The Indiana University and the Optimistic HF Exacerbation Protocols and Recommendations for Providers conclude that with the exacerbation of heart failure the provider is first notified of the change in the patient’s condition. The signs and symptoms may include; Unexplained weight gain with 3lbs in 24 hours. 5lbs in one week, Dyspnea or respiratory distress, Orthopnea, Paroxysmal nocturnal dyspnea, Pulmonary crackles, Peripheral bilateral edema, JVD, Ascites, Anorexia, Cold and Sweaty extremities, and confusion. The algorithm supports the patients in need of readmission to the hospital ("HF Exacerbation," 2018). The importance of post exacerbation care planning and follow-up is key to preventing or decreasing the readmissions of Congestive Heart failure patients. This workflow throughout the community has been proven by the Optimistic group to be the best practice in treatment Pharmacologic Monotherapy In the clinical practice of treatment, our physicians may use diuretics as first-line therapy, but this be can be recognized as inappropriate as a long-term monotherapy. Numerous clinical
ADVANCED INFORMATION MANAGEMENT AND THE APPLICATIO 9 trials demonstrate the ACE inhibitors as an ideal adjunctive therapy for the patient with heart failure already receiving diuretics, with or without concomitant digitalis (DiBianco M.D, 1990) Pharmacologic Combination Therapy Although diuretics or water pills are important to the management of patients with CHF, patients with a more severe level of Heart Failure may require regimens (Halawa, 1996). What is commonly seen in the treatment of patients who display some resistance to the diuretics is the low dose option of dopamine (Halawa, 1996). Combined with water pills, dopamine offers renal support protecting renal failure and the urine output therefore benefiting therapy (Halawa, 1996). ACE inhibitors represent the most important advance in therapeutics for CHF in the last decade (Halawa, 1996). ACE inhibitors improve left ventricular function and survival unless contraindicated (Halawa, 1996). Patients with left ventricular systolic dysfunction should receive high dose ACE inhibitor with diuretic if there is peripheral edema (Halawa, 1996). For patients who cannot take an ACE inhibitor, the combination of hydralazine and nitrates may offer some prognostic benefit (Halawa, 1996). Digoxin has been the traditional first drug of choice for CHF but with protracted controversy about its efficacy and safety (Halawa, 1996). Pharmacologic Therapy Impact on Management of CHF Congestive heart failure was named the main cause of death in the United State in 1988 with 37,400 patients, and t remained the contributing cause of death in over 200,000 patients (Carson, 1996). By 1989, the hospital discharge process was in place, and it supported patients diagnosed with CHF (Carson, 1996). During this time frame and through out to 1989, there were 2% of
ADVANCED INFORMATION MANAGEMENT AND THE APPLICATIO 10 discharges diagnosed with primary HF, while another 4% were diagnosed with secondary HF (Carson, 1996).
- Fall '18
- Health care provider, Ejection fraction