Clinical Practice Guideline For Heart Failure-Books Pdf

Clinical Practice Guideline for Heart Failure
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iii Monitor carefully for side effects including renal dysfunction electrolyte abnormalities and. hypotension, b ACE Inhibitors incremental dosing to target doses not BP control recommended. Agents Initial Dose Target Titration, captopril Three times a day 6 25 12 5 25 50 75 100 Every 2 days. enalapril Twice a day 2 5 5 7 5 10 15 20 Every week. lisinopril Daily 5 10 15 20 30 40 Every week, quinapril Twice a day 5 10 15 20 20 Every week. ramipril Daily 1 25 2 5 5 10 10 Every week, trandolopril Daily 1 2 3 4 4 Every weeks. Fosinopril Daily 10 20 40 80 80 Every 1 2 wks, i Check labs creatinine BUN Na K with each dosage adjustment.
ii Consider dose decrease or nephrology consultation for Cr 3 or K 5 3. iii For patients intolerant of ACE Inhibitor with cough an ACE receptor blocker ARB is. recommended, iv For patients intolerant of ACE Inhibitor with renal insufficiency or hyperkalemia a. combination of Hydralazine and Nitrate is recommended. c Beta blockers incremental dosing to target doses not BP control recommended. Agents Initial Dose mg Target, Carv carvedilol Twice a day 3 125 6 25 12 5 25 85 kg 50 85 kg. Metrometroprolol succinate Daily 25 50 100 150 200. Bibbb bisoprolol Daily 1 25 2 5 5 10, i Beta blocker use is recommended with caution in patients with COPD diabetes or. peripheral vascular disease, ii It is recommended that beta blockers be continued in most patients experiencing heart. failure exacerbation unless they develop cardiogenic shock refractory volume overload. or symptomatic bradycardia, iii If discontinued or reduced beta blockers should be reinstated or returned to the.
previously tolerated dose as soon as safely possible. d Aldosterone antagonists Spironolactone or Eplerenone are recommended for patients with. class III IV heart failure or post myocardial infarction. i Avoid aldosterone antagonists when creatinine is 2 5 creatinine clearance 30. or serum potassium 5 0, ii Monitor renal function and serum potassium frequently on initiation of an aldosterone. antagonist and regularly thereafter, iii In the absence of persistent hypokalemia supplemental potassium is not recommended. with an aldosterone antagonist, e Digoxin may be considered for patients with persistent signs or symptoms of heart failure on. optimized therapy with a diuretic ACE Inhibitor and beta blocker. i Digoxin dose of 0 125 mg daily is recommended in the majority of patients with a. trough digoxin level 1 0 ng mL checked 1 2 weeks after initiation. H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc. Guideline 27 Page 2 of 6, ii Digoxin dose up to but not exceeding 0 25 mg daily is recommended to achieve. ventricular rate control in patients with atrial fibrillation. f Consider adding a combination of hydralazine and a nitrate in addition to standard therapy with. an ACE inhibitor and beta blocker in African Americans. g Consider replacing ACE Inhibitor or ARB therapy with Entresto Sacubitrol Valsartan in patients. with reduced EF and NYHA class II IV symptoms, g Eliminate potentially harmful drugs.
i Most calcium channel blockers dihydropyridine CCBs may be used. ii Nonsteroidal anti inflammatory drugs NSAIDS, iii Antiarrhythmic drugs except for Amiodarone. iv Tricyclic antidepressants, h Device therapy Cardiac Resynchronization Therapy CRT. i CRT is recommended for patients in sinus rhythm with QRS 120 ms EF 35. and NYHA class III heart failure on optimal medical therapy. ii CRT may be considered for patients in atrial fibrillation with QRS 120ms EF. 35 and NYHA class III heart failure on optimal medical therapy. iii Select ambulatory NYHA class IV patients with sinus rhythm QRS 120 ms and EF. 35 may be considered for CRT, iv CRT may be considered in NYHA class I or II patients with QRS 150 ms and. reduced EF, v CRT may be considered in patients with reduced EF in whom chronic frequent. ventricular pacing is expected, i Device therapy Implantable Cardioverter Defibrillator ICD.
i Prophylactic ICD should be considered in patients with ischemic or non ischemic. cardiomyopathy and EF 35, ii ICD is recommended in survivors of cardiac arrest from ventricular fibrillation or. sustained ventricular tachycardia that is not due to a reversible cause. iii ICD is not recommended in patients with chronic severe heart failure when there is no. expectation of clinical improvement and life expectancy is less than one year. iv ICD should be considered in patients undergoing implantation of a CRT device. j Tertiary referral should be considered for patients who remain symptomatic with persistent low. EF despite optimized pharmacologic and device treatment. i Availability of research protocols, ii ii LVAD or cardiac transplant consideration. 2 Diastolic heart failure, a Thiazide or loop diuretics are recommended to reduce fluid overload. i Provide and educate patient and family re use of additional PRN diuretic for fluid. ii Addition of Metolazone dosed intermittently for persistent fluid retention. iii Monitor carefully for side effects including renal dysfunction electrolyte abnormalities and. hypotension, H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc. Guideline 27 Page 3 of 6, b ACE inhibitors should be considered in all patients who have symptomatic atherosclerotic.
