The Guidelines and Protocols Advisory Committee’s (GPAC) guideline for improved diagnosis and management of adults with chronic heart failure (HF) in the primary care setting is available to physicians across BC at www.BCGuidelines.ca.
• B-type natriuretic peptide (BNP) or N-terminal prohormone of BNP (NT-proBNP) is the biochemical test of choice for ruling-in or ruling-out the diagnosis of HF and should be considered as part of the initial evaluation of patients with dyspnea suspected of having HF.
• BNP (or NT-proBNP) testing should not be used routinely for monitoring disease severity.
• Educate the patient and family about the importance of self-monitoring to identify early decompensation at a stage where intervention may help to avoid hospitalization. Consider referral to a heart function clinic or a multidisciplinary chronic disease management clinic.
• Identify who would benefit from a palliative care assessment by using the iPall Heart Failure: Palliative Care Assessment Tool (www.bcheartfailure.ca/for-bc-healthcare-providers/end-of-life-tools/). Initiate advance care planning discussions early in the disease course.
• The goals of pharmacologic management for HF patients with preserved ejection fraction (HF-pEF) are to control heart rate, blood pressure, and volume status, as no medications have shown a mortality benefit in this patient group.
• For patients with reduced ejection fraction (HF-rEF) there is robust mortality data to support the use of pharmacological and device therapies. These treatments have also been shown to improve symptom status and quality of life, and to decrease the risk of HF-related hospitalization.
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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