Managing Heart Failure in Primary Care : A Practical Guide

by Cowie, Martin R.

• ISBN13: 9781904218203
• ISBN10: 1904218202
• Format: Paperback
• Copyright: 2003-04-01
• Publisher: Bladon Medical Pub

Summary

Heart failure is a multifactorial disease that is complex to manage and places an increasingly major burden on health care services. It is estimated that heart failure accounts for between 1% and 2% of health care expenditure in developed countries and up to 5% of admissions to general medical and geriatric wards. These figures are set to increase with the growing ageing population as well as more patients surviving myocardial infarction, but with the increased risk of a severely damaged heart that is likely to fail at some point in the future. Not surprisingly, this escalating workload is shared between the general practitioner and the hospital specialist. Unfortunately, there is still no single test that can be used for making an accurate diagnosis of the disease; heart failure is therefore recognized and diagnosed principally on the basis of signs and symptoms. Once diagnosis has been confirmed patients require careful monitoring and management for the duration of their life.

Table of Contents

Heart Failure: An Overview	p. 1
Definition and diagnosis	p. 1
Epidemiology	p. 2
The health care burden posed by heart failure	p. 3
Aetiology	p. 5
Cardiomyopathy	p. 8
Pathophysiology	p. 10
Prognosis	p. 11
Organization of care	p. 13
Aims of management	p. 14
Diagnosing and Investigating Heart Failure	p. 18
Signs and symptoms of heart failure	p. 18
Beware of alternative diagnoses	p. 20
Always start with the history	p. 20
Useful diagnostic investigations	p. 21
Open access to echocardiography	p. 25
When to refer for a specialist opinion	p. 28
Linking diagnosis to treatment	p. 29
General Management	p. 34
Lifestyle measures	p. 34
Drug Treatment of Heart Failure	p. 43
Diuretics	p. 43
Neurohormonal antagonists	p. 46
Treatment of heart failure due to diastolic dysfunction of the left ventricle	p. 63
Treatment of heart failure due to valve disease	p. 63
Treatment of other causes of heart failure	p. 64
Drug counselling	p. 64
In summary	p. 66
Surgery and Other Invasive Interventions	p. 70
Revascularization	p. 71
Valve repair/replacement	p. 71
Heart transplantation	p. 72
Other procedures	p. 73
Ongoing Care of Patients with Heart Failure	p. 78
Monitoring patients with chronic, relatively stable heart failure	p. 78
Monitoring patients with unstable, difficult to manage heart failure	p. 82
Specialized care: the heart failure clinic	p. 83
End of life care	p. 86
Audits and Standards in Heart Failure	p. 90
How to conduct a heart failure audit in general practice	p. 91
Professional guidance	p. 94
Alphabetical Index	p. 99
Table of Contents provided by Rittenhouse. All Rights Reserved.