoea, shortness of breath  

 606

5,6%

Control of known valvular heart disease 

 557

5,1%

Murmur evaluation 

 430

4,0% 

INR control

 323

3,0%

Cardiomyopathies 

320

3,0%

Pacemaker evaluation 

 286

2,6%

Syncope 

 257

2,4%

Other

 249

2,3%

Peripheral Artery Disease 

 146

1,3%

Pericardial disease

  76

0,7%

 Total number of patients

 10844

 


 

Graph Symptoms on survey day

 

 

 

 

 

 

 

 

 

 

 

 

Table 4. Procedures performed by the participating cardiologists (534 answers)

 Performed regularlyPerformed on day of survey
ECG

97%

93%

Transthoracic Echo

91%

76%

Holter ECG

88%

55%

Exercise ECG

86%

52%

Ambulatory BP monitoring

83%

43%

Trans Oesophageal Echo

52%

13%

Stress Echo Physical 

51%

18%

Dobutamine Stress Echo 

47%

9%

Spirometry

40%

16%

Tilt Table Testing

34%

7%

Cardiopulmonary Excercise testing (CPX) 

29%

8%

Sleep apnea analysis 

28%

7%

Body Box Testing 

21%

6%

Graph Procedures performed


 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Council for Cardiology Practice thanks everyone who participated in this survey