Australian Family Physician December - Chronic heart failure
Vol 39, (12) 881 - 992
The theme for the December issue of AFP is chronic heart
failure. This
month's articles include echocardiography, end stage heart failure,
acute pulmonary oedema, heart failure management, treating common warts,
lifestyle risk factors and Hepatitis A.
Take heart general practice
Rachel Lee
There has been recent passionate email
discussion by members of the Australian
Association for Academic Primary Care
about the ‘invisibility’ of general practice
research.
The healthcare reform agenda - A key role for GPs
John Knight
Despite successive ‘top down’ reform
initiatives, healthcare in Australia
continues to be conducted as a series of
silos with separate control and regulatory processes, and funding streams, which reflects that isolated high level change is ineffective in addressing current and future challenges in healthcare delivery. Questions are raised about which approaches might help deliver reform imperatives. As the first point of contact general practitioners are healthcare ‘gatekeepers’, and how they perceive change is fundamental to delivering comprehensive, coordinated and continuing healthcare strategy.
AFP reviewers 2010
All articles submitted to Australian Family Physician are sent for double blind peer review. Reviewers provide a critical commentary on the scientific quality of the material and its interest and relevance to general practice. This task is undertaken without reward by a large number of people in order to enhance the quality and scientific credibility of published articles. Without the participation of these reviewers, AFP would not be able to provide quality material to its readership. The editors of AFP sincerely thank the following reviewers for their generous contribution.
Chronic heart failure – management in general practice
Janice Charles, Graeme Miller, Ying Pan
From April 2005 to March 2010 in BEACH (Bettering the
Evaluation and Care of Health), chronic heart failure (CHF) was managed at a rate of 0.7 per 100 encounters, suggesting it was managed by general practitioners about 717 000 times per year nationally.
Heart failure management – a team based approach
Simon Stewart
Chronic heart failure (CHF) is a deadly and disabling
syndrome that has reached epidemic proportions in
Australia (and in other aging populations). Population
based, hospital data from many countries, including
Australia, has shown encouraging declines in the rate of
CHF related admissions. However, the overall burden of
CHF, in respect to the number of individuals affected, all
related hospitalisations and persistently high mortality,
remains unacceptably high.
Chronic heart failure – improving life with modern therapies
Andrew Sindone, Chris Naoum
Chronic heart failure (CHF) is an increasingly common
condition with increasing prevalence in the aging
population. It has a significant mortality and is associated
with a high incidence of hospitalisation and morbidity.
Echocardiography in heart failure – a guide for general practice
David Prior, Jennifer Coller
Heart failure is the inability of the heart to provide
sufficient cardiac output for the body’s needs without
an increase in filling pressures. Heart failure can be
difficult to diagnose as the symptoms and signs can be
nonspecific – it is important to confirm a clinical diagnosis
by demonstrating cardiac dysfunction.
Acute pulmonary oedema – management in general practice
Andrew Baird
Acute heart failure (AHF) is a clinical syndrome characterised by the rapid onset and progression of breathlessness and exhaustion. There is usually fluid
overload.1 Acute heart failure typically occurs as ‘acute decompensated heart failure’ (ADHF) either secondary to chronic heart failure (CHF) or de novo. The more severe presentations of acute heart failure are acute pulmonary oedema (APO) and cardiogenic shock. In the EuroHeart Failure Survey II2 of patients hospitalised with AHF, 37% had
de novo acute heart failure and 16% had APO.
End stage heart failure patients – palliative care in general practice
Patricia M Davidson, Peter S Macdonald, Phillip J Newton, David C Currow
Chronic heart failure (CHF) is common, and more than half of patients diagnosed with CHF will die within 5 years. Medical advances, particularly beta blocker therapy and implantable cardiac defibrillators, mean that many
individuals with CHF are living longer and cared for in the community. Patients with CHF experience a wide range of frequently distressing symptoms and in addition to breathlessness, pain, nausea and constipation, low mood is
common and generally poorly controlled. The symptom burden is of similar severity to patients with cancer, therefore integrating supportive care into CHF treatment is important in both primary and secondary care settings.
Hepatitis A – prevention in travellers
Cora A Mayer, Amy A Neilson
This article is the final in our travel medicine series for 2010, providing a summary of
prevention strategies and vaccinations for infections that may be acquired by travellers.