cardiovascular disease or diabetes and may be considered in other patients. i Ace Receptor Blockers ARB should be considered for patients who are not tolerant of an. ACE Inhibitor, ii Check labs creatinine BUN Na K with each dosage adjustment. iii Consider dose decrease or nephrology consultation for Cr 3 or K 5 3. c Beta blockers are recommended in patients with prior myocardial infarction hypertension or. requiring control of ventricular rate, d Calcium channel blockers should be considered in patients with. i Atrial fibrillation requiring control of ventricular rate and intolerance to beta blockers In. these patients diltiazem or verapamil should be considered. ii Symptom limiting angina, iii Hypertension, e Measures to restore and maintain sinus rhythm may be considered in patients who have. symptomatic atrial flutter fibrillation but this decision should be individualized. EDUCATION AND HEALTH MAINTENANCE FOR ALL PATIENTS WITH. HEART FAILURE, 1 Dietary instruction is recommended for all patients. a 2000 gram sodium diet, b Diabetic low fat renal and or weight loss maintenance dietary education as indicated.
c Fluid restriction for patients with Na levels 130 mEq L. 2 Pharmacy education and assistance, a Expected benefits possible side effects dosing and timing of prescribed medication. b Compliance assistance including pillboxes pharmacy filled medbox or dispensing systems as. c Evaluation of OTC or herbal products used for potential adverse effect or drug interaction. 3 Regular endurance exercise activity with a goal of 30 minutes 5 days weekly is recommended for. most patients if deemed safe, a Patients with EF 35 and clinically stable for 6 weeks may be candidates for cardiac rehab phase. b Education on safe exercise and activity guidelines and symptom monitoring is recommended. for all patients with chronic heart failure, 4 Telephone support. a Teleminder daily surveillance for patients at higher risk of decompensation or undergoing. frequent medication adjustments, b Reinforcement of heart failure provider contact information and importance of calling early for. changes or concerns, 5 It is recommended that patients with HF be advised to stop smoking and to limit alcohol.
consumption to 2 standard drinks per day in men or 1 standard drink per day in women. H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc. Guideline 27 Page 4 of 6, 6 Pneumococcal and annual influenza immunization are recommended unless there is a. contraindication, 7 Home health referral for patients who qualify. 8 End of life support, a Pastoral care referral for assistance with advanced directive documents. b Hospice or palliative care referral, MANAGEMENT OF CO MORBIDITIES. 1 Anemia of chronic illness, a Anemia will be screened for on admission CBC or HGB HCT and as indicated based on.
clinical history and physical exam, b Abnormal results will be referred to primary care physician for further evaluation and. management, 2 Sleep apnea, a Sleep apnea has been shown to commonly coexist undiagnosed in patients with heart failure. and has been implicated in the progression of vascular disease and heart failure. b All patients will be screened early in the program using the sleep assessment survey Patients. with abnormal criteria will be recommended for overnight pulse oximetry or referred to. pulmonologist and subsequent management directed by those results. c Patients with diagnosed sleep disordered breathing will be asked about their use of prescribed. therapies and efforts made to optimize compliance, 3 Depression. a Patients with heart failure are at risk for depression and will be evaluated for untreated. depression or effectiveness of current treatment, b Patients with untreated or sub optimally managed depression will be referred to primary care. for further management, 4 Diabetes mellitus, a Screening for undiagnosed diabetes mellitus.
b Referral to primary care for management of diabetes concerns. 5 Thyroid disorders, a Screening TSH on enrollment. b Referral to primary care for management of thyroid abnormalities. 6 Hyperlipidemia, a Screening fasting lipid panel for patients with coronary artery or vascular disease. b Treatment of abnormal lipids according to hyperlipidemia guidelines. References, 2009 Focused Update ACCF AHA Guidelines for the Diagnosis and Management of. H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc. Guideline 27 Page 5 of 6, Heart Failure in Adults A Report of the American College of Cardiology Foundation American Heart. Association Task Force on Practice Guidelines Developed in. Collaboration With the International Society for Heart and Lung Transplantation Circulation. 2009 119 1977 2016 originally published online March 26 2009. HFSA 2010 Comprehensive Heart Failure Practice Guideline Heart Failure Society of America. Journal of Cardiac Failure 2010 16 475e539, Heart Failure Society of America Practice Guidelines http www heartfailureguideline org.
President Board of Directors Date, Medical Associates Clinic. Original 10 03 Revised 01 06 Reviewed 09 10 Revised 08 16. Revised 04 04 Revised 06 07 Reviewed 09 11 Reviewed 01 18. Revised 11 04 Revised 08 08 Reviewed 09 12, Revised 03 05 Reviewed 09 09 Revised 06 14. H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc. H QI Clinical Practice Guidelines 2018 PDFs for Intranet and Internet Completed Congestive Heart Failure CPG doc Guideline 27 Page 1 of 6 Clinical Practice Guideline for Heart Failure This guideline is a uniform algorithm for Mercy Medical Center and Medical Associates Clinic and

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