Heart failure is an important public health problem that is associated with significant morbidity, mortality and healthcare costs, especially in the over-65s. Despite reductions in HF-related mortality, hospitalisations remain frequent and readmissions continue to rise. It is these admissions to hospital that put a financial strain on the local health economy, and cause stress and anxiety for the patient and supporting family.
Evidence-based guidelines offer many options to improve and extend the lives of patients with heart failure (HF). This article reviews current best practice in the management of chronic HF and of acute decompensated HF, and considers recent insights, controversies and innovations in this important field.
Optimising the management of heart failure improves patient survival and reduces hospital admissions. However, standards of care continue to vary, and many HF patients are still not receiving recommended therapy with diseasemodifying drugs or specialist input to their care. Outcomes will only improve for all HF patients if evidence-based clinical guidelines are implemented throughout the NHS.
Good hydration is essential for health, especially for people who may not feel thirsty because of ageing or illness. Maintaining good levels of hydration can prevent or help in treating low blood pressure, urinary infections and constipation. It's so easy to assess hydration status - this useful guide will help.
Colder days and longer nights are reminders that the annual winter flu season is here. It's important to offer flu vaccination to vulnerable patients (young children, the elderly and people with underlying health conditions) to help prevent serious complications. This Back to Basics will help you to make sure that your practice is offering the right flu vaccine.
Chronic kidney disease (CKD) is now classified using a combination of estimated glomerular filtration rate (eGFR) and proteinuria measured by albumin:creatinine ratio (ACR). The aim is to more accurately define each patient’s risk of cardiovascular disease and worsening CKD, and to ensure that patients are monitored appropriately.
Diabetes clinics form a major part of the workload for practice nurses, but 95% of routine diabetes care is delivered by patients themselves or by family members and carers. It is imperative that we offer people with diabetes concise, up-to-date education for effective foot care and to prevent complications.
Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their in-built reserves. This means the person is vulnerable to dramatic, sudden changes in health triggered by seemingly small events such as a minor infection or a change in medication.
A commonly heard clinical expression is "He/she is very frail". It provides a summary statement of an older person that implies concerns over vulnerability and prognosis. This is how we have conventionally considered frailty—as a descriptive label: 'the frail elderly'. In this article, we will re-frame frailty in a potentially more helpful way. We will examine frailty from the perspective of an abnormal health state that behaves just like a long-term condition. This conceptualisation of frailty opens up new approaches to helping people who are frail.