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CONTINUING PROFESSIONAL DEVELOPMENT
and avoidance of medications that can
exacerbate heart failure. ACE inhibitors
and beta-blockers are under-prescribed
and often not used at optimal doses,
and patients are often co-prescribed
medications that may exacerbate heart
failure (e.g. non-dihydropyridine calcium
channel blockers, tricyclic antidepressants,
NSAIDs and corticosteroids). Pharmacists
should provide education, support
and encouragement to patients about
recommended lifestyle changes to optimise
their health. Home medicines reviews
are an ideal opportunity to address these
recognised gaps in management.
Returning to the case, it would be important
to check that Mr MH is seeing his GP
regularly over the coming months to titrate
his bisoprolol dose to the recommended
maximum dose (or as tolerated). If available,
he should be encouraged to participate in a
disease-management program, which would
assist him and his family to understand heart
failure, the appropriate lifestyle interventions
and allow him to learn to self-manage the
condition. The pharmacist could also involve
Mr MH in a program to monitor adherence
to his medications, as non-adherence
is a common issue. Fish oil could also
be considered as an option to improve
outcomes at this stage. Given Mr MH’s recent
hospital admission, a medication review
may be appropriate in an attempt to engage
with the GP and Mr MH to further optimise
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1. What proportion of the Australian
population is estimated to have
2. Which ONE of the following features
is associated with heart failure with
preserved systolic function and not
with systolic heart failure?
c) Increased left ventricular wall thickness.
d) Ejection fraction <40%.
3. All of the following beta-blockers are
4. Cardioselective beta-blockers:
a) Are recommended in patients with mild
to moderate asthma under appropriate
supervision in patients with heart failure.
b) Are recommended in all patients with
asthma under appropriate supervision
following myocardial infarction.
c) Are recommended as first-line agents in
patients with hypertension and asthma.
d) a) and b).
5. Which ONE of the following
treatments has not been shown
to reduced mortality compared
to placebo in patients with heart
a) Fish oils.
EVIDENCE IN PATIENT CARE
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