Chronic heart failure guidelines.

I read the editorial of M. R. Cowie with great interest. The figures on the prognosis of heart failure were admirably clear. Nobody can deny the grim prognosis of heart failure patients, as reported by Mosterd and colleagues in the article to which the editorial refers. Cowie identifies patients who are likely to do especially badly: the very old, those with impaired renal function, diabetes and low blood pressure. It surprised me, however, that Cowie writes that we have disappointingly little to offer these sick, old patients with serious co-morbidity. It is generally recognized that several non-pharmacological management programmes can offer a lot to patients with advanced heart failure. These programmes often include components such as close follow-up, optimal medical treatment, intensive patient education, early attention to signs and symptoms and increased access to health care providers. In several studies, these management programmes demonstrated positive patient outcomes. Both clinic and home based interventions are tested for effectiveness. Outcomes include lower readmission rates and hospital readmission days, improved quality of life and functional capacity and a survival advantage. As Cowie states, increasingly complex poly-pharmacy is a challenge for health care providers in many European countries. In a comprehensive heart failure management programme these problems are optimally addressed. Complex medication schedules are simplified if possible and patient-tailored solutions are sought to improve patient compliance, relieve distress from side-effects and avoid medication interactions. A heart failure (nurse) specialist often liaises with other specialists to co-ordinate the complex care needed for the different co-morbidities. However, there is still a lot to be done a lot to improve the quality of life of patients by addressing the concerns of patients and families so that they can regain control of as much of their lives as possible. It is, of course, important to make sure that the programmes for the elderly are suitable. The results from several studies indicate that is necessary to broaden the ‘real health care world’ with a multidisciplinary approach, offering the severely affected heart failure patient maximal treatment and care.