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Feature Article

Heart failure guidelines. A concise summary for the GP

JOHN J. ATHERTON, RALPH AUDEHM, CIA CONNELL

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Abstract

Guidelines have recently been released by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand on the prevention, detection and management of heart failure in Australia. This article provides a brief and practical summary of the guidelines, focusing on their application to diagnosis and management of heart failure in general practice.

Key Points

  • Heart failure (HF) is generally categorised as HF associated with a reduced left ventricular ejection fraction (LVEF) below 50% (HFrEF) or HF associated with a preserved LVEF of 50% or higher (HFpEF).
  • Echocardiography is the single most useful investigation in patients with suspected HF. If not available in a timely fashion, measurement of plasma B-type natriuretic peptide (BNP) or N-terminal pro-BNP levels improves diagnostic accuracy.
  • ACE inhibitors (or angiotensin receptor blockers [ARBs]), beta blockers and low-dose mineralocorticoid receptor antagonists (MRAs) improve survival and decrease hospitalisation in patients with HFrEF.
  • The ACE inhibitor (or ARB) should be changed to an angiotensin receptor neprilysin inhibitor (unless contraindicated or not tolerated) for patients with HFrEF associated with an LVEF of 40% or less despite initial medical management.
  • Ivabradine should be considered for patients with HFrEF associated with an LVEF of 35% or less and a sinus rate of 70 beats/min or greater despite standard medical management (including a beta blocker unless contraindicated).
  • Referral for implantable cardioverter defibrillators and/or cardiac resynchronisation therapy should be considered for patients with persistent HFrEF associated with an LVEF of 35% or less despite optimal medical therapy.
  • Low-dose MRAs may be considered to decrease HF hospitalisation in patients with HFpEF.
  • Multidisciplinary HF disease management, nurse-led medication titration and exercise training have been shown to improve outcomes in patients with HF.
  • Comorbidities should be identified and managed in all patients with HF.
  • Referral to palliative care services should be considered in patients with advanced HF.

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© LARABELOVA/ISTOCKPHOTO.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© LARABELOVA/ISTOCKPHOTO.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY