Heart Failure and Heart Valve Disease | How to Optimise Management of Heart Failure in Primary Care

Introduction
Welcome to this session on how to optimise management of heart failure in primary care.

This module offers practical evidence-based approaches to manage patients with heart failure with a reduced ejection fraction (HFrEF).

Evidence for the use of heart failure medication
It is useful to appreciate the evidence base behind treatments used for HF as it helps to encourage us to optimise patients as well as explain to patients the importance of HF therapies.

Studies have shown a significant and additive mortality benefit with ACEi (or ARBs), beta-blockers and MRAs in patients with HFrEF. 

Drugs that act on the renin-angiotensin-aldosterone system (RAAS) have benefits described next.

At the end of this session you will know how to:

• identify the need to optimise patients with heart failure
• identify the need for evidence-based therapies
• appreciate the need for optimal standard therapies in symptomatic HFrEF patients (heart failure with reduced ejection fraction)
• manage HFpEF (heart failure with preserved ejection fraction)
• manage practical aspects of optimising patients with standard therapies
• manage adverse events including hypotension, bradycardia and renal impairment during medicines optimisation
• seek advice from specialist care for prompt evidence-based pharmacological optimisation with therapies including ivabradine, sacubitril-valsartan, digoxin and dapagliflozin if not confident in initiating in primary care, including when to refer back to HF specialist teams when appropriate who may elect to further optimise with drugs or devices