INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

METHODS

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

RESULTS

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

CONCLUSION

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.

Human ; Heart Failure ; Outpatient Care ; Ambulatory Care ; Primary Health Care

Background: The treatment of hypertension usually requires the use of at least two antihypertensive agents to achieve control. The combination of amlodipine plus valsartan has been shown to be effective in treating hypertensive patients with an excellent safety and tolerability profile. Data on itsefficacy and safety in Filipino patients is lacking.Methods: This was a multi-center, observational, postmarketing surveillance (PMS) study, involving about 367 centers in the Philippines. Amlodipine/valsartan 5/80 mg, 5/160 mg or 10/160 mg daily was prescribed to the study patients for 12 weeks. Study visits were conducted every four weeks, during which assessments of blood pressure (BP), compliance and presence of adverse events were made. Patients and physicians also completed a global assessment of efficacy, tolerability and compliance at the end of the study.Results: A total of 1,677 patients were included in the analysis. The study population was middle aged (mean age 53.5 plus or minus 11.7 years) and 54.4% were females. Mean BP at the baseline visit was 160.9 plus or minus 16.4/99.3 plus or minus 9.4 mm Hg. Amlodipine/valsartan effectively reduced the BP from baseline by 34.35 plus or minus 16.60/19.35 plus or minus 10.44 mm Hg (p less than 0.001). At the end of the study, 95.29% of patients had a BP less than 140/90 mm Hg. Only 111 (5.57%) of patients reported an adverse event, of which headache and dizziness/ lightheadedness were the most common.Conclusions: The fixed dose combination of amlodipine plus valsartan is effective and safe in the treatment of hypertensive Filipino patients.
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