Practical guidance on heart failure diagnosis and management in primary care: recent EPCCS recommendations.

Abstract

Heart failure (HF) is a common and costly clinical syndrome, associated with significant morbidity and reduced life expectancy, affecting around 1–2% of adults in developed countries.1 Timely diagnosis is important to optimise evidence-based treatment opportunities, which delay mortality and improve symptoms, but the early stages of HF can be difficult to identify clinically. Primary care has a vital role in providing holistic, person-centred care from first symptoms to end of life. This article summarises the key aspects of HF management for general practice including new areas of diagnostics and drug therapy. HF is a clinical syndrome characterised by certain symptoms, and possibly signs, plus objective evidence of a structural or functional abnormality of the heart. The type of HF is determined according to left ventricular ejection fraction (LVEF), although the exact cut-point continues to be an area of debate.2 HF with reduced ejection fraction (HFrEF) is commonly defined as LVEF <40%. HF with preserved ejection fraction (HFpEF) is defined as LVEF ≥50% with evidence of diastolic dysfunction or structural cardiac changes.3 Recently, the European Society of Cardiology (ESC) added a third group, HF with midrange ejection fraction (HFmrEF), for the grey area between HFrEF and HFpEF.3 All three show reduced prognosis compared with the non-HF population. The classification is important for management: HFrEF has a strong evidence base for pharmacological intervention whereas the same treatments have not shown benefit in HFpEF.4 In both HFrEF and HFpEF, the heart fails to pump adequately, causing symptoms of fluid overload and cardiac stress, such as breathlessness, ankle swelling, and fatigue. These symptoms are common and can be associated …