Managing heart failure: the key role of the GP

Management of most patients with heart failure occurs at an outpatient level, with the GP playing a central role in initial diagnosis, counselling, regular assessment of fluid status, titration and monitoring of medications and end-of-life care.

Key Points

Heart failure (HF) should be considered in all older patients presenting with a new wheeze.
Patients with severe acute decompensated HF (ADHF) are best managed in hospital; those with mild decompensation or chronic compensated HF are often managed as outpatients by their GPs.
The first priority in patients with ADHF is achievement of a euvolaemic state (via diuretics and fluid intake restriction).
Medications of use in patients with systolic HF are diuretics, ACE inhibitors/angiotensin receptor antagonists, beta blockers, aldosterone receptor antagonists, ivabradine and digoxin.
Apart from diuretics, no specific drug therapies have been shown to be consistently of benefit in patients with diastolic HF, the type of HF usually present in elderly patients.
Renal dysfunction is common in HF. Assessment of volume status, peripheral perfusion and recent changes in drug therapy should guide management.
Picture credit: © Kevin Somerville.

Monday 6 July 2026

Managing heart failure: the key role of the GP

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