Management and treatment in primary care

Management and treatment in primary care

 

Treatment in the community (without specialist input)

Primary Care Management to treat congestion/fluid overload

Consider suitability for virtual ward where available

Diuretic Management

Refer to flow chart for regime

Principles:

  • Aim for consistent reduction in weight/improvement in clinical signs/symptoms until baseline weight achieved.
  • Consider need for Amber Level care if failure of therapeutic options
  • Reduce/continue diuretic at minimum dose required to maintain euvolaemia/ baseline weight
Prognostic Medication in known heart failure cases
  • Optimise prognostic HF medications (ACE-I/ARNI/MRA/SGLT2i) where possible
  • Do not increase beta blocker in ascities, severe oedema, pulmonary oedema
Monitoring
  • In most cases monitoring of renal function is essential (consider need in those with end stage/on palliative care pathway) – time interval and frequency of monitoring may vary depending on the intervention/patient.
  • Review with assessment of heart rate, blood pressure, renal function, fluid balance and weight until on optimal therapy. (at least 1-2 weekly review where possible or sooner if needed)
Follow-up
  • For confirmed heart failure cases, consider suitability for remote monitoring if available
  • For suspected new heart failure cases, refer to heart failure assessment service as per NICE guidance

Fluid overload protocol

IMPORTANT! - DO NOT STOP HEART FAILURE TREATMENTS WITHOUT DISCUSSING WITH THE HEART FAILURE TEAM

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(c) British Society for Heart Failure, 2022-
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