Cardiovascular

Optimising the management of heart failure

Heart failure (HF) is an important cause of morbidity, mortality and misery for patients. However, there are many ways to improve and extend the lives of people with HF, if clinicians are familiar with and apply the numerous traditional, less mainstream and more innovative evidence-based treatment options. 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, fast moving field.

Heart failure: improving outcomes today

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.

Heart failure today: The challenge

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.

Plant sterols and cardiovascular risk

The World Health Organization recognises that 80% of CHD could be prevented by positive lifestyle changes. Healthcare professionals should encourage and support patients to quit smoking, increase physical activity, and make positive dietary and lifestyle changes to help better manage their heart health.

The increasing challenge of heart failure: Improving outcomes

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.

Optimising the management of heart failure

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.

Heart failure: Improving outcomes today

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.

Going back to basics in cardiovascular disease

Volume 8, Supplement 2, Jul-Aug-Sep 2011

The increasing challenge of heart failure: Improving outcomes – Introduction

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.

The effective diagnosis of heart failure

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.

How many more people will we need to anticoagulate using CHA2DS2VASc? A real-life study in British primary care

Managing stroke risk in people with atrial fibrillation (AF) is critical. The introduction of the CHAVASc score has lowered the threshold for consideration of anticoagulation to prevent stroke in AF. This means potentially extra work for clinicians in assessing AF patients, and an extra cost to the NHS from more medication and monitoring. This study aims to quantify the increase in the numbers of people requiring anticoagulation with the newer risk assessment score. Method: The GRASP-AF tool was used to quantify the number of people categorised as high risk, using the CHAVASc score compared with the standard CHADS score. Population: An inner-city population from nine general practices within a single Clinical Commissioning Group (CCG), covering a population of 42,274 patients. Results: A total of 395 patients were found to have AF. In this study, 64% were categorised as high risk using CHADS compared with 87% on CHAVASc. This represents an increase of 35% in the numbers of people classed at high risk of stroke and needing to be considered for anticoagulation. Conclusion: There are significant extra costs to implementing the CHAVASc score, both in drug costs and extra work for primary care, which need to be managed within the local health system. The greatest benefit will be at an individual level. Some people who would have had a stroke will be spared that experience. Who those individuals are, we will never know.

NICE Guidelines: A changing approach to atrial fibrillation

Atrial fibrillation (AF) is the commonest cardiac arrhythmia seen in primary care and, if left untreated, is a significant risk factor for stroke. New guidelines from the National Institute for Health and Care Excellence (NICE) include some practice-changing recommendations on diagnosing AF, the role of aspirin and the novel oral anticoagulants (NOACs), and shared decision-making to ensure patient-centred care.

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