Journal congestive heart failure pdf

A standardized medical therapy has been successful in the early stages of HF. Advanced stages of HF require frequent hospitalization due to the presence of severe HF and or associated co-morbid conditions, which require strict implementation of an appropriately individualized multidisciplinary approach and quality measures to reduce re-admissions. While pharmacological management has a limited role in advanced cases of HF, novel therapeutic agents, such as regenerative and gene therapy, are in the developmental stages and need further refinement before their approval for the treatment of HF.

Despite the appropriate measures, hospitalization in HF as a DRG has been a great challenge, especially since the adoption of the financial penalty program for excessive readmissions related to HF. In addition to the appropriate management of cases, healthcare professionals also need to provide precise and complete medical codes for procedures and diagnosis to help hospitals to receive the maximum reimbursement for the services provided to such patients.

National Center for Biotechnology Information , U. Journal List J Clin Med v. J Clin Med. Published online Jun Arati A. Inamdar 2. Ajinkya C. Inamdar 2 Ansicht Scidel Inc. Salvatore De Rosa, Academic Editor. Author information Article notes Copyright and License information Disclaimer.

Received Mar 10; Accepted Jun This article has been cited by other articles in PMC. Abstract Despite the advancement in medicine, management of heart failure HF , which usually presents as a disease syndrome, has been a challenge to healthcare providers. Keywords: biomarker, heart failure, ICD 10, readmission, utilization. Introduction 1. Background Heart failure HF is a clinical syndrome caused by structural and functional defects in myocardium resulting in impairment of ventricular filling or the ejection of blood.

Classification of HFs Heart failure can be classified as predominantly left ventricular, right ventricular or biventricular based on the location of the deficit. Class II: HF causes slight limitations to physical activity; the patients are comfortable at rest, but ordinary physical activity results in HF symptoms.

Class III: HF causes marked limitations of physical activity; the patients are comfortable at rest, but less than ordinary activity causes symptoms of HF. Diagnosis of HF The evaluation for HF is performed using various parameters: physical examination to determine the presence of clinical symptoms and signs, blood tests, including complete blood count, urinalysis, complete metabolic profile for levels of serum electrolytes including calcium and magnesium , blood urea nitrogen, serum creatinine, glucose, fasting lipid profile, liver function tests and thyroid-stimulating hormone.

Table 1 The specific biomarkers expressed in heart failure HF patients as they correlate to the underlying mechanism of the pathogenesis for HF could be utilized for the diagnosis and prognosis of HF. Open in a separate window. High NYHA functional class Reduced left ventricular ejection fraction Third heart sound Increased pulmonary artery capillary wedge pressure Reduced cardiac index Diabetes mellitus Reduced sodium concentration Raised plasma catecholamine and natriuretic peptide concentrations.

Management of Heart Failure The major goals of treatment in heart failure are 1 to improve prognosis and reduce mortality and 2 to alleviate symptoms and reduce morbidity by reversing or slowing the cardiac and peripheral dysfunction. Anticoagulants, if applicable, to decrease the risk of thromboembolism. Readmission Readmission is defined as a subsequent hospital admission within 30 days following an original admission or index stay. Several studies have been performed to determine the causes for the day readmission [ 8 , 48 , 49 , 50 ], and some of the major causes include: 1.

Quality Improvement Strategies for HF We have achieved great success in the optimization of pharmacological therapy along with the relative increase in the availability of better healthcare options. Patient education: patient education about HF and strategies for its treatment.

Figure 1. Standard and Novel Therapies for HF 8. Role of Cardiac Rejuvenation Therapy in the Management of HF Current medical management for heart failure only alleviates symptoms, delays deterioration and prolongs life modestly. Utilization and Medical Coding In addition to having the knowledge of the pathophysiology of the HF and its management with the help of established and novel therapies, it is important for a physician to understand how to document the therapy so as to satisfy the reimbursement requirements.

Conclusions Heart failure indeed is a complex disease and so far has been a major cause of morbidity and mortality in developing and developed countries. Author Contributions A. Conflicts of Interest The authors declare no conflict of interest. References 1. Dassanayaka S. Recent Developments in Heart Failure. Ohtani T. Diastolic stiffness as assessed by diastolic wall strain is associated with adverse remodeling and poor outcomes in heart failure with preserved ejection fraction.

Heart J. Zamani P. Effect of inorganic nitrate on exercise capacity in heart failure with preserved ejection fraction. Glean A. Effects of nitrite infusion on skeletal muscle vascular control during exercise in rats with chronic heart failure. Heart Circ. Maeder M. Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction.

