1. Heart Failure and Qof Quiz Justin Walker October 2010

2. Old or New?  Refer patients with suspected heart failure and previous MI urgently, to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks.

3. New!

4. Old or New?  People with suspected heart failure should initially have a 12 lead ECG and/or BNP to exclude the condition.

5. Old!  2010 guidelines suggest echo within 2 weeks if previous MI, BNP if not.

6. True or False?  Which of the following factors can lower BNP? Obesity Obesity Diuretics Diuretics ACE inhibitors ACE inhibitors Tachycardia Tachycardia PE PE Diabetes Diabetes

7. True or False?  Which of the following factors can lower BNP? ObesityTrue ObesityTrue DiureticsTrue DiureticsTrue ACE inhibitorsTrue ACE inhibitorsTrue TachycardiaFalse TachycardiaFalse PEFalse PEFalse DiabetesFalse DiabetesFalse

8. True or False?  The normal range for BNP is 100-400 pg/mol.

9. False!  The normal range for BNP is <100 pg/ml  Raised 100-400 pg/ml – Refer within 6 weeks  High >400 pg/ml – Refer within 2 weeks

10. Beta Blockers  Which of the following are licensed for the treatment of heart failure? Atenolol Atenolol Propanolol Propanolol Bisoprolol Bisoprolol Carvedilol Carvedilol Nebivolol Nebivolol Labetalol Labetalol Sotalol Sotalol

11. Beta Blockers  Which of the following are licensed for the treatment of heart failure? Bisoprolol Bisoprolol Carvedilol Carvedilol Nebivolol Nebivolol Bisoprolol and carvedilol in any grade of stable heart failure, nebivolol for stable mild to moderate HF.

12. Angiotensin II Receptor Antagonists  Which of the following are licensed for use in heart failure? Candesartan Candesartan Eprosartan Eprosartan Irbesartan Irbesartan Losartan Losartan Valsartan Valsartan

13. Angiotensin II Receptor Antagonists  Which of the following are licensed for use in heart failure? Candesartan Candesartan Losartan Losartan Valsartan Valsartan

14. Qof Rationale  Heart failure represents the only major cardiovascular disease with increasing prevalence.  Dramatic impairment of quality of life  Poor prognosis  Costly to treat.  Which is the most expensive for the NHS, myocardial infarction, heart failure or stroke?

15. Ranking  Stroke  Heart failure  Myocardial infarction

16. Qof Indicators  Register of patients with heart failure  Percentage of patients with HF confirmed by echo or specialist assessment.  Percentage of pts with HF due to LVD on an ACE-i or ARB who can tolerate therapy with no contraindication.  Percentage of pts with HF due to LVD on an ACE-i or ARB additionally treated with a licensed beta-blocker or with recorded intolerance or contraindication.  Points available 4,6,9,10

17. Qof Indicators  Register of patients with heart failure 4 points  Percentage of patients with HF confirmed by echo or specialist assessment. 6 points  Percentage of pts with HF due to LVD on an ACE-i or ARB who can tolerate therapy with no contraindication. 10 points  Percentage of pts with HF due to LVD on an ACE-i or ARB additionally treated with a licensed beta-blocker or with recorded intolerance or contraindication. 9 points