Heart Failure Part 1

Summary

In this comprehensive teaching session, renowned cardiologist Dr. Patricia Campbell offers her expert insights into diagnosing and managing HFpEF, a complex condition affecting more than 50% of all heart failure cases. She shares a real-world case study and discusses research updates regarding the escalating public health challenge of heart failure, particularly in the context of an aging population. She breaks down the nuances of HFpEF, exploring definitions, diagnostic criteria, treatment strategies, and future care pathways. Gain not only a deeper understanding of HFpEF but also learn to apply a stepwise approach to diagnosis and treatment, focusing on co-morbidity management and the use of SGLT2 inhibitors. This is an invaluable learning opportunity for medical professionals dealing with cardiovascular health. Don't miss out on the chance to learn from an experienced clinical leader in the field.

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Description

About the MedAll Primary Care CPD Programme

We are passionate about making medical education free and more accessible. In light of the increasing financial pressures faced by healthcare professionals, including the rising cost of living and strained practice finances, we felt compelled to do something. It's why we have introduced a no-cost CPD programme for doctors, nurses and other healthcare professionals working in primary care. We recognise that the high expense of traditional CPD update courses is a significant barrier, and by collaborating as an entire primary care community we hope we can offer a practical, accessible alternative.

About our speaker: Prof Patricia Campbell

Prof Patricia Campbell is a Consultant Cardiologist and Heart Failure Lead in the Southern Trust in Northern Ireland since 2018, and in 2023 she was appointed the first Clinical Lead for Heart Failure for Northern Ireland.

Who Should Join?

✅ GPs

✅ Primary care and practice nurses

✅ Practice pharmacists

✅ Other allied healthcare professionals in primary care

Note: this event is not formally accredited by an external organisation for CPD points. The current guidance for GP CPD is that it is appropriate that the credits you self-allocate should equal however many hours you spent on learning activities, as long as they are demonstrated by a reflective note on lessons learned and any changes made or planned (if applicable).

Learning objectives

Understand the complexities in diagnosing and managing Heart Failure with Preserved Ejection Fraction (HFpEF).
Analyze different case studies to better understand the presentation of HFpEF in the clinical setting.
Gain a deeper understanding of the benefits and application of SGLT2 inhibitor in managing HFpEF patients.
Recognize the importance of effectively managing congestion in HFpEF patients to improve prognosis.
Examine how to manage various co-morbidities in HFpEF patients, and learn when to seek advice from HF cardiology specialist.

