Heart failure

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Heart failure - Case studies

Changes/additions to materials (reviewed 02/05/12):

New indication for eplerenone

In April 2012, Inspra (eplerenone) was licensed for use, in addition to standard optimal therapy, to reduce the risk of cardiovascular mortality and morbidity in adult patients with NYHA class II (chronic) heart failure and left ventricular systolic dysfunction (LVEF ≤30%). This is in addition to its existing licence for use in heart failure after a recent myocardial infarction.

New NICE guidance

Since these materials were published NICE has published a new clinical guideline on the management of chronic heart failure in adults in primary and secondary care (CG108). This guideline updates and replaces the previous guidance (CG5).

These materials will be updated in 2011, taking the new NICE guidance into account.

Which beta blocker for heart failure?

A large cohort study found that among patients admitted with heart failure, the adjusted risk of death in the following 12 months was similar among patients taking atenolol and carvedilol, but slightly higher in those taking metoprolol tartrate. As we reported in MeReC Rapid Review No. 255, this new data supports the NICE recommendations on the choice of beta-blocker in heart failure.

People who develop heart failure due to left ventricular systolic dysfunction and who are not previously taking a beta-blocker should normally be offered a beta-blocker licensed for heart failure (bisoprolol, carvedilol or nevibolol). This should be offered after diuretic and ACE inhibitor therapy (regardless of whether or not symptoms persist). However, people who are already on treatment with another beta-blocker for a concomitant condition (for example, angina or hypertension) should continue with a beta-blocker either their current beta-blocker or an alternative licensed for heart failure treatment

Work through the case studies below to test your knowledge on heart failure. The answers given within this case study are model answers and not the only correct answer.

Case 1 - Alan a 71 year old with chronic fatigue and breathlessness

Case 2 -Alan two weeks after starting on an ACE inhibitor for heart failure

Case 3 - Alan - one year later with worsening breathlessness