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Feature Article

Heart failure: the crucial role of the GP

STEPHEN TOMLINSON, JOHN J. ATHERTON

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© BSiP/StOCK.aDOBe.COM MODel uSeD fOr illuStratiVe PurPOSeS ONlY

Abstract

Heart failure is common among older people and affects more than 300,000 Australians. Episodes of acute decompensation usually lead to hospitalisation and involve multiple healthcare providers. GPs play a crucial role in diagnosing the condition, providing lifestyle advice and prescribing pharmacotherapy, clinical monitoring, medication titration, managing comorbidities and co-ordinating multidisciplinary input and end-of-life care.

Key Points

  • A history, physical examination, 12-lead ECG and chest x-ray may allow heart failure to be diagnosed but further investigation is warranted if there is a high clinical suspicion.
  • The echocardiogram is the most useful investigation to aid diagnosis and determine the underlying cause in patients with suspected heart failure.
  • Plasma natriuretic peptide levels are an alternative diagnostic tool when the diagnosis is uncertain and an echocardiogram cannot be arranged in a timely fashion.
  • Effective treatments for heart failure, especially for patients with a reduced left ventricular ejection fraction (LVEF), include ACE inhibitors (or angiotensin receptor blockers), beta blockers, mineralocorticoid receptor antagonists, angiotensin receptor–neprilysin inhibitors, sinus node inhibitors, implantable cardioverter defibrillators and cardiac resynchronisation therapy.
  • Multidisciplinary heart failure management programs should be offered to patients who have been recently hospitalised with heart failure, as benefits have been shown for those with a reduced or preserved LVEF.
  • Multimorbidity is common in patients with heart failure and affects their prognosis and management.
  • End-of-life care discussions should be undertaken at an early stage and will usually involve family members and other healthcare providers.

Figures

© BSiP/StOCK.aDOBe.COM MODel uSeD fOr illuStratiVe PurPOSeS ONlY
© BSiP/StOCK.aDOBe.COM MODel uSeD fOr illuStratiVe PurPOSeS ONlY