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Heart failure: management of patients with left-ventricular systolic dysfunction
Insights
This guide offers clinical recommendations for heart failure (HF) evaluation and care. Improved diagnosis and management can prevent hospitalizations and reduce high mortality rates associated with HF.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Public Health
Background:
- Heart failure (HF) affects over 2 million Americans, with 400,000 new cases annually.
- HF has a high mortality rate, with 5-year survival around 50%.
- Nearly 1 million annual hospitalizations for HF could be preventable with better care.
Purpose of the Study:
- To summarize key recommendations for the evaluation and care of patients with left-ventricular systolic dysfunction.
- To provide a clinical practice guideline for healthcare practitioners.
- To improve prevention, diagnosis, and management of heart failure.
Main Methods:
- Development of a Quick Reference Guide based on Clinical Practice Guideline No. 11.
- Recommendations derived from extensive literature reviews and expert judgment.
- Inclusion of input from a panel of experts and consumers.
Main Results:
- Specific recommendations cover prevention in asymptomatic patients with left-ventricular systolic dysfunction.
- Guidelines address diagnosis, initial evaluation, hospital admission/discharge criteria, and pharmacological management.
- Recommendations also include patient counseling, education, exercise, rehabilitation, revascularization evaluation, and monitoring.
Conclusions:
- Improved evaluation and care strategies are crucial for reducing heart failure hospitalizations.
- The guideline provides evidence-based and expert-informed recommendations for a broad range of healthcare providers.
- Effective management can potentially lower the high mortality associated with heart failure.
Abstract:
More than 2 million Americans have heart failure, and about 400,000 new cases are diagnosed each year. Mortality is high, with 5-year mortality in the range of 50 percent. Many of the almost 1 million hospitalizations each year for heart failure might be prevented by improved evaluation and care. This Quick Reference Guide for Clinicians summarizes major recommendations in Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11. The document was prepared by RAND, a nonprofit research and policy organization, and a private-sector panel of experts and consumers. Guideline recommendations are intended for use by a broad range of health care practitioners. The guideline recommendations are based on a combination of evidence obtained through extensive literature reviews and on expert judgment where evidence was lacking. Specific recommendations are made in the following areas: Prevention of heart failure with asymptomatic left-ventricular systolic dysfunction. Approaches to diagnosis and initial evaluation of suspected heart failure. Hospital admission and discharge criteria. Pharmacological management. Patient counseling and education. Exercise and rehabilitation. Evaluation for myocardial revascularization. Patient monitoring and followup evaluation.