Challenges

Signs and Symptoms

Ÿ Breathlessness, ankle swelling and fatigue are atypical

Ÿ Lack of specificity and accuracy

Patient limitations

Lack of awareness about:

Ÿ Risk factors

Ÿ Signs and symptoms

Ÿ The need to consult

Identifying patients at risk

Conditions that should prompt cardiac function evaluation include:

Ÿ MI

Ÿ Arterial HTN

Ÿ CAD

Ÿ Diabetes

Ÿ Chemotherapy

Ÿ CKD

Ÿ LVH

Ÿ A-fib

In addition to alcohol abuse, family history of cardiomyopathy or sudden death

Testing limitations

Ÿ Availability and cost of: HF biomarker tests, echocardiography, CT scan, coronary angiography

Ÿ Availability of tests in remote areas

Ÿ Confounding factors biasing test results: obesity, diabetes, age, etc.

HF unit in hospitals

Ÿ Lack of multidisciplinary HF management with home-based or clinic-based programs

Ÿ Lack of HF patient self-management education

Medications

Knowledge of:

Ÿ Disease-modifying drugs (starting and target doses)

Ÿ Optimal sequencing according to patient profile

Ÿ Drugs or drug combinations contraindicated in HF, such as class I antiarrhythmic drugs, calcium channel blockers (verapamil, diltiazem, nifedipine, etc.), thiazolidinediones in patients with NYHA class III or IV HF, NSAIDs and others [48]

Follow-up

Ÿ Need to detect asymptomatic disease or risk factor progression

Ÿ Need to monitor adequacy of treatment and doses

Ÿ Implement new advances in care

Telemonitoring and e-records

Ÿ Absence of telemonitoring system

Ÿ Inability to obtain patient data to guide therapy or seek medical care