Heart Failure and Heart Failure and Qof QuizQof Quiz

Justin WalkerJustin Walker

October 2010October 2010

Old or New?Old or New?

Refer patients with suspected heart failure Refer patients with suspected heart failure and previous MI urgently, to have and previous MI urgently, to have transthoracic Doppler 2D transthoracic Doppler 2D echocardiography and specialist echocardiography and specialist assessment within 2 weeks.assessment within 2 weeks.

New!New!

Refer patients with suspected heart failure Refer patients with suspected heart failure and previous MI urgently, to have and previous MI urgently, to have transthoracic Doppler 2D transthoracic Doppler 2D echocardiography and specialist echocardiography and specialist assessment within 2 weeks.assessment within 2 weeks.

Old or New?Old or New?

People with suspected heart failure should People with suspected heart failure should initially have a 12 lead ECG and/or BNP to initially have a 12 lead ECG and/or BNP to exclude the condition.exclude the condition.

Old!Old!

2010 guidelines suggest echo 2010 guidelines suggest echo within 2 weeks if previous MI, within 2 weeks if previous MI, BNP if not.BNP if not.

True or False?True or False?

Which of the following factors can lower Which of the following factors can lower BNP?BNP? ObesityObesity DiureticsDiuretics ACE inhibitorsACE inhibitors TachycardiaTachycardia PEPE DiabetesDiabetes

True or False?True or False?

Which of the following factors can lower Which of the following factors can lower BNP?BNP? ObesityObesity TrueTrue DiureticsDiuretics TrueTrue ACE inhibitorsACE inhibitors TrueTrue TachycardiaTachycardia FalseFalse PEPE FalseFalse DiabetesDiabetes FalseFalse

True or False?True or False?

The normal range for BNP is 100-400 The normal range for BNP is 100-400 pg/mol.pg/mol.

False!False!

The normal range for BNP is <100 pg/mlThe normal range for BNP is <100 pg/ml Raised 100-400 pg/ml – Raised 100-400 pg/ml – Refer within 6 Refer within 6

weeksweeks High >400 pg/ml – High >400 pg/ml – Refer within 2 weeksRefer within 2 weeks

Beta BlockersBeta Blockers

Which of the following are licensed for the Which of the following are licensed for the treatment of heart failure?treatment of heart failure? AtenololAtenolol PropanololPropanolol BisoprololBisoprolol CarvedilolCarvedilol NebivololNebivolol LabetalolLabetalol SotalolSotalol

Beta BlockersBeta Blockers

Which of the following are licensed for the Which of the following are licensed for the treatment of heart failure?treatment of heart failure? BisoprololBisoprolol CarvedilolCarvedilol NebivololNebivolol

Bisoprolol and carvedilol in any grade of stable Bisoprolol and carvedilol in any grade of stable heart failure, nebivolol for stable mild to heart failure, nebivolol for stable mild to moderate HF.moderate HF.

Angiotensin II Receptor Angiotensin II Receptor AntagonistsAntagonists

Which of the following are licensed for use Which of the following are licensed for use in heart failure?in heart failure? CandesartanCandesartan EprosartanEprosartan IrbesartanIrbesartan LosartanLosartan ValsartanValsartan

Angiotensin II Receptor Angiotensin II Receptor AntagonistsAntagonists

Which of the following are licensed for use Which of the following are licensed for use in heart failure?in heart failure? CandesartanCandesartan LosartanLosartan ValsartanValsartan

Qof RationaleQof Rationale

Heart failure represents the only major Heart failure represents the only major cardiovascular disease with increasing cardiovascular disease with increasing prevalence.prevalence.

Dramatic impairment of quality of lifeDramatic impairment of quality of life Poor prognosisPoor prognosis Costly to treat.Costly to treat.

Which is the most expensive for the NHS, Which is the most expensive for the NHS, myocardial infarction, heart failure or stroke?myocardial infarction, heart failure or stroke?

RankingRanking

StrokeStrokeHeart failureHeart failureMyocardial infarctionMyocardial infarction

Qof IndicatorsQof Indicators Register of patients with heart failureRegister of patients with heart failure Percentage of patients with HF confirmed by Percentage of patients with HF confirmed by

echo or specialist assessment.echo or specialist assessment. Percentage of pts with HF due to LVD on an Percentage of pts with HF due to LVD on an

ACE-i or ARB who can tolerate therapy with no ACE-i or ARB who can tolerate therapy with no contraindication.contraindication.

Percentage of pts with HF due to LVD on an Percentage of pts with HF due to LVD on an ACE-i or ARB additionally treated with a licensed ACE-i or ARB additionally treated with a licensed beta-blocker or with recorded intolerance or beta-blocker or with recorded intolerance or contraindication.contraindication.

Points available 4,6,9,10 Points available 4,6,9,10

Qof IndicatorsQof Indicators

Register of patients with heart failure Register of patients with heart failure 4 points4 points Percentage of patients with HF confirmed by Percentage of patients with HF confirmed by

echo or specialist assessment. echo or specialist assessment. 6 points6 points Percentage of pts with HF due to LVD on an Percentage of pts with HF due to LVD on an

ACE-i or ARB who can tolerate therapy with no ACE-i or ARB who can tolerate therapy with no contraindication. contraindication. 10 points10 points

Percentage of pts with HF due to LVD on an Percentage of pts with HF due to LVD on an ACE-i or ARB additionally treated with a licensed ACE-i or ARB additionally treated with a licensed beta-blocker or with recorded intolerance or beta-blocker or with recorded intolerance or contraindication. contraindication. 9 points9 points