Timely and accurate diagnosis of heart failure (HF) is important since treatments can alter prognosis as well as improve symptoms. HF is a common syndrome with a poor prognosis and high healthcare cost, but because symptoms are non-specific, early diagnosis is difficult. Primary care has a vital role in identifying persons with HF and in providing holistic, person-centred care from the first symptoms to end of life. During the European Primary Care Cardiovascular Society (EPCCS) Clinical Masterclass 2015, updated evidence based strategies to diagnose and manage HF were discussed, challenges identified, and suggestions formulated based on new scientific insights. This document summarises the discussion and aims to guide European primary care physicians towards improved diagnosis and management of HF patients in primary care. It considers the diagnostic work-up and treatment of both HF with preserved ejection fraction (HFpEF) and with reduced EF (HFrEF), indicating where management approaches may overlap and where the syndromes require distinct strategies. The new HFmrEF (mid-range: EF: 40-49%) category, introduced in the ESC 2016 guidelines, is also considered.
This document gives practical guidance on lifestyle interventions, and which pharmacological therapy may provide benefit in various clinical presentations of HF. It thereby aims to facilitate the crucial role of the general practitioner in overseeing the overall health status of a patient, including monitoring comorbid conditions.
A brief version of this document has been published in the British Journal of General Practice (Br J Gen Pract 2017; 67 (660): 326-327. DOI: https://doi.org/10.3399/bjgp17X691553) https://bjgp.org/content/67/660/326