Download Heart Failure

Background, recognition and differentials.
By Dr L Axten
Clinical Context
 900,000 people affected by heart failure in the UK.
 About the same amount of patients again with
damaged hearts and no symptoms as yet.
 Risk of heart failure greater in men but more women
with HF.
 Incidence and prevalence rise with age1 in 35 aged 64-74
1 in 15 aged 75-84
1 in 7 aged 85 & over
Clinical Context Continued
 Prevalence of HF expected to rise due to the aging
population, improved outcomes for those with IHD
and better treatments for HF.
 Causes-previous MI, also associated with HTN & AF.
Damage to heart structures-dilated cardiomyopathy.
Prognosis
 Poor
 30-40% mortality in one year
 Thereafter mortality is 10% a year
 Prognosis has improved in the last ten years
 Younger patients do better, as do those without co-
morbidities
 HF failure has a massive impact on quality of life and is
associated with mood disorder
GP perspective
 On average a GP will have 30 patients on their list with
HF
 A GP will have on average 10 new diagnosis per year
 Deprived areas have a higher incidence of HF
 GP consultations cost approx £45m a year
 With referral to OPD costing approx £35m a year
 Cost of community pharmacy being £129m a year
NHS perspective
 1 million in-patient beds per day
 5% of all admissions to MAU
 Hospital admissions for HF are expected to rise by 50%
over the next 25 years
 Protracted hospital admission 7-9 days
 1 in 4 readmissions in 3 months
Patients perspective
 Affect on quality of life
 Loss of earnings
 Mood disorders
 Physical limitation
 Many patients receive sub optimal treatment
Diagnosing heart failure
 What are the signs and symptoms of heart failure?
Diagnosing Heart Failure
 Signs and symptoms of HF are often non specific
 Common-breathlessness, during activity or at rest (PND or
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orthopnoea)
Fatigue
Exercise intolerance
Fluid retention
Non-specific symptoms of heart failure include nocturia,
anorexia, abdominal bloating and discomfort,
constipation, and cerebral symptoms such as confusion,
dizziness and memory impairment
Signs and symptoms do not correlate to the severity of
heart damage
Diagnosing heart failure 2
 Raised JVP has high predictive value for HF but is not
often present
 Tachycardia, third heart sound, displaced apex beat
are not significant to HF in isolation
 Lung crepitations
 Hepatomegaly
New York Heart Association
Classification of heart failure
 Grade 1- No limitations.
 Grade 2- Slight limitations on physical activity.
Ordinary activity results in breathlessness,
palpitations, fatigue or angina. (Mild HF)
 Grade 3- Marked limitation of physical activity.
Comfortable at rest although less than ordinary
physical activity will lead to symptoms in grade 2.
(Moderate HF)
 Grade 4- Inability to carry out physical tasks without
discomfort. Symptoms present at rest. (Severe HF)
Differentials
 Many conditions present with symptoms similar to HF
 Obesity, chest disease, venous insufficiency, drug
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induced ankle swelling (calcium channels blockers),
drug induced fluid retention (NSAID’s),
Hypoalbuminaemia
Intrinsic renal or hepatic disease
Pulmonary embolic disease
Depression and anxiety
Severe anaemia or thyroid disease
Bilateral renal artery stenosis