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BPJ 50 February 2013

Best Practice Journal

Identifying patients with heart failure in primary care

Heart failure is now described as either heart failure with reduced ejection fraction (HF-REF) or heart failure with preserved ejection fraction (HF-PEF). Identifying people with suspected heart failure in primary care is often based on the patient’s presenting symptoms and signs. Ideally, a formal diagnosis should always be made with echocardiogram, however, referring every patient with suspected heart failure is likely to be impractical, given resource limitations. Other investigations such as brain natriuretic peptide (BNP) and electrocardiography (ECG) can assist in making a diagnosis. View Article

Managing patients with heart failure in primary care

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. View Article

Dabigatran revisited

Dabigatran has been available for general practitioners to prescribe since July, 2011. Dabigatran is indicated for prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation, and for venous thromboembolism prophylaxis after major orthopaedic surgery (specifically hip and knee replacement). There is currently no evidence that it should be used for indications other than these. Non-haemorrhagic gastrointestinal adverse effects (primarily dyspepsia) are the most frequently reported adverse reaction to dabigatran, although bleeding, as with any anticoagulant medicine, remains one of the main risks. There have been no reports of new adverse effects emerging since dabigatran has been used in general practice. View Article

Encouraging smoke-free pregnancies: the role of primary care

One in ten New Zealand women smoke during pregnancy and this figure is significantly higher among Māori and women living in lower socioeconomic areas. Prospective parenthood provides motivation to stop smoking and health professionals can increase smoking cessation rates by offering support at this time. Non-pharmacological interventions are first-line for women who want to stop smoking during pregnancy or while breast feeding, however, nicotine replacement therapy (NRT) is appropriate, following a brief risk-benefit assessment. The post-partum period is characterised by a high level of smoking relapse, especially among women who live in households with other people who smoke. Therefore it is important that smoking cessation advice also includes partners and family/whānau. View Article