Bhella P. Abnormal haemodynamic response to exercise in heart failure with preserved ejection fraction. Heart Fail. Angadi S. High-intensity interval training vs.

Paulus W. A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. Yancy C. Watson R. ABC of heart failure. Clinical features and complications.

BMJ Br. Lindenfeld J. Marti C. Acute heart failure: Patient characteristics and pathophysiology. Poole D.

Muscle oxygen transport and utilization in heart failure: Implications for exercise in tolerance. Heidenreich P. Dunlay S. Lifetime costs of medical care after heart failure diagnosis. Askoxylakis V. Long-term survival of cancer patients compared to heart failure and stroke: A systematic review. BMC Cancer. Krumholz H. Normand SL. Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia. JAMA J. Recent trends in heart failure-related mortality: United States, — Roger V.

Epidemiology of heart failure. Anker S. Inflammatory mediators in chronic heart failure: An overview. Hofmann U. A translational view on inflammation in heart failure. Basic Res. Oikonomou E. The role of inflammation in heart failure: New therapeutic approaches.

Tang W. Prognostic value of elevated levels of intestinal microbe-generated metabolite trimethylamine- N -oxide in patients with heart failure: Refining the gut hypothesis. Nagatomo Y. Maries L. Pfister R. Simons J. Evaluation of natriuretic peptide recommendations in heart failure clinical practice guidelines. Maisel A. A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath.

Murtagh G. Ahmad T. Novel biomarkers in chronic heart failure. Gaggin H. Biomarkers and diagnostics in heart failure. Emerging biomarkers in heart failure. Paterson I. Imaging heart failure: Current and future applications. Morbach C. Clinical application of three-dimensional echocardiography. Butler J. The emerging role of multi-detector computed tomography in heart failure.

Upadhya B. Exercise intolerance in heart failure with preserved ejection fraction: More than a heart problem. Fonarow G. Januzzi J. Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. West R. Ouwerkerk W. Pocock S. Predictors of mortality and morbidity in patients with chronic heart failure.

Tamargo J. Novel therapeutic targets for the treatment of heart failure. Drug Discov. Dickstein K. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology. Abraham W. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: A randomised controlled trial.

Bui A. Home monitoring for heart failure management. Guidi G. A multi-layer monitoring system for clinical management of Congestive Heart Failure. BMC Med. S3 Dharmarajan K. VanSuch M. Effect of discharge instructions on readmission of hospitalised patients with heart failure: Do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?

Health Care. Causes and patterns of readmissions in patients with common comorbidities: Retrospective cohort study. Desai A. The three-phase terrain of heart failure readmissions. Center for Medicare and Medicaid Services. Rajaram R.

Barlas S. Rehospitalization for heart failure: Predict or prevent? Hernandez M. Predictors of day readmission in patients hospitalized with decompensated heart failure. Jolly K. Inglis S. Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst. Hospital strategies to reduce heart failure readmissions: Where is the evidence?

Ota K. Physician-directed heart failure transitional care program: A retrospective case review. Feltner C. Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Bekelman D. JAMA Intern. Taylor R. Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure REACH-HF facilitated self-care rehabilitation intervention in heart failure patients and caregivers: Rationale and protocol for a multicentre randomised controlled trial.

BMJ Open. Giamouzis G. Hospitalization epidemic in patients with heart failure: Risk factors, risk prediction, knowledge gaps, and future directions. Scalvini S. Heart failure. Optimal postdischarge management of chronic HF. Fleg J. Exercise training as therapy for heart failure: Current status and future directions.

Hirai D. Exercise training in chronic heart failure: Improving skeletal muscle O2 transport and utilization. Inouye S. Predicting readmission of heart failure patients using automated follow-up calls. Thomas R. Specialist clinics for reducing emergency admissions in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials.

Swedberg K. Zannad F. Effect of nesiritide in patients with acute decompensated heart failure. McMurray J. Goldhaber J. Role of inotropic agents in the treatment of heart failure. Krishnamoorthy A. The etiology of heart failure varies the treatment plan to some degree; however, most of the treatment recommendations are based on the presence of heart failure alone, regardless of the cause.

Classification of heart failure is based on symptoms and calculated left ventricular ejection fraction LVEF. Heart failure due to left ventricular dysfunction is categorized into heart failure with reduced ejection fraction HFrEF , heart failure with preserved ejection fraction HFpEF , and heart failure with mid-range ejection fraction HFmrEF.

