Chronic Care - Professor Richard Kirk 2023

Professor Richard Kirk
MA FRCP FRCPCH
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Chronic Care
Clinic Follow Up Schedule*
Ejection FractionNT-proBNP (pg/ml)
  • < 35% - every 3 months
  • > 45% - if less than 12 yrs age every 6 months, if older annually
  • < 1,000 every 3 months
  • 1,000-4,000 every 1-2 months
  • > 5,000 monthly
  • >10,000 Admit to hospital
* Once the heart rate reduction strategy has been achieved by following  Figure 1 when the predominant physiology is HFrEF or Figure 2 when the physiology is HFpEF

If heart rate reduction is achieved and NT-proBNP >660 pg/ml adjust ACEi dose
If EF remains < 35% after 1 year on treatment consider ICD
Chronic Phase Medications
Patients
Class Medication
Details
AllACE inhibitors< 1 yr age captopril
> 1 yr Enalapril/Ramipril
EF < 45%MRA
β Blockers
Eplerenone/Aldactone
Carvedilol/Bisoprolol*
EF < 40%HCN channel blocker**Ivabridine
EF < 40% & NTproBNP>660 pg/mlARNi**Sacubritril/Valsartan
EF < 30%AntiplateletAsprin
VT or Atrial ArrhythmiaClass III antiarrhythmic
Amiodarone ? ICD if VT
* if diastolic pressure is low
** Reduce diuretics to prevent hypotension
Undertake
  • Annual CPET once older than 8 years. (the first 2 consecutive tests with similar results  I dont understand)
  • Cardiac MRI after 1 yr of maximum therapy to assess presence of LGE
Figure 1. HFrEF Physiology
Figure 2. HFpEF Physiology
Last Updated: April 2023
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