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