Heart failure is an intricate clinical condition of symptoms and signs that suggest malfunction of the heart. This is often caused by structural and or functional defects of the heart. A good number of patients have heart failures as a result of left ventricular systolic dysfunction (LVSD).
“More often than not, LVSD is associated with reduced left ventricular blood ejection fraction. Some patients have heart failure as a result of a preserved ejection fraction (HFPEF). Whereas the most popular cause of heart failure in the United States (US) is coronary artery disease, many patients have had a myocardial infarction,” Owan TE, Hodge D.O., Herges R.M, et al. (2006).
Heart failure and or related diseases often increase steadily with age, a typical age at first diagnosis being at 76 years. Prevalence of heart failure is even expected to rise in the near future as a result of an increased ageing population. Improved survival of people with heart disease and more effective treatments of the same are more reasons for such increased prevalence.
“Heart failure has a poor prognosis: 30–40% of persons diagnosed with the condition die within a year, after which the mortality rate is less than 10% for every succeeding year. However, there has been better prognosis in the past 10 years. The 6-month mortality rate further decreased from 26% in 1995 to 14% in 2005 and even further now,” Petersen S, Rayner M, and Wolstenholme J. (2002).
“Heart failure accounts for over a million inpatient bed-days 2% of all NHS inpatient bed-days in the US and 5% of all emergency medical admissions to hospital. The admissions because of the heart condition are even projected to rise by 50% over the next two decades, largely as a result of the ageing population,” Hobbs FD, Roalfe AK, and Davis R.C., et al. (2007).
This article provides acceptable and standard practices on adults with heart failures, especially those with chronic heart failures. Such trials entail diagnosis, treatment, and rehabilitation.
Clinical trials as well as therapeutic care should take into account the patients’ needs and preferences. A patient with acute heart failure for instance should be able to make or rather should be given an opportunity to make an informed decision about his/her therapeutic care together with the healthcare professionals.
If the patient does not have the ability to make reliable decision about his/her the trials and or therapeutic care, the healthcare professional should follow established guidelines set by the Department of Health on consent and the professional code of practice as set out in the Mental Capacity Act.
Also important is good communication between the patient and the professional. These may be in different forms but a recommended practice involves a written document that suits the patient’s unique clinic diagnosis and can also act as evidence. Clinical trials and therapeutic care given and information communicated to the patients should be appropriate to the latter’s medical history and culture.
Such information should be accessible to people with special needs such as physical, sensory, learning disabilities, and or to those who neither speak nor read English. Family members, guardians and or care-takers should also have an opportunity to contribute in the decisions about the trials and care.
“During clinical examinations, it is important to refer patients with supposed heart failures and or previous myocardial infarction (MI) urgently to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks,” Owan TE, Hodge D.O., Herges R.M, et al. (2006).
“Clinical trials on treatment should measure serum natriuretic peptides (B-type natriuretic peptide [BNP] or N-terminal pro-B type natriuretic peptide [NTproBNP]) in patients with suspected heart failure without previous MI. Because very high levels of serum natriuretic peptides carry a poor prognosis, refer patients with suspected heart failure and a BNP level above 400 pg/ml (116 pmol/litre) or an NTproBNP level above 2000 pg/ml (236 pmol/litre) urgently, to have the 2D echocardiography and assessment within 2 weeks,” Owan TE, Hodge D.O., Herges R.M, et al. (2006).
Trials on treatment involve offering both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction. It is also advisable to use clinical judgments when deciding which drug to use first.
Offer only beta-blockers licensed for heart failure to all patients with the heart condition due to left ventricular systolic dysfunction, including: adults and those patients with other vascular diseases, erectile dysfunction, diabetes mellitus, interstitial pulmonary disease, and or chronic obstructive pulmonary disease (COPD) without reversibility.
Professionals are also advised to seek specialist guidance to offer one of the following alternatives if the patient fails to respond to treatment despite optimum therapy with an ACE inhibitor and a beta-blocker. They may include: an aldosterone antagonist licensed to handle heart failure patients and an angiotensin II receptor antagonist (ARB) licensed for heart failure.
Clinical trials about rehabilitation should involve a supervised exercise-based rehabilitation program designed for patients with heart failure in groups. While at it, it is advisable to ensure the patient is stable and does not have a condition or device that would immaturely conclude the rehabilitation program.
During the program, you could also include a psychological and or educational component. The program may be incorporated within an existing exercise-based or other cardiac rehabilitation program.
“It should be noted patients with chronic heart failure require monitoring. This monitoring should include; a clinical assessment of functional capacity, fluid status, cardiac rhythm, nutritional status, cognitive status and a review of medication; including need for changes and possible side effects, serum urea, electrolytes, and creatinine. Also, when a patient is admitted to hospital because of heart failure, the professional should seek advice on their management plan from a specialist in heart failure,” Petersen S, Rayner M, and Wolstenholme J. (2002).
Lastly, patients with this kind of heart condition should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimized. The timing should take into account patient and career wishes, and the level of community care and support.
Dr. Dalal Akoury, M.D., M.P.H. is a family physician with a wealth of knowledge and years of experience in integrative medicine. She will highly be of assistance.
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