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How I diagnose and manage HFpEF Dr Patricia Campbell Consultant Cardiologist Southern Trust, NI Clinical Lead for HF, Northern IrelandDisclosures • Speaker Honoraria/Advisory Board: • Novartis, Pfizer, Astra Zeneca, Vifor, Pharmacosmos, Boehringer Ingelheim, Bayer67y female HTN x 25 years (lercanidipine, perindopril) Obesity BMI 37 T2DM HbA1C 117 (metformin, linagliptin) CKD GFR 48 Guillain-Barré syndrome 11 years ago67y female 4 hospital admission under medical teams in 4 months SOBOE, swollen legs BP 158/99 HR 90 sinus Soft pan systolic murmur Peripheral volume overload67y female Non-anaemic Hb 131 Normal WBC, inflammatory markers GFR 41, Na 130, K 4.7 Normal thyroid function Ferritin 130, Tsat 19% NTproBNP 1108pg/ml CXR upper lobe venous diversion, small bilateral pleural effusions 67y female Echo summary: “Pulmonary Referral sent for review in Hypertension” specialist centre Preserved LV systolic function. Mild LVH with diastolic dysfunction. Mild-moderate TR. High probability of pulmonary hypertension with estimated RVSP of 58mmHg.67y female • Each admission treated with IV diuretics and discharged after ~2Kg weight loss • Back in ~1 weeks later each time • I was then asked to see…HF Burden is Rising HFpEF >50% of all HF cases 1.6% of population have HF – Conrad N Lancet 2018;391:572–80 2023-2024 Update 1.06% General population screening 4.2%, 0.49% 11.8% of over 65y olds – Savji JACC Heart Fail 2018;6:701-709 https://www.health-ni.gov.uk/sites/default/files/publications/health/rdp-ni-2024.pdfJasinska-Piadlo A, Campbell P. Heart 2023;0:1–10. doi:10.1136/heartjnl-2022-321097 Myocardial Left ventricular fibrosis Congestion hypertrophy Abnormal cardiac Epicardial coronary contraction vascular disease Abnormal cardiac Microvascular coronary relaxation artery disease Pulmonary vessel Hypertension dysfunction Kidney impairment Right heart dysfunction Chronotropic Atrial Fibrillation incompetence Inflammation Diabetes Obesity Jasinska-Piadlo A, Campbell P. Heart 2023;0:1–10. doi:10.1136/heartjnl-2022-3210Why more HF in Northern Ireland? • Defining era in health care • Ageing population, largest growth >85y, projected to continue SYSTEMS, NOT STRUCTURES: CHANGING HEALTH & SOCIAL CARE https://www.health-ni.gov.uk/sites/default/files/publications/health/expert-panel-full-report.pdfP Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3Definition ESC definition: “Those with symptoms and signs of HF, HFpEF, simply put, is when a person has a diagnosis of heart failure with evidence of structural and/or functional cardiac abnormalities and their LVEF is 50% or higher and/or raised natriuretic peptides (NPs), and with an LVEF ≥50%, have HFpEF” STEP 1 80% diagnosed at this stage P Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3P Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3P Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3 LVH CXR findings NTproBNP 1108 RWT calc at 0.44 Lavoli 45 (SR) E/e’ 21 (SR) (IVS + PW/LVDd) TR Gradient 3.3m/s RAP 15Imagine her NTproBNP was 110 instead of 1108? P Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3HFAPEFF score 6 B Pieske DOI 10.1093/eurheartj/ehz641 H2FPEFF score 6 YNV Reddy doi.org/10.1161/CIRCULATIONAHA.118.034646What did I do? Screening for, treatment of Diuretics for SGLT2 inhibitor fluid retention aetiologies, CV and (Class I) non-CV comorbidities (Class I) (Class I) CV Loop (Furosemide, Bumetanide, Torasemide) AF: anticoagulate, rate ± rhythm control Dapagliflozin 10mg o.d. CAD: antiplatelet, lipid-lowering, revascularise Valvular heart disease +/- Thiazide (Bendroflumethiazide, HTN: ACEi/ARB, Calcium Channel Blockers, OR Chlorthalidone, Hydrochlorthiazide, diuretics Indapamide, Metolazone) Stroke Non-CV Empagliflozin 10mg o.d. +/- MRA (Spironolactone, Eplerenone) DM: SGLT2i; [avoid saxagliptin & TZD] Obesity: GLP-1RA, exercise, caloric restriction CKD: SGLT2i, ACEi/ARB, finerenone Lung disease/sleep disorder: OSA screen/treat Also: thyroid disorders, frailty / cachexia / sarcopenia, iron deficiency & anaemia, P Campbell. Lancet 2024 doi.org/10.1016/S0140-6736(23)02756-3 electrolyte disorders, gout & arthritis, erectile dysfunction, depression, cancer, infectionTreatment Dapagliflozin 10mg OD Bumetanide 2mg bid Increase ACEi Spironolactone 25mg od Sleep Cardiac rehabilitation Studies Change linagliptin for GLP1RAWhat might future care look like for HFpEF?? Might there be another ’pillar”? I think soFINEARTS-HF Hot off the press ESC 2024 Finerenone non steroidal MRA Conclusion • HFpEF diagnosis more complicated than LV systolic dysfunction • Use simple steps outlined to aid stepwise approach to diagnosis • SGLT2i • Treat congestion • Treat co-morbidities • Call on HF cardiologist for advice if unsure