Heart failure - assessment answers

1. Which of the following is not one of the four pillars of pharmacotherapy for heart failure with reduced ejection fraction?
c. Diuretic

2. What is the target dose of sacubitril + valsartan for chronic heart failure?
d. Sacubitril 97mg + valsartan 103mg twice daily

3. In primary care, over what time period should the four pillars be optimised?
b. Six to 12 weeks

4. Which two statements regarding the treatment of hypervolaemia in people with heart failure are correct?
a. Symptoms should be treated with a diuretic, with the aim of reducing the medication as symptoms resolve
c. Treatment with the four pillars can help with hypervolaemia due to the diuretic effects of some agents

5. Most people with heart failure want more information about the condition, and GPs are a preferred and trusted source of that information. True or False?
a. True

6. Which three statements regarding the conversations you should have with people with heart failure are correct?
a. Always check for patient understanding about heart failure
c. Discuss a medicines therapy plan with all patients at the time of diagnosis – starting all four pillars as soon as possible after diagnosis is important
e. It is helpful to involve whānau and provide written information to back up your conversations

7. Name two potential barriers to optimal treatment for people with heart failure.
Possibilities include: lack of understanding or engagement; time required for appointments, blood tests and travel to the clinic; cost of appointments and medicines (eg, co-payments); side effects of treatment (eg, hypotension or postural hypotension).

8. Initiating and optimising the four pillars requires weeks of close monitoring and medication changes. Name one way you could reduce your time commitment.
Possibilities include: following up virtually using video, telephone or email; involving others for some of the clinical variable monitoring (eg, medical care assistants, kaiawhina); using other clinicians to monitor and titrate the medicines (eg, the practice-based clinical advisory pharmacist, pharmacist prescriber or nurse practitioner); collaborating with Māori and Pacific health providers.

9. Which two statements regarding initiation and optimisation of the four pillars are correct?
b. Eplerenone is an alternative MRA available with Special Authority approval if spironolactone is not tolerated
c. If the patient is taking a diuretic, the diuretic properties of some agents within the four pillars should be considered

10. For a patient already taking an ACE inhibitor, how should you initiate sacubitril + valsartan?
b. Switch to sacubitril + valsartan at least 36 hours after the last dose of ACE inhibitor

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