Feature Article

Prevention and management of heart failure

Arvin Lamanna, John J Atherton



Heart failure is associated with substantial morbidity and mortality. Lifestyle and behavioural modification to reduce cardiovascular disease risk factors are important in preventing the condition, and the pharmacological management is guided by the findings on echocardiography.

Key Points

  • Bedside clinical assessment and chest x-ray may allow a diagnosis of heart failure but do not allow the diagnosis to be ruled out.
  • The echocardiogram is the single most useful investigation to confirm or rule out the diagnosis of heart failure and to guide management.
  • Plasma natriuretic peptides are useful when the diagnosis is uncertain and an echocardiogram cannot be arranged in a timely fashion.
  • ACE inhibitors (or angiotensin receptor blockers) and beta-blockers are the gold standard for treating systolic heart failure, with aldosterone antagonists providing added benefit if symptoms persist.
  • Implantable cardioverter defibrillators and cardiac resynchronisation therapy provide added benefit in selected patients.
  • Multidisciplinary heart failure disease management programs should be offered to patients recently hospitalised with heart failure.