The family physician’s role in treating CHF
Generalists should identify patients at risk
As more medical centers break ground on their heart failure clinics, specialists say the general practitioner will have an important role: identifying patients at risk, so aggressive treatment can be started before advanced disease develops.
"The biggest message is prevent, prevent, prevent," says Americo Simonini, MD, cardiologist for the CHF clinic being assembled at Cedars-Sinai Medical Center in Los Angeles.
"The risk factors are there — high BP, cardiographic evidence, an enlarged heart," Simonini says, but too often patients go on to develop heart disease that is difficult to reverse.
Find and treat patients quickly
"It’s important to identify these patients and modify their risk," he says. When patients are found with low ejection fraction or other signs of abnormal function, they can be referred to a heart failure center. These centers are more likely to do the following to get patients on a fast track to control their disease:
- The right regimen can be determined.
- Symptoms can be handled.
- Patients can get into clinical protocols.
"That’s very important," he says.
Simonini notes the perspectives change with treating CHF patients and many generalists may not be comfortable with the parameters of this type of care.
"The patients are a challenge," he says. Most have systolic blood pressure of 80, 85, or 90. "Most internists are not comfortable with that."
Treatment often requires doctors "to know what to push." That’s why only 30% of patients who could benefit from ACE inhibitors get them — and only a fraction of these patients get optimal doses.
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