Clinical review of the person with heart failure

Clinical review of the person with heart failure

 

Patients with a confirmed diagnosis of heart failure benefit from ongoing review. In line with current NICE guidelines (CG108), this should occur at least every six months and more frequently in unstable patients or those with comorbidity.

Review in Primary Care

Assess and screen for comorbidities (e.g. Hypertension, Renal dysfunction, Diabetes Pulmonary disease, Ischaemic heart disease etc

Optimise comorbidities

Measure renal function (including urine for ACR) and electrolytes

Consider social care assessment including assessment of social isolation, housebound with appropriate coding

Or review by heart failure specialist
- Physician/Specialist Nurse/Pharmacist

Review medication - including side effects and the need for changes

Reassess the stage of heart failure (NYHA score).
Assess need for repeat imaging to re-evaluate e.g. ventricular function, MR, TR, PAP.
Ensure treatment is appropriate for the patient’s heart failure syndrome e.g. reassessment for cardiac device.

then:

Assess clinical status, response to treatment, cardiac rhythm and fluid status, record NYHA score

Assess, offer and refer to cardiac rehabilitation

Record clinical frailty score and assess function, cognitive function and nutritional status

Identify patients in the last year of their life and consideration of need for palliative care and advance planning (e.g. deactivation of ICD, deprescribing) and end of life status

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(c) British Society for Heart Failure, 2022-
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