| 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 | Â | Â |
 | 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 | Â | Â | 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 |