The outlook is bleak for patients with untreated or suboptimally treated heart failure (HF). Conversely, optimising management (HF) improves patient survival and reduces hospital admissions. However, standards of care continue to vary, and many HF patients are still not receiving recommended therapy with disease-modifying drugs or specialist input to their care. Outcomes will only improve for all our HF patients if evidence-based clinical guidelines are implemented throughout the NHS.
GPs and practice nurses face many challenges when diagnosing and managing heart failure. This comprehensive supplement reviews all aspects of chronic and acute HF, from epidemiology, through diagnosis, lifestyle interventions, pharmacological and device therapies to implementation of current guidelines.
Evidence-based guidelines offer many options to improve and extend the lives of patients with heart failure (HF). This article reviews current best practice in the management of chronic HF and of acute decompensated HF, and considers recent insights, controversies and innovations in this important field.
Optimising the management of heart failure improves patient survival and reduces hospital admissions. However, standards of care continue to vary, and many HF patients are still not receiving recommended therapy with disease modifying drugs or specialist input to their care. Outcomes will only improve for all HF patients if evidence-based clinical guidelines are implemented throughout the NHS.
Heart failure is an important public health problem that is associated with significant morbidity, mortality and healthcare costs, especially in the over-65s. Despite reductions in HF-related mortality, hospitalisations remain frequent and readmissions continue to rise. It is these admissions to hospital that put a financial strain on the local health economy, and cause stress and anxiety for the patient and supporting family.
Despite advances in management, heart failure (HF) remains a deadly clinical syndrome, with a five-year survival of 58% compared with 93% in the matched general UK population. In this comprehensive supplement, my colleagues provide excellent reviews of all aspects of chronic and acute HF, from epidemiology, through diagnosis, lifestyle interventions, pharmacological and device therapies to implementation of current guidelines. Rather than regurgitating the content of their articles, I would like to pick out some areas worthy of thought and discussion. I will discuss challenges to clinicians in the diagnosis and management of HF, diagnostic use of natriuretic peptides (NPs), newer medical therapies and their future use, device therapies, and implementation of the evidence base into clinical practice.
Heart failure (HF) is a complex clinical syndrome, characterised by symptoms including breathlessness, fatigue, reduced exercise tolerance and fluid retention. Signs and symptoms may be non-specific or difficult to elicit, and some primary healthcare professionals continue to lack confidence in their ability to identify patients with HF. A systematic approach to history-taking, examination and referral aims to help improve the accuracy of the diagnosis and ensure that HF patients are referred for specialist assessment and receive evidence-based therapies.
Chronic heart failure (CHF) continues to be a leading cause of death and readmission to hospital in the UK. Since the availability of specialist CHF services is variable, many patients rely on practice nurses to review their care. The National Institute for Health and Care Excellence (NICE) guidelines have proved very helpful, but are now a cause for confusion as new evidence changes the management of heart failure.
A really useful reference for your practice, this handy Back to Basics tells you all you need to know about heart failure treatments.
Remote monitoring is an emerging model of care in heart failure (HF) which has been shown to be clinically beneficial. In this study, patients were recruited to a new telemonitoring programme after referral to a community HF service. Following enrolment, there was a 58% reduction in the risk of HF admissions (0.71 vs. 0.30 per year, p<0.001). During the programme patients received, on average, nine home visits, eight telephone calls and three clinic appointments per person per year.
Heart failure (HF) imposes a significant burden across the UK, both for patients and the NHS. Optimal management of HF could improve patient outcomes and reduce costs for clinical commissioning groups (CCGs). HF is, however, complex to manage, and despite recent improvements there is evidence of a continuing lack of adherence to guideline recommendations. Enhance HF™ is a tool that supports GPs in optimising the management of HF due to left-ventricular systolic dysfunction to help deliver more costeffective care for patients in their practice.
Since the introduction of the Quality and Outcomes Framework (QOF), GPs have been incentivised to keep a register of patients diagnosed with heart failure (HF). Such registers are only effective if they are audited regularly, since they are likely to contain errors and omissions. GRASP-HF is a new tool designed to help busy practices achieve a systematic approach to the identification, diagnosis and management of patients with HF.