Managing heart failure related peripheral oedema in primary care

You consult with a 78 year old woman. She reports increased ankle swelling and has longstanding heart failure with reduced ejection fraction (measured as 25% on her most recent echocardiogram) because of previous myocardial infarction. She is known to local heart failure services.

Heart failure is a clinical syndrome caused by a structural or functional cardiac abnormality. It is characterised by reduced cardiac output or elevated intracardiac pressures, which can result in inadequate tissue perfusion. Heart failure affects approximately 900 000 patients in the UK.1 If a patient who was hitherto stable deteriorates, this is referred to as “decompensated” heart failure, and may manifest as pulmonary or peripheral oedema. This article provides an approach for primary care physicians to managing peripheral oedema in people known to have heart failure in the community. The article includes a recap of the best available evidence.