May 2014, 22:12
05 August 2014
Malaysia CPG for Heart Failure
Jeyamalar Rajadurai, David Chew, Hasri Samion, Kannan Pasamanickam, Mohd Rahal Yusoff,Nik Mazlina binti Mohammad, Robaayah Zambahari, Sim Kui Hian, Sree Raman and 1 more
Heart Failure (HF) is a clinical diagnosis. To satisfy the definition of HF, symptoms, signs and/or objective evidence of cardiac dysfunction must be present. (Fig. 1)
HF may be the result of any disorder of the endocardium, myocardium, pericardium or great vessels although commonly, it is due to myocardial dysfunction. It may occur in the presence of reduced left ventricular (LV) function, the left ventricular ejection fraction (LVEF) <40% (HFrEF) or with normal LV function, the LVEF > 50% (HF with with preserved LV function -HFpEF). If the LVEF is 41-49% it is called HFpEF, borderline.
It may be classified as Acute HF or chronic HF depending on the acuteness of the clinical presentation.
HF is not a complete diagnosis. It is important to identify the underlying disease and the precipitating cause(s), if present. Common causes are coronary artery disease and hypertension. Patients with Chronic HF may occasionally develop acute decompensation. Important causes that can lead to this Acute HF include acute myocardial infarction/ myocardial ischemia, arrhythmias (e.g. atrial fi brillation) and uncontrolled Blood Pressure. (Fig. 2)
Prevention and early intervention wherever appropriate, should be the primary objective of management. (Fig. 3)
Management of HFrEF (both Acute HF and Chronic HF) and grades of recommendations are as outlined in Flow Charts 1 & 2 and Tables 1 & 2.
Management of HFpEF remains empiric since trial data are limited.
Non pharmacological measures includes counseling the patient and family about the disease, diet and fl uid intake, regular exercise and appropriate lifestyle changes such as smoking cessation and abstinence from alcohol.
HF in pregnancy and in children are best managed in tertiary centres.
Performance measures should be instituted to assess quality of care.
Heart Failure - Left Ventricular Ejection Fraction - Acute Myocardial Infarction - Chronic Heart Failure - Clinical Practice Guideline
Consultant Cardiologist, Consultant Paediatric Cardiologist, Family Medicine Specialist, Senior Consultant Cardiologist, Senior Consultant Physician
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