Managing heart failure: it is important that patients with heart failure are diagnosed and receive treatment as early as possible. Karen Boylett discusses how practice nurses can play a crucial role in early detection of the main risk factors and help ensure a systematic approach to patient care.(CHD)

KEY POINTS

* The most common cause of heart failure is coronary artery disease and about a third of cases result from hypertension. (1)

* A holistic approach to the management of heart failure, involving both primary and secondary care, may be one of the best way to deliver systematic care.

Heart failure is an increasingly important problem for primary care. It is almost as common as type 2 diabetes in older patients, with an incidence that is rising by 10% a year. (1) This is in spite of the fact that the incidence of most cardiovascular diseases has declined over the past 20 years. Heart failure is becoming more common, in part, because the population is ageing--most patients with heart failure are over the age of 75. But, ironically, improvements made in the secondary prevention of coronary heart disease have meant more patients are surviving after acute myocardial infarction and these patients are at increased risk of heart failure.

Heart failure, which arises because the heart muscle has become too weak to pump enough blood around the body to satisfy demand for oxygen, especially during exercise, is a common and debilitating disease that has an enormous impact on health services. The incidence of heart failure in the UK has been estimated at about one case per 1,000 population per year, with a steep rise with advancing age to over 10/1,000 in those aged over 85 years. (2) However, despite being more common than diseases such as AIDS, (3-4) the burden heart failure places on patients, their carers and on the NHS is often underestimated.

Many of the symptoms associated with heart failure--fluid retention, breathlessness, poor exercise tolerance with fatigue--are caused by dysfunction of organs other than the heart.

Ventricular dysfunction is usually the basic disorder in congestive heart failure and often triggers compensatory mechanisms that preserve cardiac output but produce symptoms and signs such as oedema and dyspnoea. The most common cause of heart failure is coronary …