Heart Failure Management in Primary Care
Summary
Heart failure management in primary care encompasses early detection, accurate diagnosis, initiation and optimisation of evidence-based therapies, and ongoing multidisciplinary support. General practitioners play a pivotal role in recognising symptoms such as breathlessness, fatigue and fluid retention; arranging echocardiography to assess ejection fraction; and measuring biomarkers such as N-terminal pro B-type natriuretic peptide to confirm cardiac dysfunction. Once diagnosed, patients are classified into heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF), guiding pharmacological strategies including renin-angiotensin-aldosterone system inhibitors, beta-blockers and mineralocorticoid receptor antagonists. Optimal management also involves up-titration to target doses, regular review of comorbidities and patient education on self-care, symptom monitoring and lifestyle modification. Structured care pathways and integration with specialist heart failure nurses and community services aim to reduce unplanned admissions, improve quality of life and enhance adherence to clinical guidelines across diverse health systems.
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Heart Failure Management in Primary Care publication trend
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Technical terms
Ejection fraction (EF): The proportion of blood expelled from the left ventricle with each heartbeat.
Heart failure with reduced ejection fraction (HFrEF): A subtype of heart failure with EF ≤40%, responsive to specific pharmacotherapies.
Heart failure with preserved ejection fraction (HFpEF): A subtype with EF ≥50%, characterised by diastolic dysfunction and management uncertainty.
N-terminal pro B-type natriuretic peptide (NT-proBNP): A blood biomarker released in response to ventricular stretch, used to support diagnosis.
Primary care: The frontline of healthcare, typically delivered by general practitioners and community teams.
References
- Few geriatric heart failure patients investigated according to clinical guidelines: a retrospective review of patient records. BMC Geriatrics (2023).
- Impact of an extended audit on identifying heart failure patients in general practice: baseline results of the OSCAR‐HF pilot study. ESC Heart Failure (2020).
- Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study. BJGP Open (2019).
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