title: Management of Chronic Heart Failure in Primary Care: What Evidence do we have for Heart Failure with Preserved Systolic Function?
abstract: Chronic Heart Failure (CHF) is a debilitating illness commonly encountered in primary care. Its prevalence in developing countries is rising as a result of an ageing population, and an escalating epidemic of hypertension, type 2 diabetes and coronary heart disease. CHF can be specifically diagnosed as Heart Failure with Reduced Systolic Function (HF-RSF) or Heart Failure with Preserved Systolic Function (HF-PSF). This paper illustrates a common presentation of HF-PSF in primary care; and critically appraises the evidence in support of its diagnosis, prognosis and management. Regardless of the specific diagnosis, long term management of CHF is intricate as it involves a complex interplay between medical, psychosocial, and behavioural factors. Hence, there is a pressing need for a multidisciplinary team management of CHF in primary care, and this usually takes place within the broader context of an integrated chronic disease management programme. Primary care physicians are ideally suited to lead multidisciplinary teams to ensure better co-ordination, continuity and quality of care is delivered for patients with chronic conditions across time and settings. Given the rising epidemic of cardiovascular risk factors in the Malaysian population, preventive strategies at the primary care level are likely to offer the greatest promise for reducing the growing burden of CHF.
authors.affiliation: MBBS (Newcastle-upon-Tyne), DFFP (UK), DRCOG (UK), MRCGP (UK), Fellow in Chronic Disease Management (Monash University, Melbourne), Head of Primary Care Medicine Discipline, Associate Professor & Consultant Family Medicine Specialist, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia (Anis Safura Ramli).
authors.forename: As
authors.initials: A
authors.lastname: Ramli
authors.affiliation: BMedSc, MBBS, MD, FRACP, FAHA, Medical Director, Chronic Heart Failure Program, Southern Health, Associate Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia (Bruce Jackson).
authors.forename: B
authors.initials: B
authors.lastname: Jackson
authors.affiliation: MPharm, FSHP, Senior Pharmacist, Chronic Heart Failure Program, Dandenong Hospital, Melbourne, Australia (Cjeng Tiong Toh).
authors.forename: Ct
authors.initials: C
authors.lastname: Toh
authors.affiliation: MBBS (Mangalore), MMed Family Medicine (UKM), Fellow in Community Geriatrics and Rehabilitation Medicine (Monash University, Melbourne), Senior Lecturer & Family Medicine Specialist, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia (Ambigga Devi).
authors.forename: D
authors.initials: D
authors.lastname: Ambigga
authors.affiliation: AM, MBBS, M.Med (Primary Care), M.Ed.St, FRCP (Edin), FRACGP, MD, Professor & Head of School of Primary Health Care, Pro Vice-Chancellor, Berwick Campus, Monash University, Melbourne, Australia (Leon Piterman).
authors.forename: L
authors.initials: L
authors.lastname: Piterman
keywords: Chronic heart failure; Malaysia; chronic disease management; preserved systolic function; primary care