Heart failure (HF)
is the most common cause of hospitalization for most age groups and particularly for those over the age of 65. The prevalence of HF increases with age, and as more patients survive a myocardial infarction, more patients are projected to develop HF. This article focuses on the key outpatient tasks that family physicians should be considering and doing for their HF patients.
1. Preventing heart failure by treating conditions that cause it.
2. a. Establishing the diagnosis of heart failure using a multi-faceted approach: etiology, specific signs and symptoms, and echocardiography.
b. Determining the type of heart failure:
systolic, diastolic or both.
3. Assessing the patientís volume status, symptom severity, andprognosis.
4. a.Establishing the patientís self-care goals:
daily weights, diet, and activity prescription.
b.Determining the level of ancillary support needed.
c. Utilizing a regular follow-up regimen
5. a. Managing volume status with diuretics
b.Preventing disease progression and delaying mortality by using angiotensive-converting enzyme (ACE) inhibitors and beta-blockers when indicated.
c.Individualizing medication regimens to include digoxin and other drugs when indicated based on type of heart failure present, comorbid conditions, and adverse effects of medications.
6. Working closely with a cardiologist when a diagnostic or therapeutic challenge arises or for possible cardiac transplant candidates.
7. Considering screening patients at high risk for left ventricular (LV) dysfunction.