1. Exacerbating factors have been addressed and are under control 2. Volume status has been optimize 3. Diuretic therapy has been successfully transitioned to oral medication, with discontinuation of IV vasodilator and inotropic therapy if required for at least 24 h 4. Oral therapy for chronic heart failure (HF), including angiotensin convertase enzyme inhibitors (ACEIs) and beta blockers (for patients with reduced LVEF), has been established with stable clinical status 5. Patient and family education completed, including clear discharge instructions 6. Left ventricular ejection fraction (LVEF) documented: echocardiography is the gold standard 7. Smoking cessation (if applicable) counseling initiated 8. Follow-up clinic visit scheduled within three days of discharge, usually for 7–10 days For patients with advanced HF or recurrent admissions for HF, before discharge, the following are preferred 1. Oral medication regimen for heart failure has been established for 24 h 2. No intravenous vasodilator or inotropic agent for at least 24 h
CONGESTIVE HEART FAILURE 4 3. Ambulation before discharge to evaluate the beneficial effect of therapy and restoration of functional capacity 4. Plans for post-discharge management to prevent readmission (scale present in home, visiting nurse or telephone follow-up generally no longer than three days after discharge) 5. Appropriate referral to a specialist for disease management of precipitant cause(s) if applicable The discharge plan for the hospitalized patients should address the following issues: 1. Medication reconciliation, written plans for dietary sodium restriction and recommended activity level 2. Follow-up by phone or clinic visit soon after discharge to reassess volume status 3. Medication and dietary adherence 4. Alcohol moderation and cessation of smoking 5. Monitoring of body weight, electrolytes and renal function 6. Consideration of referral for formal disease management Out-Patient Management of CHF 1.
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- Fall '17
- Beverly, charles
- Cardiology, Ejection fraction