| Challenges | |
Signs and Symptoms | Breathlessness, ankle swelling and fatigue are atypical Lack of specificity and accuracy | |
Patient limitations | Lack of awareness about: Risk factors Signs and symptoms The need to consult | |
Identifying patients at risk | Conditions that should prompt cardiac function evaluation include: | |
MI Arterial HTN CAD Diabetes | Chemotherapy CKD LVH A-fib | |
In addition to alcohol abuse, family history of cardiomyopathy or sudden death | ||
Testing limitations | Availability and cost of: HF biomarker tests, echocardiography, CT scan, coronary angiography Availability of tests in remote areas Confounding factors biasing test results: obesity, diabetes, age, etc. | |
HF unit in hospitals | Lack of multidisciplinary HF management with home-based or clinic-based programs Lack of HF patient self-management education | |
Medications | Knowledge of: Disease-modifying drugs (starting and target doses) Optimal sequencing according to patient profile 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 | Need to detect asymptomatic disease or risk factor progression Need to monitor adequacy of treatment and doses Implement new advances in care | |
Telemonitoring and e-records | Absence of telemonitoring system Inability to obtain patient data to guide therapy or seek medical care |