Chronic heart failure

December 2010

FocusChronic heart failure

Chronic heart failure

Improving life with modern therapies

Volume 39, No.12, December 2010 Pages 898-901

Andrew Sindone

Chris Naoum

Background

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.

Objective/s

This article describes the aspects of modern therapy that can improve survival, reduce hospitalisation and improve quality of life for CHF patients.

Discussion

A careful history, physical examination and judicious investigation (including chest X–ray, electrocardiogram, complete blood profile and echocardiogram) can often identify the cause of CHF, the severity of CHF and help guide management. Treatments which have been shown to be of significant benefit include angiotensin converting enzyme inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers. Loop diuretics, nitrates, digoxin, hydralazine and amiodarone may be used when patients do not respond to initial therapy. Review by a cardiologist is often useful to exclude myocardial ischaemia and to perform echocardiography which is a key investigation in assessment of CHF patients. Ongoing regular review with uptitration of medications to achieve target blood pressure and pulse and exclude exacerbating conditions can lead to improvements in care and facilitate successful outcomes in CHF patients who are often very unwell.

Chronic heart failure (CHF) affects over 300 000 Australians with another 30 000 new cases diagnosed each year.1 Prevalence increases with age, from 2.5% in people aged 55–64 years to 8.2% in those aged over 75 years.1 Despite improved understanding of the pathophysiology and management, morbidity and mortality remain high, with CHF causing 43 000 hospitalisations and 2200 deaths in 2006. This underestimates the burden of disease as it does not include indirect deaths and hospitalisations due to CHF.1 A sound understanding of modern therapies is crucial as general practitioners play a central role in the management of CHF.

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Correspondence afp@racgp.org.au

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Type

Focus

2010