The Basics
A syndrome caused by cardiac dysfunction resulting from myocardial muscle dysfunction.
What is Heart Failure?
SOB at rest, fatigue, Inability to lay flat at night (paroxysmal nocturnal dyspnea), edema, ascites, scrotal edema, early satiety or abdominal discomfort with nausea and vomiting, wheezing, and confusion.
What are symptoms of Heart Failure?
The ACC/AHA/HFSA prescriptive guide for managing heart failure last updated in 2022 with revised guidelines expected in 2025.
What is Guideline directed medical therapy (GDMT)?
This is one way the patient can identify if he/she is retaining fluids before they become symptomatic.
What is standardizing daily weights? Ensure patient has a scale and knows how and when to use it.
Ensuring patients are connected to resources, primary care providers and specialists in their community prior to discharge.
What is best practice in the discharge plan for the heart failure patient?
Pathologic myocardial hypertrophy or dilation in response to increased myocardial stress.
What is Myocardial Remodeling?
Elevated jugular venous pressure, Irregular heart sounds, Rales, ascites, edema, cool extremities, and irregular pulse.
What are signs of Heart Failure?
Diuretics/ACEI/ARB/ARNI/Beta Blockers/MRAs/SGLT2I/
What are common classifications of drugs used for GDMT?
When a heart failure patient is discharged on an oral diuretic this can be useful to prevent fluid volume overload when they are discharged home.
What is a diuretic adjustment plan?
Time frame for patient to see PCP or cardiologist after discharge from the hospital.
What is 7 days?
Coronary Artery Disease (Peripartum cardiomyopathy, MI, Alcoholic cardiomyopathy, Hypertension, Drug induced cardiomyopathy) and Hypertrophic cardiomyopathy, acute coronary insufficiency, infiltrative cardiomyopathy.
What are causes of Heart Failure?
Low sodium diet, blood pressure control, exercise, medications, fluid restriction, lab monitoring, and cardiology consults.
What are ways to manage heart failure?
Healthcare access and medication access and affordability
What are barriers to GDMT?
This type of specialty care is recommended for patients with advanced heart failure.
What is Advanced Heart failure specialty care? This population includes LVAD/cardiac transplantation/palliative care/ outpatient inotropic therapy).
Having this type of team involved in discharge planning for the heart failure patient appears to be a key element in successful prevention of 30-day readmissions in the heart failure patient.
What is a multidisciplinary team?
The single most useful diagnostic test in the evaluation of patients with heart failure.
What is the Echocardiogram?
Stage A, Stage B, Stage C, and Stage D.
What are the stages of Heart Failure?
Surgical Revascularization/Implanted hemodynamic monitoring/CRT device/Valve surgery
What are nonpharmacological interventions in the treatment of heart failure?
Skipping oral diuretic, high sodium diet, drinking excess fluids, drinking alcohol, inactivity, doing illicit drugs, missing physician appointments, refusing outpatient services.
What are types of nonadherence to medical plan?
Time frame in which pertinent labs (renal panel/BMP) should be drawn after inpatient discharge.
What is 7 days?
The systems involved in the response to HF are the sympathetic nervous system, the renin-angiotensin-aldosterone system, and antidiuretic hormone [1-3]. Other vasoactive substances are also affected, including the vasoconstrictor endothelin and the vasodilators atrial natriuretic peptide, B-type natriuretic peptide (BNP), and nitric oxide. These hormonal changes are seen with both systolic and diastolic dysfunction.
What is neurohormoral activation?
Liver failure, kidney damage or failure, sudden cardiac death, depression, and anxiety.
What are some complications of heart failure?
Deactivation of ICD device/Transplantation/ Left ventricular assist devices/Mechanical Circulatory Support/and Palliative/Hospice Care.
What are ethical considerations and end of life care for the heart failure patient?
Name 2 out of 7 Class 1 goals of care recommendations for all patients with Heart failure.
What is:
1.Palliative and supportive care
2.High quality communication with conveyance of prognosis
3.Ongoing clarification of goals of care
4. Shared decision making
5. Symptom Management
6. Caregiver support
7. Improve quality of life and relieve suffering
Interventions by this team promotes patient safety and contributes to positive outcomes in the heart failure patient after an inpatient discharge.
What is a transitional care team?