Executive Summary: HFSA Comprehensive Heart Failure Practice Guideline. J Card Fail ;– A copy of the HFSA Comprehensive Heart. Heart failure (HF) is a syndrome characterized by high mortality, frequent hospitalization, reduced quality of life, and a complex therapeutic regimen. Knowledge. Lindenfeld J, et al. HFSA Comprehensive. Heart Failure Guideline. J Card Fail ;e1-e HFSA Practice Guideline ().
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Heart Failure Guidelines (2010)
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Practce by Randy Tobey Modified over 4 years ago. Levy D et al.
The progression from hypertension to congestive heart failure. Aggressive BP control in patients with prior MI: BNP testing is discussed extensively in the section on acute decompensated HF.
Largest reduction in deaths were among those attributed to progressive HF. N Engl J Med ; Packer M et al. Use with caution in patients with: Diabetes with recurrent hypoglycemia Asthma or resting limb ischemia. Should physicians avoid the use of beta-blockers in patients with heart failure who have diabetes?
Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: However, the use of beta blockers in patients with HF and the concomitant conditions listed in this recommendation is well established, and the elderly are represented in most HF trials.
This table shows a reduction in all-cause mortality from Primary outcome was composite of cardiovascular death or hospital admission for HF. At median follow up of Aldosterone Antagonists An aldosterone antagonist is recommended for patients on standard therapy, including diuretics, who have: Renal function issues on next slide.
Data monitoring board stopped study after 10 months of follow up due to mortality increase in placebo group. A-HeFT used a novel primary end point consisting of weighted values for all-cause death, first hospitalization for HF, and change in quality of life according to the Minnesota Living with Heart Failure questionnaire.
Taylor AL et al. N Engl J Med ;. Diuretics Diuretic therapy is recommended to restore and maintain normal volume status in patients with clinical evidence of fluid overload, generally manifested by: Signs of elevating filling pressures include jugular venous distention, peripheral edema, pulsatile hepatomegaly, and, less commonly, rales.
Diuretics Restoration of normal volume status may require multiple adjustments. Once a diuretic effect is achieved with short-acting loop diuretics, increase frequency to times a day if necessary, rather than increasing a single dose. Thus some recommendations might be off label. Epleronone is indicated for post-MI LV dysfunction. It is a diuretic, but is used in HF primarily for neurohormonal inhibition.
N Engl J Med. Mortality by Intention-to-Treat HR Biventricular Pacing Biventricular pacing therapy is recommended for patients with all of the following: There were three treatment arms: Treatments may differ based on cardiac disorder.
HFSA Comprehensive Heart Failure Practice Guideline. – Semantic Scholar
Evaluation for ischemic disease and inducible myocardial ischemia should be included. Echocardiography Electrocardiography Stress imaging via exercise or pharmacologic means, using guudeline perfusion or echocardiographic imaging Cardiac catheterization This is a transition to several special considerations in heart failure: Exacerbating factors addressed Near optimum fluid status and pharmacologic therapy achieved Transition from IV to oral diuretic completed Patient education completed with clear discharge instructions Follow-up clinic visit scheduled, usually days Should be considered prior to discharge for patients with advanced HF or a history of recurrent admissions: Oral regimen stable for 24 hours No IV inotrope or vasodilator for 24 hours Ambulation before discharge to assess functional capacity Plans for post-discharge management Referral for disease management, if available Items for post discharge planning: Three variables are the strongest predictors of mortality in hospitalized ADHF patients: This education and counseling should be delivered by providers using a team approach.
Teaching should include skill building and target behaviors. Examples of skills and target behaviors: Perform daily weights Develop action plan for notifying provider if symptoms change State reasons for taking medications Describe a plan for a missed dose State blood pressure goal and current blood pressure Demonstrate ability to read food label for sodium per serving Adapted from: Arch Int Med ; The guidepine labels on the left are from the same brand and show the variability that can occur from one soup to another.
The label on the right is from another brand and appears to show a much higher sodium content. But when you look at the servings per container upper ovalsyou practjce that the soups on the left have 2 per container, meaning you must double sodium content. As a result, the container on the left has the greatest amount of sodium—nearly mg. Labels from cups of soup.
The evidence that led to the A rating was a collection of single-center randomized controlled trials. Examples include the following: Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with congestive heart failure: Home comrehensive be a nurse days after discharge Results: More intervention group that usual-care patients remained event-free 38 vs.
A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. Nurse-directed multidisciplinary intervention on high risk hospitalized patients 70 or older.
Risk ratio for readmission at 90 days.
HFSA 2010 Comprehensive Heart Failure Practice Guideline
Cost effective management programme for heart failure reduces hospitalisation. Education on HF and self-management with follow-up at nurse-directed HF clinic for 1 year after discharge. No difference in survival rate at 1 year. Mean time to readmission days in treatment vs. Randomized, controlled trial of integrated heart failure management: Eur Heart J ; Clinical review at hospital-based HF clinic early after discharge, education sessions, personal diary, information booklets, and regular follow up at HF clinic and PC practitioner.
No significant difference in groups for combined endpoint of death or readmission. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: Follow-up at a nurse-led HF clinic.
All are single-site studies or studies done at associated hospitals see Naylor. Interventions range from a single home visit by a nurse Stewart to more complex and long-term strategies using a HF clinic. Transitional care of older adults hospitalized with heart failure: J Am Geriatr Soc ; Mean age of patients Improvements in QOL were only short-term.