Communication disconnect concerning erectile dysfunction in male heart failure patients: cardiologists and GPs need to talk about sex
Authors: Wehrmann L , Hausmann L , Pohlink C 
Published: October 2022

Abstract

Background
Heart failure (HF) and erectile dysfunction (ED) share risk and pathogenetic factors manifesting in a higher prevalence of ED in male HF patients. Despite being a recognized comorbidity, scientific research in this field is limited.

Purpose
This research aims to better understand the patient journey from a patients' as well as health care professionals' (HCP) perspective in terms of communication, education and ED treatment as recognized concomitant disease in HF patients.

Methods
Data was collected using two independent online surveys between Nov 21 and Jan 22 from diagnosed male HF patients (N=927) and HCPs including general practitioners (GP), cardiologists and internists (N=78) on quality of life (QoL) with focus on sexual life. As part of the patient survey, male HF patients with ED (N=176) were asked to provide further information about their experiences and ED-related communication with HCPs.

Results
Male HF patients reported their sexual life as being important (56%*) and their sexual health impacting QoL, with 43% of all men asked (N=927) being unsatisfied with their sexual life.
Focusing on HF patients with ED (N=176), half was not aware of the link between HF and ED. Only 33% of male HF patients stated that they were informed about a potential link by their HCP, equally distributed to GPs, cardiologists and urologists. HCPs in turn reported that only 20% of their patients proactively consult them, but the majority of male HF patients with ED (69%) stated that they feel left alone and wish for more personal exchange regarding the topic of ED with a doctor (74%).
HCPs reported awareness of strong ED burden in 70% of their male HF patients. In contrast to the patients' perspective, 56% of HCPs report that they do address the topic of ED to their HF patients. Top ranked reason for not addressing the topic of ED from HCP side were the assumption and/or knowledge that patients feel uncomfortable talking about ED. Interestingly, only 7% of male HF patients with ED indeed indicated feeling uncomfortable.
Despite their pronounced sexual dissatisfaction only 40% of male HF patients with ED indicated that they talk to a doctor about ED treatment options. In consequence, only 22% of them take prescription drugs. More frequently, HCPs reported that about one third of their patients are non-compliant with HF medication due to ED highlighting the high importance of sexual health for patients' QoL.

Conclusions
We identified a communication disconnect between HCPs and HF patients regarding ED. As patients' QoL is strongly affected by sexual health, they wish for more personal exchange and information. There is a strong need to proactively address the topic of ED by cardiologists and GPs as the first point of contact for HF patients. New ideas for tools generating a better understanding and more confident conversations about HF and ED are warranted.
*On a scale from 1 = “not important” to 10 = “very important” rated ≥7.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH