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Monday, April 15, 2013
  Clinical Accuracy Spoken Here  

HF: Compensatory
Neurohormonal Changes

Cardiac or ventricular remodeling is a structural transformation in which the normally elliptical heart increases in mass and becomes more spherical. In concert, these processes produce a poorly contractile and less compliant heart, resulting in:

  • Increased filling pressures
  • Pulmonary or systemic edema
  • Hypoxia
  • Redistribution of blood flow away from skeletal muscle and the splanchnic circulation
  • Tissue lactic acidosis
  • Cachexia

Evidence exists that the neurohormonal system plays an important role in LV remodeling which is ultimately responsible for the failing heart.

[Reference: HF, Module A, Prevalence and Pathophysiology]

  Excellence in Case Mgmt  

HF: Is There Support for

The evidence base for telemonitoring in HF remains limited. The individual components of home telemonitoring need to be separately tested to compare their individual effects.

Existing studies suggest that in spite of initial costs to establish telemonitoring it will reduce long term costs associated with rehospitalization and travel. However, establishing the necessary combination of case management and close monitoring to assure consistent, improved outcomes and associated cost reductions has yet to be determined by evidence-based studies.

[Reference: HF, Module D, CM Role]

  Improving Patient Care...  

HF: Using the NYHA
Classification System

The NYHA classification is used to quantify HF. Heart failure patients are subjectively placed in one of four categories, depending on how their condition affects the performance of normal physical activities (functional capacity). The objective assessment (EKG, ST, ECHO) is meant to offset this. There is no set correlation between functional capacity and objective assessment. A functional capacity 1 is not automatically an objective assessment A.

For example: Person with no symptoms but a large pressure gradient across the aortic valve:

Functional Capacity: Class 1
Objective Assessment: Category D

[Reference: HF, Module B, Assessment]


Tom RasmussenTom Rasmussen
Athena Forum


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Cathy WrightCathy Wright, BSN, RN
Clinical Editor
Athena Forum




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Athena Forum on the Move!

Athena Forum at the 2013 ACMA Conference San Diego

Athen Forum at ACMA 2013
Bev Gulvin and Sarah Hill of Athena Forum chatting
with the "shy" CEO of ACMA Greg Cunningham.

Athen Forum at ACMA 2013
Tom Rasmussen, publisher Athena Forum with Bev Gulvin, Andrea D'Agostino from SutterHealth CA,
winner of the Athena Forum prize bag by Dooney & Burke,

along with Kim Billings and Sarah Hill, Athena Forum marketing team.

Athen Forum at ACMA 2013
Athena Forum's Marketing Manager Bev Gulvin with Athena Forum member
Gilbert Dorado, CM Director at Presbyterian Intercommunity Health, Whittier, California.

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