Archive \ Volume.13 2022 Issue 1

Congestive Heart Failure: Diagnosis and Management in Primary Health Care

Ibrahim Abdulrahman Altukhays¹*, Salman Hejab Alosaimi¹, Meshari Assaf Alotaibi¹, Amirh Ayman Zamzami², Zainab Adel Slais², Amani Mohammed Al Zainaldeen², Laila Hassan Hakami³, Badria Fahad Al Saber³, Ahmed Sanad Ibrahim Alrashidi⁴, Khaled Soud  Alraddadi ⁴, ‎‏Maitham Ahmed Alfardan⁵, Mohammed Abdulrahman Alotaibi⁶

¹Department of Family Medicine, ‎‏Dwadmi Hospital, Dwadmi, KSA. ²Faculty of Medicine, Medical University of Lodz, Lodz, Poland. ³Faculty of Medicine, King Khaled Hospital, Al-Kharj, KSA. ⁴MBBS, King Salman Bin Abdulaziz Medical City, Madina, KSA.⁵Emergency Department, ‎‏Oyun Central Hospital, Al Ahsa, KSA. ⁶Faculty of Medicine, Shaqra University, Shaqra, KSA.

Abstract

Heart failure disease has been one of the major chronic cardiovascular diseases that cause morbidity, mortality, and hospitalization of all cardiac patients. Heart failure has a significantly increased lifetime risk of development is about 20%. Symptomatic predictions are usually non-specific and hardly can discriminate the occurrence of heart failure from other diseases. It represents a challenging problem because of its economical and medical burden on the health care system. However, the management and presentation of a patient with heart failure remain in the fields of doubt. This review will highlight the importance of diagnosing and managing Congestive heart failure patients for primary health care physicians. This review was collected and classified from eligible published English written documents, articles, clinical trials. This electronic research engine was included: PubMed. This review discussed the diagnosis and management of Congestive heart failure and the details regarding this topic including definitions classifications, were included in this review. The primary care physician approach is often concerned with traditional palliative therapies before worsening the condition and plans to assess different reports regarding heart failure patients throughout their follow-up schedules.

Keywords: Congestive heart failure, Diagnosis, Management, Prognosis, Primary health care

INTRODUCTION

Heart failure disease has been one of the major chronic cardiovascular diseases that cause morbidity, mortality, and hospitalization of all cardiac patients. Heart failure has a significantly increased lifetime risk of development is about 20% [1, 2]. Other studies estimated the overall lifetime risk percent according to gender, where men 33% are higher in developing heart failure than women 28% [3, 4]. Although, congestive heart failure prevalence differs according to the specific studied population. However, the estimated prevalence of heart failure is roughly 1-2% and might increase to >10% among people over 70 of age [4, 5]. Furthermore, there has been a remarkable escalation in the incidence of chronic cardiovascular diseases in recent decades [6, 7].

The final stage of various cardiac issues is usually congestive heart failure. It is represented as a challenging problem because of its economical and medical burden on the health care system. Understanding the pathological and physiological condition of congestive heart failure has improved over the past 20 -30 years, where new modalities for identifying therapies are developed [4, 8].

However, the management and presentation of a patient with heart failure remain in the fields of doubt. In this review, we will highlight the importance of diagnosing and managing Congestive heart failure patients for primary health care physicians.

Low-frequency neuromuscular stimulation is a safe and effective rehabilitation protocol that could partially reverse the abnormal response to exercise in advanced heart failure patients helping in their symptoms and improved activities [9].

In a study, Rano K. sinuraya et al. revealed that the Cost related to CVD in all primary health care centers in Bandung is higher after the implementation of national health insurance [10].

MATERIALS AND METHODS

This review was collected and classified from eligible published English written documents, articles, clinical trials. This electronic research engine was included: PubMed. The keywords “Congestive” ‘Heart’ and ‘Failure’ including words used in Mesh ((((‘Diagnosis’ [Mesh])), ((‘Prognosis’ [Mesh])), ((‘Management’ [Mesh])), ((‘Primary’ [Mesh])) were used in combinations. This review discussed the diagnosis and management of Congestive heart failure and the details regarding this topic including definitions classifications, were included in this review.

Review

Diagnosis

Symptoms and Signs in Clinical Presentation

The progression and prognostic assessment of congestive heart failure depend on the European Society of Cardiology (ESC) 2016 guidelines for diagnosing and treating acute and chronic heart failure and the American college of cardiology\ American heart association (ACC\AHA) [11]. Symptomatic predictions are usually non-specific and hardly can discriminate the occurrence of heart failure from other diseases. However, detection of the early signs of heart failure can be more specific, such as apical impulse displacement and jugular venous pressure elevation (Table 1) [11-13].

Risk Factors and Prognosis

In general, heart failure outcome is associated with many significant dependents and independent risk factors. Ethnicity is one of the major risk factors that affect the outcome of the diseases. The predictions of increased risk of deaths in Asian patients with heart failure differ from the European ones [14-16]. Gender differences have often a greater impact impairing the quality of life in patients. In several studies, the overall lifetime risk percent according to gender were men 33% are higher in developing heart failure than women 28% [3, 4].  However, other studies introduced women to have a stronger probability to be affected by congestive heart failure than most men. Moreover, women have a greater probability of developing typical heart failure with preserved ejection fraction than men [17, 18]. Compared to men women have different physiological features that are considered a strong risk factor for heart failure development (Table 2) [19].

Unplanned hospitalization of patients with heart failure, nominates marks of mortality, and recurrent hospitalization [16, 20, 21]. Cardiovascular and non-cardiovascular comorbid diseases play a sensitive role in maintaining the prognostic statements of congestive heart failure progression. These comorbidities highly impact the diagnosis and management of heart failure. Diabetes, anemia, and metabolic iron deficiency (Table 3) are often observed in congestive heart failure patients and are acknowledged to complication the prognostic assessment of heart failure.

Diabetes mellitus risk of presence might not worsen the survival rate after all, but it does interplay a significant role with the etiology that increases the risk of deaths in patients with heart failure. This depends on the duration, other comorbidities, and damaged organs (Table 4) [22, 23]. Diabetes type 2 is found to have strong mortality risks in heart failure patients compared with cardiac patients without diabetes [22, 24].

Practical Management of Congestive Heart Failure in Primary Healthcare

In the practical management of congestive heart failure, patients might experience various levels of intense symptoms and signs underlying this condition. The primary care physician approach is often concerned with traditional palliative therapies before worsening the condition and plans to assess different reports regarding heart failure patients throughout their follow-up schedules. If the role of palliative care is ineffectual then a referral should be noted [25]. The (Table 5) below presents a brief idea about the practical management of heart failure with preserved ejection fraction [26].

CONCLUSION

Heart failure has a significantly increased lifetime risk of development is about 20%. The final stage of various cardiac issues is usually congestive heart failure. It is represented as a challenging problem because of its economical and medical burden on the health care system. Ethnicity and gender differences had often a greater impact impairing the quality of life in patients. However, the progression and prognostic assessment of congestive heart failure depend on the European Society of Cardiology (ESC) 2016 guidelines for diagnosing and treating acute and chronic heart failure and the American college of cardiology\ American heart association (ACC\AHA. In the practical management of congestive heart failure, patients might experience various levels of intense symptoms and signs underlying this condition. The primary care physician approach is often concerned with traditional palliative therapies before worsening the condition and plans to assess different reports regarding heart failure patients throughout their follow-up schedules. If the role of palliative care is ineffectual then a referral should be noted.

ACKNOWLEDGMENTS: None

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT: None

ETHICS STATEMENT: None