Arrhythmias are common complications of heart failure, especially atrial fibrillation (AF) (figure 14) which can increase the risk of stroke and thromboembolism or ventricular arrhythmias.1
If patients with heart failure develop AF (figure 14) either permanent or paroxysmal, should be assessed for potentially reversible causes and stroke risk. Unless there is a very strong contra-indication, patients with heart failure and AF should be anticoagulated.
Episodes of asymptomatic, non-sustained ventricular tachycardia are common. “Complex ventricular arrhythmias”, include frequent premature ventricular complexes and non-sustained ventricular tachycardia are associated with a poor outcome.1
Patients with heart failure have a wide range of co-morbidities due to their advanced age. Some co-morbidities will cause heart failure in the first place, for example, cancer treatment with chemotherapy. Others are risk factors for developing heart failure, such as obesity or hypertension (see below). Polypharmacy is a common consequence and can be very challenging.
Co-morbidities of heart failure include:
Heart failure has a profound impact on quality of life, prognosis and survival of those affected. Its incidence and prevalence rise with age due to better healthcare and therapeutic advances. It is a costly condition to diagnose and manage, representing 1–2% of total NHS expenditure and an annual cost of care of £625 million, mainly due to the high rates of readmission, high volume of consultations and prescriptions.
Survival rates for acute heart failure vary post discharge depending on age at admission, presence or absence of LVSD, place of care (cardiology ward or general medical ward), therapeutic options (whether ACE inhibitors, ARBs, beta blockers and diuretics have been initiated according to guidelines) and on referral follow up with a cardiology specialist.
The pathophysiology of heart failure remains key to understanding how to diagnose and manage the different types of heart failure accordingly.
In following modules, we will explore investigations, diagnosis algorithm and pharmacological and non-pharmacological options for the management of heart failure.
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Further recommended reading
Henderson J. A Life of Ernest Starling. Oxford University Press, 2010