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Heart Failure Prevention and Management

CME For Primary Care Physicians

CME (continuing medical education) credit available from Harvard Medical School through November 2018.

Published Materials

The primary goal of this educational program is to update primary care physicians on the prevention and management of heart failure (HF). We present the latest evidence on how to prevent the progression of the disease and how to utilize available medications including newer agents to treat heart failure patients.

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Heart failure affects 5.8 million people in the US, but is expected to affect 8 million by 2030.1,2 Heart failure is one of the most common reasons for hospitalizations and the most expensive Medicare diagnosis.3

Annual hospital admissions for common Medicare diagnoses

Heart failure is a progressive disease. Steps can be taken to prevent or slow the progression to heart failure and evidence-based treatment can reduce hospitalization and mortality in patients who already have heart failure.

ACCF/AHA stages of heart failure 4

Prevention: patients at risk or with structural heart disease

Patients older than 80 years treated for hypertension, defined as systolic pressure >150 mmHg, had a 64% decrease in HF episodes.5

Treating hypertension reduces of heart failure episodes in older patients

In patients who have structural heart disease (e.g. previous myocardial infarction, left ventricle hypertrophy) and a reduced ejection fraction without symptoms of heart failure, adding angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta blockers reduces the progression to heart failure.6,7

Patients with heart failure - Algorithm for pharmacologic treatment in HF with ejection fraction ≤ 40%

In order to achieve greatest mortality benefit, doses of ACE inhibitors and beta blockers are titrated to maximum tolerated levels, however, even a low dose is better than no dose.8

Management of patients with preserved ejection fraction

  • Treat hypertension

  • Use diuretics to control symptoms

  • Control heart rate in patients with atrial fibrillation

  • Treat symptomatic ischemic heart disease


Additional Resources for prescribers 
Additional Resources for patients

Information current at time of publication, November 2015.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.


References
  1. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.
  2. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606-619.
  3. Centers for Medicare & Medicaid Services. Medicare Provider Utilization and Payment Data: Inpatient. Online: CMS.gov; 2013.
  4. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-327.
  5. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887-1898.
  6. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. . N Engl J Med. 1992;327(10):685-691.
  7. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357(9266):1385-1390.
  8. Packer M, Coats AJ, Fowler MB, et al. Effect of carvedilol on survival in severe chronic heart failure. The New England journal of medicine. 2001;344(22):1651-1658.