Making Best Practice, Every Day Practice
Heart failure affects around three in every hundred people aged 65 to 74 years, and increases with age. About 40% of patients with heart failure will die within one year of diagnosis, underlining the need for prompt diagnosis and effective therapy. In this article we explore what goes wrong in heart failure, and how cardiac resynchronisation can help.
Since the first description of a beta-blocking agent in 1962, this class of drug has become among the most widely used in the management of cardiovascular disease (CVD). Betablockers are now used routinely after a myocardial infarction, in patients with angina pectoris and as an additional therapy in the management of high blood pressure. However, they have traditionally been avoided in heart failure because it was thought that they were potentially harmful. But some large, well-designed randomised controlled trials have provided an overwhelming body of evidence to dispel this myth once and for all.
About 40% of patients with heart failure die within one year of diagnosis,underlining the need for more effective management.Nearly one-third of patients with heart failure may have an abnormality in the electrical conducting system of the heart.In this article,we review cardiac resynchronisation and its role in managing chronic heart failure.
Heart Failure Specialist Nurses (HFSNs) now work in the community alongside their general practice colleagues. They can act as a valuable resource to support the primary care team in the management of heart failure patients. They carry out home visits and run community clinics to stabilise patients after discharge from hospital following an acute event. The aim is to educate patients and their family carers how to manage living with heart failure, up-titrate medications to optimal levels, stabilise the patient and then hand them back to the care of the primary care team, knowing that they will be referred back to the HFSN should their condition deteriorate. However, some complex patients with advanced heart failure (NYHA III or IV) and at high risk of re-hospitalisation are retained in the specialist nurse caseload.
Heart failure has gradually emerged from the ‘shadows’ of cardiovascular medicine, to a condition that is now actively investigated, treated and monitored. Appropriate diagnosis and management of heart failure is rewarded in the GMS QOF points. In this article, we will briefly review the impact and causes of heart failure, and then explore how many patients with heart failure you can expect to have on your register and how many new cases you should be aiming to find each year.
Heart failure is a high priority in primary care, with the National Service Framework for Coronary Heart Disease, the NICE Heart Failure Guidance, and the new General Medical Services contract quality indicators all setting clear standards for improving the management of patients with this increasingly common condition. This four-page pull-out supplement provides you with a need-to-know, need-to-keep guide.
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