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Monday, February 3, 2014
  Clinical Accuracy Spoken Here  

Heart Failure: Subjective vs.
Objective Assessment

The NYHA classification is widely used to quantify the clinical assessment of HF and establish the relation between symptoms and the amount of effort required to provoke them. Functional capacity is based on subjective criteria. The objective assessment is meant to offset this and is based on measurements including:

  • EKGs
  • Stress tests
  • X-rays
  • Echocardiograms
  • Radiologic images
There is no set correlation between functional capacity and objective assessment.

[Reference: Heart Failure, Module B, Assessment & Complications in HF]
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  Excellence in Case Mgmt  

Heart Failure: Follow-up Reduces Readmissions

Discharge planning and transitions of care are an integral part of the successful management of HF. Team members contribute to specific discharge planning elements. The case manager is responsible for managing and coordinating the action-oriented discharge in concert with the plan of care.

A critical part of the discharge plan is to establish a follow-up appointment and a plan to verify that it is adhered to. This is integrally tied to reducing readmission rates. Studies have established that patients discharged home from the hospital that have early follow-up have a correspondingly lower risk of 30-day readmissions.

[Reference: Heart Failure, Module D, CM Role]
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  Improving Patient Care...  

Heart Failure: The Evidence Says...

Nearly all patients with HF due to LV systolic dysfunction should be routinely managed with a combination of three drugs. These include:

  • A diuretic (for symptom management of volume overload)
  • An ACEI (angiotensin-converting-enzyme inhibitor) or ARB (angiotensin II receptor blocker)
  • B-Blocker (Beta-adrenergic antagonists)

The benefits of these drugs have been well established based on numerous large-scale clinical trials in patients with LV systolic dysfunction.

For patients with HF and preserved EF, there is less evidence based data available to guide pharmacologic intervention.

[Reference: HF, Module C, Treatments and Interventions]
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