Challenges on management of heart failure in Indonesia: a general practitioner’s perspective

  • Rizki Rizki Faculty of Medicine, University of Brawijaya, Malang
  • Bambang B. Siswanto Department of Cardiology and Vascular Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta
Keywords: heart failure, general practice, primary care
Abstract viewed: 2261 times
PDF downloaded: 1031 times


Heart failure has become a public health problem with increasing incidence and prevalence. Many patients first came to the primary care and managed by general practitioner. Accurate diagnosis is essential to provide good management of heart failure. However, symptoms and signs alone are often neither sufficient nor specific to confirm the diagnosis. Some studies show that heart failure patients are still incorrectly diagnosed and inadequately treated, despite the availability of current guidelines. Inadequacy of facilities is the main obstacle in diagnosing and managing heart failure, especially in developing countries like Indonesia. The medications recommended for treating heart failure are still under-prescribed. This review discuss about the challenges of diagnosis and management of heart failure in primary care.

Keywords: heart failure, general practice, primary care


  1. McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J. 2012;33(14):1787-847.

  2. Khunti K, Hearnshaw H, Baker R, Grimshaw G. Heart failure in primary care: qualitative study of current management and perceived obstacles to evidence-based diagnosis and management by general practitioners. Eur J Heart Fail. 2002;4(6):771-7.

  3. Hobbs FDR, Korewicki J, Cleland JGF, Eastaugh J, Freemantle N, and on behalf of the IMPROVEMENT investigators. The diagnosis of heart failure in European primary care: The IMPROVEMENT programme survey of perception and practice. Eur J Heart Fail. 2005;7(5):768-79.

  4. Fox KF, Cowie MR, Wood DA, Coats AJ, Poole-Wilson PA, Sutton GC. A rapid access heart failure clinic provides a prompt diagnosis and appropriate management of new heart failure presenting in the community. Eur J Heart Fail. 2000;2(4):423-9.

  5. de Giuli F, Khaw KT, Cowie MR, Sutton GC, Ferrari R, Poole-Wilson PA. Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom. Eur J Heart Fail. 2005;7(3):295-302.

  6. McDonald K. Current guidelines in the management of chronic heart failure: Practical issues in their application to the community population. Eur J Heart Fail. 2005;7(3): 317-21.

  7. McGeoch G, Lainchbury J, Town GI, Toop L, Espiner E, Richards AM. Plasma brain natriuretic peptide after long-term treatment for heart failure in general practice. Eur J Heart Fail. 2002;4(4):479-83.

  8. Sparrow N, Adlam D, Cowley A, Hampton JR. The diagnosis of heart failure in general practice: implications for the UK National Service Framework. Eur J Heart Fail. 2003;5(3):349-54.

  9. Kelder JC, Cramer MJ, Rutten FH, Plokker HW, Grobbee DE, Hoes AW. The furosemide diagnostic test in suspected slow-onset heart failure: popular but not useful. Eur J Heart Fail. 2011;13(5):513-7.

  10. Rutten FH, Grobbee DE, Hoes AW. Differences between general practitioners and cardiologists in diagnosis and management of heart failure: a survey in every-day practice. Eur J Heart Fail. 2003;5(3):337-44.

  11. Pont LG, van Gilst WH, Lok DJ, Kragten HJ, Haaijer-Ruskamp FM; Dutch Working Group on Heart Failure. The relevance of heart failure severity for treatment with evidence-based pharmacotherapy in general practice. Eur J Heart Fail. 2003;5(2):187-93.

  12. McMurray J, Cohen-Solal A, Dietz R, Eichhorn E, Erhardt L, Hobbs FD, et al. Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers ¨in heart failure: Putting guidelines into practice. Eur J Heart Fail. 2005;7(5):710-21.

  13. Sparrow N, Adlam D, Cowley A, Hampton JR. Difficulties of introducing the National Service Framework for heart failure into general practice in the UK. Eur J Heart Fail. 2003;5(3):355-61.

  14. de Groote P, Isnard R, Assyag P, Clerson P, Ducardonnet A, Galinier M, et al. Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey. Eur J Heart Fail. 2007;9(12):1205-11.

  15. Siswanto BB, Radi B, Kalim H, Santoso A, Suryawan R, Erwinanto, et al. Heart Failure in NCVC Jakarta and 5 hospitals in Indonesia. CVD Prevention and Control. 2010;5(1): 35-8.

  16. Rukmini, Rosihermiatie B, Nantabah Z. Availability and eligibility of primary health center room for services based on topography demography and geography in Indonesia. Bulletin on Health System Research. 2012;15(4):408-17.

How to Cite
Rizki R, Siswanto BB. Challenges on management of heart failure in Indonesia: a general practitioner’s perspective. Med J Indones [Internet]. 2014Mar.11 [cited 2024May29];23(1):58-2. Available from:
Brief Communication