From the Guidelines
The profile of a specific disease, in this case, heart failure, can be characterized by seven distinct profiles, ranging from critical cardiogenic shock to advanced NYHA class III, as outlined in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Disease Profile Overview
A disease profile for heart failure includes its definition, causes, symptoms, diagnosis, treatment options, and prognosis. Heart failure is a chronic progressive condition where the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen, leading to symptoms such as shortness of breath, fatigue, and swelling in the legs.
Key Features of Heart Failure Profiles
The profiles are as follows:
- Profile 1: Critical cardiogenic shock with life-threatening hypotension and rapidly escalating inotropic/pressor support.
- Profile 2: Progressive decline with dependence on inotropic support and signs of continuing deterioration.
- Profile 3: Stable but inotrope-dependent, with clinical stability on mild-moderate doses of intravenous inotropes.
- Profile 4: Resting symptoms on oral therapy at home, with frequent symptoms of congestion at rest or with activities of daily living.
- Profile 5: Exertion intolerant, with the patient being comfortable at rest but unable to engage in any activity.
- Profile 6: Exertion limited, with the patient being comfortable at rest without evidence of fluid overload but able to do only some mild activity.
- Profile 7: Advanced NYHA class III, with the patient being clinically stable with a reasonable level of comfortable activity despite a history of previous decompensation.
Modifier Options
Profiles 3 to 6 can be modified for patients with recurrent decompensations leading to frequent emergency department visits or hospitalizations, and other modifier options include arrhythmia and temporary circulatory support for hospitalized patients Profiles 1 to 3, as noted in the 2022 guideline 1.
Importance of Accurate Profiling
Accurate profiling of heart failure patients is crucial for guiding treatment decisions and improving patient outcomes, as it allows healthcare providers to tailor management strategies to the individual patient's needs and optimize their quality of life, as emphasized in the 2013 ACCF/AHA guideline for the management of heart failure 1.
From the Research
Disease Profile
- Hypertension is a leading modifiable risk factor for cardiovascular disease and the most common chronic condition seen by family physicians 2
- It is defined by an elevated systemic blood pressure and afflicts 30-40% of the adult population worldwide 3
- The disease burden for hypertension is great, and it greatly increases the risk of cardiovascular morbidity and mortality 3
Causes and Risk Factors
- Factors that result in an elevated blood pressure include genetic factors, a sedentary lifestyle, obesity, salt intake, aging, and stress 3
- The aetiology of hypertension involves the complex interplay of environmental and pathophysiological factors that affect multiple systems, as well as genetic predisposition 4
Treatment and Management
- Treatment of hypertension reduces morbidity and mortality due to coronary artery disease, myocardial infarction, heart failure, stroke, and chronic kidney disease 2
- First-line antihypertensive medications include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics 2, 4
- Lifestyle changes, including dietary modifications and increased physical activity, are effective in lowering BP and preventing hypertension and its CVD sequelae 4
- Combination therapy with calcium channel blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors has been shown to be an effective dual therapy 5, 6
Diagnosis and Evaluation
- Assessment of adults with hypertension should focus on identifying complications of the condition and comorbid cardiovascular risk factors 2
- The evaluation of patients with hypertension includes accurate standardized blood pressure measurement, assessment of the patients' predicted risk of atherosclerotic CVD and evidence of target-organ damage, and detection of secondary causes of hypertension and presence of comorbidities 4
- The use of ambulatory and home blood pressure monitoring improves diagnostic accuracy 2