Heart failure for healthcare providers

• Clinical audit – optimising treatment in patients with heart failure(external link)  BPAC, NZ, 2023. This helps clinicians identify patients who have been diagnosed with heart failure for at least three months to assess whether they are receiving optimal care.
• Addressing heart failure in primary care PART 1(external link) PART 2(external link) BPAC, 2022 NZ
• NZ guidelines for the management of chronic heart failure(external link) The National Heart Foundation of NZ, 2009
• Guidelines for the prevention, detection, and management of heart failure in Australia 2018(external link) National Heart Foundation of Australia and Cardiac Society of Australia and NZ, 2018
• Beta-blockers for cardiovascular conditions: one size does not fit all patients(external link) BPAC, NZ, 2017
• Guide for initiation and up-titration of ACE inhibitors in patients with heart failure(external link) Waitematā District Health Board, NZ, 2014
• Managing patients with heart failure in primary care(external link) BPAC, NZ, 2013
• Identifying patients with heart failure in primary care(external link) BPAC, NZ, 2013
• ACE Inhibitor titration for heart failure(external link) SAFERx, Waitematā DHB, NZ, 2013
• Congestive heart failure – te mate manawa kikī(external link) HQSC, NZ, 2019
• Cardiology Research Review Issue 80(external link) Research Review, NZ, 2019
• Management of iron deficiency in chronic heart failure Research Review, NZ, 2019

High-Intensity Care After Acute HF Pays Off Across LVEF Spectrum: STRONG-HF

The benefits of close follow-up and rapid uptitration of medications after an acute heart failure (HF) hospitalization apply to patients across the range of left ventricular ejection fraction, according to an analysis of the STRONG-HF trial. Read more about the trial on the tctMD site, March 2023. (external link)

Management of heart failure

"Once heart failure has been diagnosed, the goal of treatment is to improve symptoms and signs and avoid or reduce hospital admissions. In the majority of patients with symptomatic heart failure,

• a diuretic is used first-line to reduce fluid overload.
• An ACE inhibitor and beta-blocker are then added,
• followed by spironolactone if the patient is still symptomatic.
• An angiotensin-II receptor blocker, digoxin and anticoagulants can be added as appropriate.
• Surgical interventions may be considered for some patients." 

Read more about Identifying patients with heart failure in primary care(external link) BPAC, NZ, 2013

Management of iron deficiency in chronic heart failure

The following information is taken from a research review education series.

• "Anaemia is a frequent finding in patients with chronic heart failure (CHF), being present in approximately one-third of patients with CHF.
• Anaemia in CHF increases the risk of hospitalisation and death, and also leads to substantial reductions in exercise tolerance and quality of life (QOL). 
• The pathophysiology of anaemia in CHF is multifactorial. Iron deficiency is the most common cause of anaemia in patients with CHF,  and it is increasingly being recognised that CHF is an iron-deficient state.
• Measurement of serum ferritin alone cannot exclude iron deficiency in patients with CHF. Ferritin is an acute phase reactant and levels increase in response to inflammation, which complicates the diagnosis of iron deficiency. 
• Due to the inflammation associated with CHF, diagnosis of iron deficiency in patients with CHF should be based on both serum ferritin levels and transferrin saturation (TSAT) as follows:
                'Ferritin <100 μg/L (absolute iron deficiency); or Ferritin 100–300 μg/L with TSAT <20% (functional iron deficiency)'
• Australia and New Zealand 2018 guidelines practice advise that oral iron supplementation is ineffective at normalising iron status or improving QOL in patients with CHF. IV iron should be considered in patients with CHF associated with iron deficiency, with or without anaemia." 

Read more about Management of iron deficiency in chronic heart failure Research Review, NZ, 2019

e-Learning courses

Support people to stay well with heart failure(external link) LearnOnline, NZ

Videos and webinars

Video: PHARMAC seminars: Congestive heart failure - Professor Gerry Devlin – Prof. Gerry Devlin (52 minutes)

(PHARMAC Seminars, NZ, 2019)

Video: Goodfellow Unit: Internal medicine day - Heart Failure

(The Goodfellow Unit, NZ, 2018)

Video: Congestive heart failure by Dr Hitesh Patel

(external link)
(Ascot Cardiology Symposium, NZ, 2014)

Heart failure