The series aims to provide practical strategies to assist general practitioners in giving travel
advice, as a synthesis of multiple information sources which must otherwise be consulted.
Manning up for men’s mental illness
John Ogrodniczuk, John Oliffe
Depression is often positioned as a woman’s disease, in part due to the recognition of a
lower incidence of depression among men compared to women. However, downstream
indicators including men’s self harm and suicide suggest that depression may be less
often diagnosed because men tend to deny illness, self monitor and treat symptoms,
and avoid health services or have difficulty engaging care providers.
Treating common warts – options and evidence
Lawrence Leung
Nongenital warts are a common condition seen in general practice, affecting patients
of all ages. There are many treatment options and patients often self medicate with
remedies from folklore or tradition before presenting to their doctor.
Hereditary haemochromatosis – diagnosis and management
Katie Allen
Hereditary haemochromatosis is a common inherited disorder in which excessive iron is
absorbed and which, over time, may cause
A persistent sore throat
Jennifer Pecina, Nathan Jacobson, Kale Bodily
A previously healthy female, 18 years of age, presented with a 10 day history of multiple symptoms including sore throat, vomiting, diarrhoea, cough, lethargy, neck pain and fever.
Complementary medicine in general practice – a national survey of GP attitudes and knowledge
Marie Pirotta, Vicki Kotsirilos, Jared Brown, Jon Adams,
Tessa Morgan, Margaret Williamson
Integrative medicine is a holistic
approach to patient care that utilises
both conventional and complementary
therapy. This article compares the
demographics of Australian general
practitioners who do, and those who do
not, practise integrative medicine, and
their perceptions and knowledge about
complementary medicines.
Lifestyle risk factors in general practice – routine assessment and management
Elizabeth Denney-Wilson, Mahnaz Fanaian, Qing Wan, Sanjyot Vagholkar,
Heike Schütze, Mark Harris
Evidence based guidelines recommend
that adults be assessed for modifiable
lifestyle risk factors: smoking, nutrition,
alcohol and physical activity (SNAP)
regularly. This article discusses the routine
practices of GPs regarding assessment
and management of these risk factors.
Cardiovascular absolute risk assessment and management - Engagement and outcomes in general practice patients
Qing Wan, Nicholas Zwar, Sanjyot Vagholkar, Terry Campbell, Mark Harris
Despite a decline in recent decades,
cardiovascular disease (CVD) remains
the major cause of death and disability in
Australia. To improve primary prevention
of CVD, many clinical guidelines
recommend using cardiovascular absolute
risk (CVAR) assessment to guide risk
factor management.
Mailing GP reply letters after psychiatric assessment – a pilot randomised controlled trial
Rob Selzer, Michael McGartland, Fiona M Foley, Paul B Fitzgerald,
Steve Ellen, Grant Blashki, Stuart J Lee
Patients are not always fully aware of
the details of their assessment and
management plan detailed in the letter
sent from the specialist to the general
practitioner following referral. One
approach to solving this problem is for
the specialist to copy the GP reply letter
to the patient.
Fostering registrar research – a model to overcome barriers
Taryn Elliott, Caroline Laurence, Moira McCaul
Research and critical thinking are essential skills for general
practitioners. However, evidence indicates that GPs tend to lack
confidence in their research ability.
Healthcare teams – a practical framework for integration
Julie Hepworth, John E Marley
Delivering integrated team care is a major priority for many countries.
In Australia this is a component of the GP Super Clinic Program but it is
also a focus of the broader primary care sector.
GPs with special interests – impacting on complex diabetes care
Claire Jackson, Jane Tsai, Cathy Brown, Deborah Askew, Anthony Russell
The growing prevalence and impact of type 2 diabetes mellitus is of
international concern.
AFP in Practice
Carolyn O'Shea
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues
Clinical Challenge
Kate Molinari
Questions for this month’s clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
Book reviews
Books reviewed this month are The Vulva - A Clinician’s Practical Handbook by Gayle Fischer & Jennifer Bradford, The upside of down: A personal journey and toolkit to overcome depression by Tamra Mercieca, Therapeutic Guidelines: Antibiotic, Version 14 by Therapeutic Guidelines & Herbs and Natural Supplements - An evidence based guide, 3rd edition by Lesley Braun & Marc Cohen