Communication points to bear in mind

When preparing for a consultation, it is useful to consider the patient’s frame of mind, especially if they have just been diagnosed with heart failure. The term itself can be frightening to a patient or family member. In recognition of this many healthcare professionals and patient groups often prefer to call it “heart inefficiency” or just HF.  

An explanation in simple terms can be helpful; for example, that the heart is not pumping properly so is less efficient at sending oxygenated blood around the body. An analogy sometimes used is of a central heating pump that is no longer able to send as much water around the heating system as before.  

A patient may be wondering “why me?”. There are many reasons why a patient may develop heart failure including high blood pressure, a heart attack (many more patients now survive heart attacks but with residual damage to heart muscle that leads to HF), heart valve disease, disease of the cardiac muscle, diabetes, and sometimes excess alcohol or toxicity from other medications. Regardless of the cause, common symptoms of heart failure include: 

• Fluid retention: swelling of the ankles, legs or abdomen
• Chronic lack of energy or tiredness
• Shortness of breath especially on exertion or when lying flat (e.g. in bed).

These symptoms are not specific to heart failure but if a person is not known to have the disease, the presence of this combination of symptoms, especially in a person who has increased risk of developing heart failure, should prompt advice to see the GP in the first instance. 

For a patient with heart failure, self-monitoring their symptoms can help healthcare professionals to make appropriate adjustments to treatment medication.

Reviewing the patient’s medicines in the context of current treatment recommendations and considering aspects relevant to the consultation is a key part of preparation. If the patient has been in hospital, information in the discharge medicines referral may also be helpful. Table 1 outlines the more common treatments used in the management of heart failure and Table 2 summarises their licensed use or where there is NICE guidance.  

Whatever the cause or type of heart failure, if there is fluid retention diuretics will be required. Additional treatment recommendations depend on the type of heart failure and are based on the evidence from trials showing reduced mortality and/or improved quality of life. Medication doses will need to be individualised depending on the patient’s symptoms, observations such as blood pressure, heart rate, fluid balance and blood test results, and any co-morbidities.

NICE guidelines for chronic heart failure  alongside technology appraisals for individual medicines (sacubitril + valsartan, dapagliflozin, empagliflozin, ivabradine) give more information on place in therapy. 

For a patient with a new diagnosis of heart failure, specialist heart failure services in community or hospital teams (depending on local services) will initiate, titrate and monitor treatment and, once optimised, refer to their GP for ongoing review.