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HeartFailure2016_ Rosemary Fernandez –
Diagnosis and Treatment of Heart Failure
Speaker Key
Rosemary Fernandez
My name is Rosemary Fernandez. I'm a Camden community Heart Failure
Nurse Specialist. What my talk was about today, was the diagnosis and treatment of
patients with heart failure, especially with left ventricular systolic dysfunction.
What is heart failure?
Heart failure is a complex clinical syndrome of different signs and symptoms,
that suggests that the heart, as a pump, is inefficient.
How might it present to a GP?
There's numerous signs and symptoms, but the main ones that a patient might
present with, are breathlessness and swollen ankles. They might also present with an
inability to exercise for long periods of time, which they used to be able to do before.
They could also be using an extra pillow at night, or be waking up with shortness of
breath during the night. Those are a few of the symptoms that the patient would be
presenting with.
How is it diagnosed?
Heart failure is diagnosed using an echocardiogram. With patients who’ve
already had a previous history of heart disease, we would suggest that you refer them
for an echocardiogram, especially if they present with symptoms of breathlessness, or
ankle swelling.
If the patient hasn’t got a cardiac history, then we would suggest that you do a blood
test called a BNP and follow that up with an echocardiogram, if the BNP is raised.
BNP can be raised with other conditions as well, so it’s good to take a full history
from the patient, as well as a clinical examination of the patient.
What are the medications for treatment?
The medications for treatment are all evidence based medications. We use the
NICE Guidelines 2010. So, if a patient presents and has had a confirmed diagnosis of
left ventricular systolic dysfunction, we would want them started on an ACE inhibitor
and a beta blocker, but not at the same time.
If they were still symptomatic, start them on a mineral corticoid, such as eplerenone
or spironolactone. For the shortness of breath and fluid overload, they could be given
some diuretic therapy.
What is the role of the Community Heart Failure Service?
The role of the Community Heart Failure Service, is to support patients with a
diagnosis heart failure. We also help them manage their condition in the community.
We offer up titration of their medications, and we monitor that. We also prevent
unnecessary hospital admissions for deterioration in the patient’s condition.
So, if the patient decompensates in their heart failure, we manage them with diuretics,
and monitor their renal function.
We also make referrals to other services that the patient might require, because of
either their heart failure, or other comorbidities that they have.
We also manage patients whose heart failure is more complex, and who have other
comorbidities that complicate their condition.
Are there any new medications that will become available?
There is a new drug called Sacubitril Valsartan, which is being started in
secondary care, at the moment. But, you will be getting patients that will have it on
their drug list when they come out into the community.
It is licensed for patients with a left ventricular systolic dysfunction of less than 35%,
and who are on a stable does of an ACE inhibitor, or an ARB.
Where can GPs find out more?
GPs can find out more about the heart failure pathway from the GP website.
We’ve also got our contact details and email address on the website. But, if you wish
to speak to anyone of the nurses, you can contact us on: 0203 317 2362.