Heart Failure Education and Discharge Program. Program Contents ____________________________________________________________________. Program Goals Prevalence of HF Definition of HF Etiology / Types of HF HF Classification Systems Physiological Response to HF
Heart Failure Education and Discharge Program
part of the hospital’s Core Measure
Because not all patients have volume overload at the time of initial or subsequent evaluation, the term “heart failure” is preferred over the older term “congestive heart failure.”
Hypertension, smoking, obesity, diabetes, metabolic syndrome, alcohol abuse, COPD, increasing age
Types of Heart FailureLeft ventricular systolic dysfunction (LVSD)_______________________________________________________________________
When the left ventricle fails, increased fluid pressure is transferred back through the lungs, causing congestion, and ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the venous system, seen as swelling in the legs and ankles.
Any condition that leads to prolonged high blood pressure in the arteries or veins of the lungs (pulmonary hypertension) strains the right side of the heart. When the right ventricle fails or is unable to properly pump against these abnormally high pressures, cor pulmonale is the result.
Cor Pulmonale is dilation and hypertrophy of the right ventricle due to pulmonary hypertension, typically caused by chronic lung disease or sleep apnea.
The New York Heart Association (NYHA) established a classification system for HF, based upon the caregiver’s observations and assessments of the patient’s functional capacity. These Stages I-IV (“mild”, “mild”, “moderate”, “severe”) have been used for many years to describe the degree of failure.
No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or dyspnea.
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation or dyspnea.
Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation and dyspnea.
Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased
It has been recognized for many years that the NYHA functional classification reflects a subjective assessment by a healthcare provider and can change frequently over short periods of time. It has also been recognized that the treatments used may not differ significantly across the NYHA classes.
In 2009, the ACC/AHA Joint Committee on HF Guidelines believed that a staging system was needed that would reliably and objectively identify patients during the course of their developing disease. This would be linked to treatments uniquely appropriate at each stage of illness, and would recognize:
Stages of Heart Failure
ACC/AHA 2009 Guidelines for the Diagnosis and Management of Heart Failure in Adults
In this classification, movement through the prodromal structural changes of the early disease process and into the functional changes of frank HF is signaled by objective changes. Each Stage is associated with increased therapeutic interventions.
The 2009 Staging System is intended to complement rather than replace the NYHA Classes.
Perhaps the most difficult thing about this disease is that the body’s homeostatic response to early cardiac dysfunction actually aggravates the pathologic process.
increased heart rate and afterload
increase in sodium and water retention
Dyspnea, fatigue, edema, orthopnea (dyspnea when head is not elevated), paroxysmal nocturnal dyspnea, cough, anorexia
Increasing jugular venous distension, S3 gallop, rales, edema
May or may not be done depending on presentation, symptoms, whether new onset of disease or not, and whether there is ischemic heart disease
Not recommended as a part of routine evaluation in patients with known heart failure
BNP is a substance secreted from the ventricles in response to changes in pressure that occur when heart failure develops and worsens. The level of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. The BNP level in a person with heart failure - even if the HF condition is stable - is higher than in a person with normal heart function.
enalapril (Vasotec), captopril (Capoten),
lisinopril (Zestril, Prinivil)
Angiotensin I is normally converted to angiotensin II by angiotensin converting enzyme (ACE), so an ACE inhibitor blocks formation of Angiotensin II
Reduced sodium (and water) retention
Decreased heart rate and blood pressure
Reduce cardiac hypertrophy
decreases both rate and contractility.
The widespread incidence of HF is due to a difficult combination of factors:
Core Measures will be used to guide “pay for performance” reimbursement in the near future.
of heart failure on admission
of the Core Measure requirements associated
with this diagnosis.
Start heart failure teaching
Start heart failure teaching
Heart failure is a progressive disease which requires ongoing monitoring and interventions to preserve function and to delay clinical progression. It is not curable, but it is generally manageable.
Thank You for your time and attentionto this very important quality of care issue.Our HF patients and families are thankful for the time and attentionyou give to them!!