Chronic heart failure growing

The prevalence of heart failure is increasing in Australia, according to experts from Melbourne’s Alfred Health

Dr Ingrid Hopper and Kellie Easton write in Australian Prescriber that the condition now affects 1-2% of the population, and pharmacists can help with drug and non-drug interventions.

The authors explain that there are two forms of heart failure – reduced ejection fraction and preserved ejection fraction – which are often indistinguishable clinically. It is important to differentiate the two forms of heart failure with echocardiography because the treatments are different, they say.

“Lifestyle modifications, such as smoking cessation, minimal alcohol intake and regular exercise, and education on self-management are important strategies for all patients,” say the authors.

Ongoing education about self-management is key to caring for patients with heart failure, they say.

Patients and their health professionals should keep an eye out for breathing difficulties or difficulty catching the breath with usual daily activities, reduced exercise tolerance, abdominal bloating and poor appetite, which often herald an exacerbation and/or hospitalisation.

“A low-salt diet should be recommended, along with smoking cessation, minimal alcohol intake and regular exercise. A cardiac rehabilitation program and a multidisciplinary heart failure team (doctors, nurses, pharmacists) have been shown to be beneficial.”

Patients also need to monitor their weight regularly so that they and their carers are alert to any weight gain which would suggest fluid retention.

It is recommended that heart failure with reduced ejection fraction is treated with a combination of drugs. ACE inhibitors, heart-failure-specific beta blockers and aldosterone antagonists have been proven to reduce mortality and morbidity.

To achieve the best health outcomes, research shows that drug doses should be titrated upwards to the maximum tolerated while monitoring symptoms, heart rate, blood pressure, serum potassium and renal function.

The authors say no drug has been shown to improve survival in patients with preserved ejection fraction. To improve patients’ quality of life, risk factors such as hypertension should be aggressively managed.

The authors also warn that comorbid disease may worsen heart failure or complicate its treatment.

“Over half of patients with heart failure reported five or more chronic conditions in a US community-based study,” they write.

“While cardiac diseases including hypertension, hypercholesterolaemia, ischaemic heart disease and myocardial infarction are the more common comorbidities, chronic obstructive pulmonary disorder, diabetes, depression and renal failure are most strongly associated with adverse outcomes.

“Renal dysfunction with heart failure, termed cardiorenal syndrome, has a particularly poor prognosis.”

The full article is available here.

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