General Practice Heart Failure Review Template

Symptoms	Are symptoms stable? Are they still symptomatic? If so escalate treatment as per pathways Are they becoming fluid overloaded or dehydrated? Record weight, blood pressure and pulse Check and record pulse rhythm using a code
Medication review	For Heart Failure with a reduced ejection fraction: ACEi / ARB at maximum tolerated licenced dose? If not titrate up unless BP less than 90 systolic or side effects Beta blocker at maximum tolerated licenced dose? If not titrate up unless BP less than 90 systolic or side effects Mineralocorticoid Receptor Antagonist (MRA; e.g. Eplereonone for men or Spironolactone for women) at maximum tolerated licenced dose? Start Dapagliflozin or empagliflozin for heart failure If they remain symptomatic after the above (any degree of breathlessness or other HF symptoms) – refer to hospital clinic for consideration of other therapies. For Heart Failure with preserved ejection fraction: No evidence for disease modifying therapies Titrate diuretics to symptoms and oedema
Bloods	Renal function, potassium, sodium, haemoglobin stable?
Comorbidities and risk factors	Hypertension, Diabetes, Atrial fibrillation Smoking cessation Alcohol intake Cognitive status and nutritional status
Other tests and treatments	Flu / pneumococcal vaccine is recommended for all HF patients Annual ECG: if QRS width is newly >130ms (3.25 small squares) then refer for reassessment in hospital HF clinic (to consider Cardiac Resynchronisation Therapy) Consider resuscitation status and advanced care planning

As per NICE guidance we aim that patients should be discharged back to GP care once all appropriate hospital therapies have been considered.

Heart failure treatment pathways

The community heart failure nurses also have limited capacity and do not routinely review stable patients once they have been established on a suitable medication regime.

Related Posts