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New program aims to improve outcomes for heart failure patients


Jolyon Attwooll


16/06/2021 5:51:11 PM

A Brisbane cardiologist believes a new program could improve outcomes by helping GPs diagnose and treat patients with heart failure.

Stethoscope and ECG reading.
The program is designed to help GPs improve patient outcomes and their quality of life.

The initiative, called ‘Heart Failure: taking an active role’, is being run by NPS MedicineWise in collaboration with the National Heart Foundation and includes a number of resources for clinicians.
 
Dr John Atherton, Director of Cardiology at Royal Brisbane Women’s Hospital, says he hopes it will provide greater clarity over the approaches to diagnosis in patients with heart failure.
 
‘I would like the clinicians in primary care to feel they can take an active role, and they shouldn’t just have to sit back. I would encourage a collaborative approach,’ he said.
 
‘They are going to be most often confronted with the issues people with heart failure face.’
 
In an introductory video on the NPS website, Dr Atherton said a key part of the program is to ‘try and de-mystify the use of echocardiography’, which he describes as ‘the single most useful investigation in patients with suspected heart failure’.
 
It highlights that an echocardiogram to confirm a heart failure diagnosis can also classify it as reduced or preserved ejection fraction (HFrEF or HFpEF) to guide how treatment should be approached.
 
The interpretation of echocardiography reports and how they can be used is another area considered in the program, along with discussion on drug therapies and how those therapies are monitored. Non-pharmacological approaches are also covered.
 
Professor Nicholas Zwar, a GP who contributed to the most recent update of the guidelines on the diagnosis and treatment of hypertension published by the National Heart Foundation, told newsGP he welcomes anything that enables greater understanding in the field.
 
‘Understanding systolic versus diastolic heart failure, what sort of ejection fractions in different age groups … There’s a lot to know about diagnosis and management of heart failure,’ he said.
 
‘It’s not a simple area and it’s one that’s changed a lot over the past 5–10 years.’
 
According to Dr Atherton, the program could help GPs improve patient outcomes and their quality of life, as well as reduce the hospitalisation rate of those diagnosed with heart failure.
 
Among the resources is an article aiming to simplify guidance for GPs on how to up-titrate medication for patients suffering heart failure with reduced ejection fraction (HFrEF), and previous studies underlining the challenges that can be encountered when putting up-titration into practice.
 
The program describes the role of GPs in starting and optimising doses and medicines for patients as ‘vital’, while Professor Zwar says primary care clinicians play a crucial role in the diagnosis and treatment of heart failure.
 
‘I think in broad terms, when you have a prevalent condition as heart failure is, particularly with an ageing population, specialists doing the majority of the management is not practical because access is not easy and quite expensive,’ he said.
 
‘There is a need for GP involvement and for GPs to do a fair bit of the work and use the specialists as a source of advice, rather than being the main providers.
 
‘GPs will know what other things are going on.’
 
The NPS MedicineWise program underlines how widespread heart failure is across the country, with around 480,000 Australians affected, and emphasises how GPs are ‘ideally placed’ to reduce the number of hospitalisations.
 
It also underlines the role of patient education and self-management with action plans and Home Medicine Reviews.
 
Currently only 50% of people with heart failure are alive five years after diagnosis.
 
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Dr Michael Charles Rice   17/06/2021 7:05:57 AM

"There is a need for GP involvement and for GPs to DO A FAIR BIT OF THE WORK and use the specialists as a source of advice, rather than being the main providers"

But here's the rub: if I could borrow a phrase from the ivory tower "Where's the business case?" According to the NHF website "People with heart failure can gain substantial benefit from education, self-management including action plans, and referrals such as multidisciplinary services and Home Medicines Reviews (HMRs)" and I would very much like to see analysis of the funding streams associated with such an approach.

Not doubt hospitals could "save" buckets. How would that translate to primary care resources?

‘GPs will know what other things are going on,' and of course 'GPs are ideally placed' (LOVE that phrase!) but do our patients have purchasing power to access all this, from us, meanwhile looking after their cancer screening, diabetes, renal disease, mood, immunisations, musculoskeletal...

Show me the money!