Heart Failure

symptoms on admission _________________________________________________________________

diagnostic tests and results:

BNP______________

Echocardiogram________________________________________________________________

MUGA scan: ___________________________________________________________________

Cardiac catheterization: __________________________________________________________

Other: ________________________________________________________________________

Possible cause(s) of your patient's heart failure (look at history): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does your patient have left or right sided heart failure or both (list symptoms)? __________________________________________________________________________________________________________________________________________________________________________________________

What stage Heart Failure is your patient in and why did you choose this stage? __________________________________________________________________________________________________________________________________________________________________________________________

Medications prescribed (include generic and trade names and dosage):

diuretic __________________________________________________________________________

Beta blocker ______________________________________________________________________

ACEI ____________________________________________________________________________

ARB _____________________________________________________________________________

Digitalis___________________________________________________________________________

Statin _____________________________________________________________________________

Anticoagulant/ platelet inhibitor _______________________________________________________

Referring to the CORE measures for CHF, is your patient getting the appropriate treatment? If not, what is missing and why do you think it is missing? _________________________ ______________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

What about for his/her stage of CHF? If not, what is missing? ___________________________________________

_____________________________________________________________________________________________

Evaluation of your patient's treatment since admission (trending):

Subjective: ____________________________________________________________________________

______________________________________________________________________________________

Objective signs (VS, labs...use measurable outcomes): _________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________-

Discharge teaching started/done (be specific about what was taught and how):

activity level ___________________________________________________________________________

diet _________________________________________________________________________________

Fluid intake ___________________________________________________________________________

weight monitoring _____________________________________________________________________

what to do if symptoms worsen ____________________________________________________________

_____________________________________________________________________________________

discharge medications: _________________________________________________________________ ______________________________________________________________________________________

______________________________________________________________________________________

Follow up instructions with MD ____________________________________________________________

List any barriers to learning? _____________________________________________________________________

List any ancillary consultations you would recommend for this patient .____________________ _______________

______________________________________________________________ _______________________________

Heart Failure Guide

Types of Heart Failure

Signs/Symptoms Left- Sided Heart Failure Right-Sided Heart Failure

Edema Mild to moderate Moderate to Severe

Fluid Retention Pulmonary edema/ Pleural Effusion Ascites

Organ Enlargement Heart Liver (Jaundice may be present)

Respirations Dyspnea prominent, PND Dyspnea possible but not as prominent

JVD Mild to moderate Neck veins visibly distended

GI symptoms Mild Loss of appetite, bloating, constipation

Stages of Heart Failure

Stage A

Pts at High Risk: HTN, CAD, DM, Metobolic syndrome; pts using cardiotoxins

Treatment: Treat HTN, smoking cessation, treat lipid disorders, exercise, discourage ETOH and drug abuse, control metabolic syndrome

Meds: ACEI or ARB in appropriate pts

Stage B

Patients with Structural heart disease w/o symptoms of HF: (Hx of MI, LV remodeling including LVH and low EF), asymptomatic valve disease

Treatment: All measures under Stage A

Meds: Same as A, plus Beta- blockers in appropriate pts

Stage C

Structural heart disease with symptoms of HF and sob, fatigue, reduced exercise tolerance

Treatment: All measures under A and B, dietary salt restriction

Meds: Same as for A& B, plus diuretics for fluid retention, may include Aldosterone antagonist/ Hydralazine/ nitrates

Devices in selected patients: Pacemakers/AICDs

Stage D

Refractory HF –needing special interventions: symptoms at rest despite maximum drug therapy

Treatment: All appropriate measures under A, B, and C. Decision making to choose appropriate level of care. Compassionate end of life care/hospice. Heart transplant, chronic inotropes, permanent mechanical support, experimental surgery/drugs.

CORE Measures Congestive Heart Failure

1. Evaluation of left ventricular systolic function (LVSD)

can be found:

· narrative description in the progress notes

· cardiac cath lab report

· echo report

· MUGA scan report

· gated heart scan report

2. ACEI or ARBI for left ventricular systolic dysfunction

-or contraindications documented

· ACEI/ARB allergy

· moderate/severe aortic stenosis

· chronic renal failure or renal insufficiency

3. Smoking cessation counseling

4. Discharge teaching including:

· activity level after discharge

· diet/fluid intake after discharge

· all discharge medications

· follow up instructions with MD/APN/PA

· weight monitoring

· what to do if symptoms worsen

Heart failure exercise KBurns