Medical Forum is launching its own podcast next week with the first in a series of presentations by cardiologist Dr Steve Gordon from Western Cardiology who will be talking to journalist Eric Martin on the role of general practice in the management of heart failure.
Heart Failure has become a significant public health problem, impacting an increasing number of patients throughout our health system. It affects >2% of the Australian population, with >10% of those over the age 75 years.
Signs and symptoms maybe non-specific, but a high degree of suspicion in general practice may lead to early diagnosis and treatment with significant morbidity and mortality benefit.
Dr Gordon says a patient’s GP plays a critical role in all stages of heart failure management, from early identification and diagnosis through to end-of-life care.
“GPs really are team leaders, taking on a pivotal role in coordinating the multidisciplinary care required to improve outcomes and quality of life for their patients with heart failure, regardless of their classification,” he said.
“Forming an early diagnosis as soon as heart failure is suspected can have a significant impact on disease prognosis. An echocardiogram remains the single most useful diagnostic tool, with biomarkers BNP or pro-BNP useful indicators when a clear diagnosis cannot be reached through clinical examination and echocardiography.
“A GP’s regular review of patients can significantly improve their quality of life – developing a management plan and regular contact time to manage and respond to symptoms, fluid balance, renal function and electrolyte balance, blood pressure and iron deficiency.”
Dr Gordon said there had been significant advances in heart failure management in recent years.
“For our patients with HErEF, the introduction of the ‘Four Pillars’ (ACEi/ARNI, B Blockers, Spironolactone and SGLT2i) of treatment has improved their prognosis and quality of life. It is now recognised that greatest long-term prognosis comes from starting patients with low dose of all four pillars as soon as possible after diagnosis.
“Initiation and ongoing management can be safely accomplished in primary care or in collaboration with a patient’s treating cardiologist.
“There are two changes a GP can make that will help their patients – firstly, change their ACEi/ARB to an ARNI. This has been shown to reduce hospitalisations and improve mortality. Secondly, as SGLT2i are the newest pillar of the four, many of our patients are still treatment naive and this can easily be added during your next review.
“Our patients with HEpEF have been a management challenge in the past, with a lack of prognosis-improving options. However, now we have a chance to positively impact their outcomes with the TGA approval of SGLT2i, once PBS approved management and initiation in general practice will be feasible and improve outcomes for this patient group”
ED: Dr Gordon has received an educational grant from Novartis to produce these podcasts.