The latter may consist of mixed left ventricular dysfunction a combination of systolic and diastolic heart failure. Heart failure is a complex clinical syndrome with high morbidity and mortality. It requires a multifaceted treatment approach, including patient education, pharmacologic management, and surgical interventions to optimize clinical outcomes.

Specialty trained HF nurses are essential to the interprofessional team caring for patients with HF. They educate the patient on the importance of lifestyle modifications and medical compliance to help improve morbidity and mortality for the patient. They also educate the patient on symptom and weight management to prevent HF exacerbations and hospital admissions.

The clinical pharmacists assist the medical providers by reviewing patient medication lists and decreasing potential adverse drug-drug interactions. Primary care medical providers and cardiologists must coordinate care to minimize any adverse outcomes of medical therapy and prevent the progression of this disease. A collaborative interprofessional team can greatly improve the quality of life for patients with HF and decrease mortality. This book is distributed under the terms of the Creative Commons Attribution 4.

Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Universidad Central de Venezuela. Continuing Education Activity Heart failure is a complex clinical syndrome in which the heart cannot pump enough blood to meet the body's requirements. Introduction Heart failure is a complex clinical syndrome that results from a functional or structural heart disorder impairing ventricular filling or ejection of blood to the systemic circulation.

Etiology Congestive heart failure is caused by structural abnormalities of the heart, functional abnormalities, and other triggering factors.

Epidemiology Approximately 6. Pathophysiology The adaptive mechanisms that may be adequate to maintain the overall contractile performance of the heart at relatively normal levels become maladaptive when trying to sustain adequate cardiac performance.

Framingham Diagnostic Criteria for Heart Failure The commonly used Framingham Diagnostic Criteria for Heart Failure requires the presence of 2 major criteria or 1 major and 2 minor criteria to make the diagnosis of heart failure.

These include: Acute renal failure. Stage D: Goal-directed medical therapies indicated for stage C and consideration for heart transplantation.

In patients with advanced disease and decreased life expectancy, palliative care discussions and advance directive planning should be considered. The scoring criteria are as follows: One point for each of the following History of stroke or transient ischemic attack. Complications Clinical complications of HF include decreased quality of life, decreased functional capacity, unintentional weight loss cardiac cachexia , renal dysfunction cardiorenal disease , and liver dysfunction hepatic congestion.

Deterrence and Patient Education Risk factor reduction and aggressive management of comorbid conditions in patients with high-risk HF is key to preventing the associated morbidity and mortality of this disease. Continue angiotensin-converting enzyme inhibitors ACEIs or angiotensin receptor blockers ARBs and beta-blockers during treatment of acute exacerbations. Only consider withholding beta-blockers in patients hospitalized after a recent beta-blocker initiation. Vasodilators e.

Enhancing Healthcare Team Outcomes Heart failure is a complex clinical syndrome with high morbidity and mortality. Review Questions Access free multiple choice questions on this topic. Comment on this article. Figure congestive heart failure. Image courtesy S Bhimji MD. References 1. Savarese G, Lund LH. Card Fail Rev. Diagnosis of heart failure: the new classification of heart failure. Vnitr Lek. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure.

Nat Rev Cardiol. Impact of risk factors for major cardiovascular diseases: a comparison of life-time observational and Mendelian randomisation findings. Open Heart. J Am Coll Cardiol. The pathophysiology of heart failure. Cardiovasc Pathol. Effects of enalapril on mortality in severe congestive heart failure.

N Engl J Med. Diagnosis and evaluation of heart failure. Am Fam Physician. Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J. Curr Heart Fail Rep. Int J Cardiovasc Imaging. Calibrated scintigraphic imaging procedures improve quantitative assessment of the cardiac sympathetic nerve activity.

Sci Rep. Use of isosorbide dinitrate and hydralazine in African-Americans with heart failure 9 years after the African-American Heart Failure Trial. Am J Cardiol. Eur J Heart Fail. Imamura T, Narang N. ESC Heart Fail. Adv Exp Med Biol. J Card Fail. Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure.

Disposition of acute decompensated heart failure from the emergency department: An evidence-based review. Am J Emerg Med. Long-term management of end-stage heart failure. Best Pract Res Clin Anaesthesiol. Heart failure. Cardiovasc Drugs Ther. Eur Heart J. Congestive Heart Failure. In: StatPearls [Internet].

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