Table 1.

Perceived internal and external barriers for prescribing ACE-I for CHF, divided in literature-based and self-reported barriers (N = number of GPs reporting barrier)

	Literature-based barriers	N	Self-reported barriers	N
Internal	Do not agree with: I believe that the standard therapy for new CHF patients should be an ACE-I, irrespective of the severity of the disease	1
	I believe that the standard therapy for known CHF patients should be an ACE-I, irrespective of the severity of the disease	2
	I believe that ACE-I should be prescribed in as high a dose as possible for CHF patients	2
	Agree with: I believe one should be reserved in prescribing ACE-I to CHF patients, because of the risk of renal insufficiency	11	Starting, checking, and titrating ACE-I dose is difficult	3
	I believe one should be reserved in prescribing ACE-I to CHF patients, because of the risk of hypotension	12	Fears about adverse effects of ACE-I	8
	I find initiating ACE-I difficult in CHF patients already using a diuretic	18
	I find it difficult to frequently titrate the ACE-I dose in CHF patients	25
	I believe that CHF patients who are stable on their current medication, should not be put on an ACE-I	18	Not wanting to change treatment when patients are stable	4
	I believe it is not useful to prescribe ACE-I to very old CHF patients	10	Doubts about usefulness of ACE-I, especially in elderly patients	3
			Difficulties with treating complex cases (comorbidity/polyfarmacy)	3
External			Problems with patient compliance or motivation	5
	I believe that a cardiologist should initiate ACE-I therapy in CHF patients	3	Problems in interacting with specialist care	9
	I find it hard to change treatment initiated by a cardiologist	33
			Time constraints	1
			Difficulties with screening for undertreated heart failure patients	4