New CHF prevention, detection and management guidelines released

New guidelines for the prevention, detection and management of chronic heart failure (CHF) have been released by the Heart Foundation and the Cardiac Society of Australia and New Zealand. The current positions statement has been published in the MJA.Detection and management of CHF is complex; diagnosis is based on clinical features, chest x-ray and objective measurement of ventricular function, and it is thought that plasma levels of B-type natriuretic peptide may play a role in diagnosis as an exclusion test. The guidelines define CHF as "a complex clinical syndrome with typical symptoms (eg. dyspnoea, fatigue) that can occur at rest or on effort that is characterised by objective evidence of an underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood (particularly during exercise). A diagnosis of CHF may be further strengthened by a beneficial clinical response to treatment(s) directed towards amelioration of symptoms associated with this condition."A clear diagnostic algorithm to assist clinicians in their route of investigation is detailed in the position statement.Management involves prevention, early detection, slowing disease progression, symptom relief, and prolonged survival. Common causes are reported to be ischaemic heart disease, hypertension and idiopathic dilated cardiomyopathy.Evidence-based non-pharmacological and pharmacological management approaches such as diet and exercise, as well as preventing and treating asymptomatic left-ventricular dysfunction, respectively, are detailed. Concise information is also provided on medications to avoid or use with caution in patients diagnosed with CHF. Furthermore, recommendations for biventricular pacing and implantable cardioverter defibrillator treatment are detailed along with information regarding surgical approaches. The key features of the most successful post-discharge CHF management programs have been summarised, with the authors noting that "predominantly nurse-led, multidisciplinary programs of care, delivered either in the home or through specialist CHF clinics, significantly reduce the risk of rehospitalisation, improve quality of life, reduce healthcare costs and prolong survival."These guidelines have been endorsed by the Royal Australian College of General Practitioners, Heart Support Australia, the Royal College of Nursing Australia, the Internal Medicine Society of Australia and New Zealand, and the Australian Cardiac Rehabilitation Association. Reference...