Disease Management and Practice Guidelines for Heart Failure

Abstract

Physicians informed about the current recommendations for diagnosis and management of heart failure find significant challenges applying up-to-date recommendations consistently in a population of patients. The first challenge is the chronicity of the disorder. The physician cannot be content to effectively manage the individual through an acute episode; the greater challenge is to prevent decompensations during the course of the illness. The second challenge is the prevalence of heart failure in elderly individuals. The prevalence of heart failure approaches 10% in individuals over age 80. In this age group, comorbidities create significant management challenges for the practicing physician at a significant cost. Whereas physicians may be mindful of the clinical morbidity and mortality associated with heart failure, they may be unaware of the total treatment costs for heart failure, including drugs, physician costs, and nursing home stays, costs estimated at more than $17 billion in health care expenditures yearly. The third challenge is the need to recognize that the physician alone cannot successfully manage heart failure. Because of the chronicity of the disorder, and the complexity of caring for older adults, primary care physicians must incorporate the patient, members of the patient’ s support network, other physician consultants, and other disciplines in a system of care.