Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006

Abstract

Chronic heart failure (CHF) is found in 1.5%–2.0% of Australians. Considered rare in people aged less than 45 years, its prevalence increases to over 10% in people aged ≥ 65 years. CHF is one of the most common reasons for hospital admission and general practitioner consultation in the elderly (≥ 70 years). Common causes of CHF are ischaemic heart disease (present in > 50% of new cases), hypertension (about two‐thirds of cases) and idiopathic dilated cardiomyopathy (around 5%–10% of cases). Diagnosis is based on clinical features, chest x‐ray and objective measurement of ventricular function (eg, echocardiography). Plasma levels of B‐type natriuretic peptide (BNP) may have a role in diagnosis, primarily as a test for exclusion. Diagnosis may be strengthened by a beneficial clinical response to treatment(s) directed towards amelioration of symptoms. Management involves prevention, early detection, amelioration of disease progression, relief of symptoms, minimisation of exacerbations, and prolongation of survival.

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

“…HF is a complex, disabling and potentially deadly clinical syndrome, of increasing public health importance as the population ages 21. Our study examined hospitalised patients with ‘first-ever’ HF, and accordingly, a vast majority (>93%) were emergency presentations to hospital.…”

Evidence-based chronic heart failure management programs: reality or myth?

“…“A complex clinical syndrome with typical symptoms (eg, dyspnoea, fatigue) that can occur at rest or on effort and is characterised by objective evidence of an underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood (particularly during physical activity).” (5, p. 9).…”

“…The demands on the healthcare organisations are significant and relate to recurrent hospitalisation in high-risk individuals within the 40 000 or more Australians hospitalised with a primary diagnosis of heart failure each year 1 4. It is within this context that CHF management programmes (CHF-MPs) have been developed to optimise the management of those hospitalised with CHF in order to reduce preventable morbid and fatal events 5. The overall efficacy of these programmes has been established through several meta-analyses6 7 8 in particular multidisciplinary CHF-MP’s either delivered in the community or via specialist clinics to reduce the risk of all-cause hospitalisation or mortality by 26% (95% CI 0.63 to 0.87) and 25% (95% CI 0.59 to 0.96) respectively 7.…”

“…The overall efficacy of these programmes has been established through several meta-analyses6 7 8 in particular multidisciplinary CHF-MP’s either delivered in the community or via specialist clinics to reduce the risk of all-cause hospitalisation or mortality by 26% (95% CI 0.63 to 0.87) and 25% (95% CI 0.59 to 0.96) respectively 7. Consequently, CHF-MPs are now a recommended part of the post-discharge management of patients with CHF throughout the world 5 9 10…”

“…This was to determine if the previously documented heterogeneity in CHF-MPs11 persists despite supportive evidence and available expert guidelines5 9 10 for these programmes of care. Specifically, we examined if and how current CHF-MPs apply evidence-based recommendations from national5 and international guidelines9 10 for the management of patients with CHF to optimise their health outcomes. An outline of the recommendations that are applicable to this study are listed in table 1 including the level of evidence supporting these recommendations.…”