From the Research
The first line of management for heart failure in a general practice setting in New Zealand involves ACE inhibitors and beta-blockers, typically started at low doses and gradually titrated upward as tolerated, as recommended by the most recent and highest quality study 1. The management of heart failure in a general practice setting in New Zealand should prioritize reducing morbidity, mortality, and improving quality of life.
Key Considerations
- ACE inhibitors, such as cilazapril, enalapril, or lisinopril, are recommended as first-line treatment for heart failure, due to their ability to reduce mortality and morbidity 2, 3.
- Beta-blockers, such as carvedilol, metoprolol, or bisoprolol, should also be initiated, as they have been shown to improve survival and reduce hospitalizations in patients with heart failure 3, 4.
- Diuretics, like furosemide (20-40mg daily), may be added to manage fluid overload symptoms, and angiotensin receptor blockers (ARBs) such as candesartan or losartan can be used as alternatives for patients who cannot tolerate ACE inhibitors 2, 5.
- Regular monitoring of renal function and electrolytes is essential, particularly during medication initiation and dose adjustments, to minimize the risk of adverse effects 2, 5.
- Lifestyle modifications, including salt restriction, fluid restriction if needed, regular physical activity as tolerated, and smoking cessation, should accompany pharmacological treatment to optimize outcomes 3, 4.
- Early referral to a cardiologist is recommended for patients with severe symptoms, rapid deterioration, or complex comorbidities, to ensure timely and specialized care 3, 4.
Recent Developments
- The use of sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has been shown to be superior to ACE inhibitors in improving prognosis in patients with heart failure with reduced ejection fraction (HFrEF) 1.
- This novel therapy may offer additional benefits in terms of reducing cardiac workload, inhibiting harmful neurohormonal activation, and improving cardiac remodeling, and its potential uses in hypertension and heart failure are being explored 1.