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

Introduction: COVID-19 emerged as a new disease during the early period of 2020. Given that our institution is a cardiac specialty center and our patients have numerous co-morbidities compared to the general population, we wanted to determine the clinical profiles and in-hospital short-term outcomes of suspect, probable and confirmed adult COVID-19 patients seen at our institution. Methodology: We prospectively enrolled 323 adult (115 health care workers) suspect, probable and confirmed COVID- 19 patients admitted from March to June 2020. We described and analyzed their clinical presentation, and in-hospital outcomes. Results: There were 117 (36.22%) RT-PCR positive patients with 36.53% confirmed, 13.00% probable and 50.46% suspect patients. For probable and confirmed patients, 25%, 21.25%, 23.13% 16.25% had no, mild, moderate, and severe symptoms, respectively with 14.28% critical cases. Over-all mortality rate for probable and confirmed cases was 25.54% with 91.3% mortality rate for critical cases. Co-morbidities with statistically significant association with severity of disease were as follows: hypertension, heart disease, cerebrovascular disease, diabetes mellitus and COPD. Conclusion During the early period of the COVID-19 pandemic, only 36.53% of cases admitted at our institution were COVID-19 confirmed by RT-PCR. One-third of the cases were severe and critical, with more clinical instability, increased inflammatory markers, and higher in-hospital morbidity and mortality.
COVID-19 ; Pandemics ; Philippines