Heart Failure and Heart Valve Disease | Management in the community, self-care, integrated care and admission avoidance

Heart failure and comorbidities
Patients with heart failure (HF) often have comorbidities such as diabetes, chronic kidney disease or chronic obstructive pulmonary disease (COPD).

It is important to consider the patient holistically and to take into account comorbidities when managing these patients. Optimising comorbidities improves outcomes in HF. Multidisciplinary team (MDT) working practices with expertise across various specialities is an emerging approach to managing patients expediently.

Diabetes, for example, significantly increases the risk of HF. Diabetes is found in approximately 25% of patients with chronic HF and is responsible for approximately 40% of decompensated acute HF admissions [1]. Diabetes decreases survival rate in patients living with HF, compared with those without diabetes. 

Around half of all patients with HF have chronic kidney disease (CKD). Microalbuminuria is an independent risk factor for cardiovascular disease (CVD) including HF-related hospitalisation and mortality. Microalbuminuria should therefore be proactively looked for and managed appropriately.

Patients with HF may also have frailty, in which case patients should have an holistic, personalised and symptoms-based approach to their care. In these circumstances, patients may prefer to be admitted to a virtual ward or be managed at home, were they to decompensate. 

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

• list key elements of patient self-management in heart failure
• recognise and manage symptoms of decompensating heart failure
• recall the principal prognostic medications for those with left ventricular systolic dysfunction
• describe ideal care pathways for optimal management of heart failure in primary care
• identify ways in which you could adapt your practice to improve care for those with heart failure