Cardiology

Treating Comorbidities in Heart Failure Tackling the Hidden Burden

Most patients with heart failure (HF) also have comorbidities that require clinical attention. HF is part of
a cardiovascular–kidney–metabolic syndrome, in which HF and its comorbidities share common metabolic and inflammatory pathways, and have common therapeutic targets. Comprehensive care should optimise guidelinedirected medical therapy while addressing these comorbidities. Recent advances in management include sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, finerenone, intravenous iron and vaccinations. GPs are well placed to deliver holistic, patient-centred care to patients with HF.

Atrial Fibrillation Management in Patients with Heart Failure

Atrial fibrillation (AF) often occurs in conjunction with heart failure and people with both conditions have increased mortality and morbidity. a combined focus on risk factor reduction and stroke prophylaxis is required, alongside a complex decision regarding suitability and preference for rhythm control over rate control. Most rhythm control medications should be used with caution in people with heart failure with reduced ejection fraction. Interventional approaches, involving complex ablation or cardiac resynchronisation therapy, have also started to change clinical decision-making for AF patients.

Modern Medicine – Issue 2, 2025

Pulmonary Hypertension: What’s New in Diagnosis and Treatment?

Pulmonary hypertension (abnormally elevated pulmonary artery pressure; PH) is often identified during investigation of shortness of breath. Most often it is a result of underlying cardiac and chronic respiratory diseases. Diagnostic criteria for PH have changed recently, with a lower mean pulmonary artery pressure of 20mmHg now used to define PH. Although most commonly due to left heart disease, sometimes it is due to chronic pulmonary arterial disease (WHO Group 1 PH), for which targeted pulmonary vasodilators are efficacious. A systematic diagnostic approach is needed to determine the underlying diagnosis, leading to the optimal treatment, often in partnership with an expert PH centre.

Modern Medicine – Issue 1, 2025

Stroke Risk Mitigation: Prescribing and Monitoring anticoagulation in atrial Fibrillation

Atrial fibrillation (AF) heightens the risk of stroke. Patients with AF should have their stroke risk assessed, and high-risk patients should commence on nonvitamin K-dependent oral anticoagulants (NOACs) as the first-line antithrombotic agent. A patient’s reversible bleeding risk factors should be however reviewed and specifically addressed. Antiplatelet agents such as aspirin do not reduce stroke risk but have bleeding risks comparable to NOACs, therefore have no role in stroke risk reduction. Management should also include regular reviews to ensure medication adherence and persistence.

Modern Medicine – Issue 5 2024.

Resistant Hypertension: An Approach to Management

Resistant hypertension (RH) is a prevalent and significant cause of morbidity and mortality. Adverse health outcomes can be significant. True RH must be confirmed by adequate in-office and out-of-office blood pressure (BP) measurements. Common causes of apparent RH include white-coat hypertension, nonadherence with prescribed antihypertensive therapy, inadequate antihypertensive combination therapy and the use of interfering concomitant medications. Obesity, obstructive sleep apnoea and renal parenchymal disease are among the most common contributing features of RH; patients should be screened for secondary causes of hypertension. Management of RH relies on lifestyle measures, pharmacotherapy and interventional approaches, where required.

Modern Medicine – Issue 5 2024.

“Time is Brain” in Acute Ischaemic Stroke Management

Stroke is the second leading cause of death and the third leading cause of long-term disability worldwide. In SA, stroke is the second highest cause of mortality after HIV/AIDS and is among the top ten leading cause of long-term disability, accounting for 25 000 deaths a year and 95 000 years lived with disability.

Modern Medicine – Issue 2 2024

European Society of Hypertension : 2023 Guideline Update

The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high blood pressure (BP) clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes.

Modern Medicine – Issue 1 2024

Fenofibrate + Statin Found to Reduce Diabetic Retinopathy Progression

Diabetic retinopathy is a significant cause of vision impairment and is predicted to become an increasingly large global public health problem. Diabetic retinopathy often affects those of working age and can have significant health, social and economic implications. Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPAR-a) agonist, has been suggested as an adjunctive therapeutic option for diabetic retinopathy in patients with diabetes and existent diabetic retinopathy.

Modern Medicine – Issue 6 2023

Heart Failure with Reduced Ejection Fraction: Advances in Management

Heart failure (HF) is a leading cause of morbidity and a major burden on healthcare resources. Targeting modifiable risk factors and use of guideline-directed medical therapies in at-risk individuals is a crucial first step in the prevention of HF progression. All eligible patients with HF with reduced ejection fraction should be treated with the ‘big four’ pharmacological drug classes – angiotensin receptor neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and SGLT-2 inhibitors – which have proven benefit in reducing cardiovascular mortality and HF hospitalisation.

Modern Medicine – Issue 6 2023