Rossouw Liezel, Lachman Anthony S, Von Pressentin Klaus B
Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town.
S Afr Fam Pract (2004). 2025 Jun 13;67(1):e1-e8. doi: 10.4102/safp.v67i1.6126.
Heart failure poses a significant global health challenge, with a considerable burden in Africa, where the annual mortality rate stands at 34%, twice the global average. Patients suffering from acute heart failure occupy numerous beds at the district level, and only a limited number can be referred for further evaluation and imaging at secondary or tertiary care facilities. Patients rely on their primary care physicians for the diagnosis and management of heart failure, as well as for identifying those who would benefit from referral to cardiology and formal echocardiography. This article discusses the significance of the new heart failure guidelines within the South African primary care public setting. It emphasises the importance of identifying risk factors and considers the value of access to family physicians, outreach clinic doctors, training on available adult primary care guidelines and telemedicine-supported cardiac ultrasound. Optimal medical therapy, which includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and spironolactone, has been shown to reduce readmissions and mortality rates. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a potent addition to conventional therapy and are currently being considered for inclusion in the National Essential Medicines List. Patients admitted to the hospital should not be discharged while experiencing persistent congestion, as this is associated with an increased risk of rehospitalisation, mortality and higher healthcare costs. Comprehensive patient education regarding medications, thorough follow-up during the six weeks post-discharge and linkage to primary healthcare are associated with decreased hospitalisation rates and improved outcomes.
心力衰竭是一项重大的全球健康挑战，在非洲负担尤为沉重，其年死亡率达34%，是全球平均水平的两倍。患有急性心力衰竭的患者在地区层面占用了大量床位，只有少数患者能够被转诊至二级或三级医疗机构进行进一步评估和影像学检查。患者依赖初级保健医生对心力衰竭进行诊断和管理，以及确定那些将从转诊至心脏病学专科和接受正规超声心动图检查中获益的患者。本文讨论了新的心力衰竭指南在南非初级保健公共环境中的重要性。它强调了识别风险因素的重要性，并考虑了家庭医生、外展诊所医生的可及性、现有成人初级保健指南培训以及远程医疗支持的心脏超声检查的价值。包括血管紧张素转换酶（ACE）抑制剂、β受体阻滞剂和螺内酯在内的优化药物治疗已被证明可降低再入院率和死亡率。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是传统治疗的有力补充，目前正被考虑纳入国家基本药物清单。住院患者在仍有持续性充血时不应出院，因为这与再入院风险增加、死亡率上升以及更高的医疗费用相关。关于药物的全面患者教育、出院后六周内的彻底随访以及与初级医疗保健的联系与住院率降低和预后改善相关。
