Contemplating Heart failure management as your next step?
The prospect of conducting Heart failure reviews might initially feel overwhelming for many pharmacists. However, with the right guidance and support, you can equip yourself with the knowledge and confidence needed to support your practice with Heart failure reviews. Drawing inspiration from our recent podcast episode, this article outlines the five critical checkpoints that pharmacists need to prioritise when conducting a Heart failure review.
1. Patients with LVSD Classification
One essential step is to take into consideration the classification of Heart failure the patient has. For instance, when dealing with patients classified under LVSD, pharmacists must ensure that the patient is receiving appropriate treatment, encompassing an ACE inhibitor/angiotensin receptor blocker, and a beta blocker. It's crucial to review these medications, not only to check that they are on them, but also to ensure they are optimised at the maximum tolerated doses.
2. Annual Review & Functional Capacity Assessment
It is equally important to ensure that each patient undergoes both an annual review, and an assessment of functional capacity. This is applicable to all patients, irrespective of their Heart failure classification. The functional capacity assessment acts as a grading system and is used to assess a patient's ability to perform daily activities - a concept similar to the COPD breathlessness score.
3. Evaluation of Heart Failure Symptoms
Pharmacists must also ensure that they evaluate the Heart failure symptoms exhibited by the patient. This includes breathlessness, ankle swelling, and weight, as these indicate the level of fluid retention. Weight monitoring, in particular, is very important.
4. Assessment of Pulse & Regularity
Pharmacists should also check their patient's pulse. There is a cycle of interdependence between heart failure and atrial fibrillation and each makes the other more likely to occur. For that reason, it's crucial this is done manually to check for regularity, as it won't be picked up by a machine or may display as an error.
5. Examination of Blood Pressure & Blood Tests
As expected, monitoring the patient's blood pressure is an important aspect of a Heart failure review. It's also essential for pharmacists to routinely request specific blood monitoring parameters, including their full blood count, urea & electrolyte levels, kidney function, HbA1c, and non-fasting lipid levels.
In addition the these 5 key checks, other general checks such as reviewing & stopping other OTC & prescribed medications that can worsen heart failure, advice on fluid intake, smoking cessation & alcohol intake, appropriate exercise & immunisations should also be addressed during a review.
The highlighted points above capture the essential checks that pharmacists need to consider during Heart failure reviews. Understanding and implementing these essential checks can enable you to not only enhance Heart failure management, but also contribute to a better understanding of other chronic & acute conditions that you may come across, enabling you to identify red flags and manage your patient holistically.
If you are interested in learning more, we encourage you to explore our comprehensive training program on Heart failure reviews here:: https://cpaweb.org.uk/p/heart-failure-reviews
Additionally, you can tune in to our recent podcast episode on Heart failure reviews here: https://youtu.be/Q6kdo1QCEco