Heart Failure

Objectives

1. In patients with newly diagnosed heart failure determine the underlying cause, as treatment will differ.
2. In an older patient presenting with fatigue include heart failure in your differential diagnosis.
3. In a patient with symptoms suggestive of heart failure and a normal ejection fraction do not exclude this diagnosis.
4. In patients with heart failure periodically assess functional impairment using validated tools (e.g., New York Heart Association class, activities of daily living).
5. To guide your management of a patient with an exacerbation of heart failure:
   • Identify possible triggers (e.g., infection, arrhythmia, adherence, diet, ischemia)
   • Consider comorbid conditions (e.g., renal failure)
6. When treating heart failure:
   • Identify the type of heart failure (e.g., systolic, diastolic) because the treatment is different
   • Appropriately prescribe medications to reduce mortality as well as treat the symptoms of congestive failure (e.g., diuretics, beta-blockers, ACE inhibitors, digoxin)
7. For patients with heart failure ensure you offer patient education and self-monitoring, such as routine self-weighing, healthy diet, medication adherence, smoking cessation, and exercise, to minimize exacerbations.
8. In a patient with heart failure recognize non-sustained response to treatment as an indicator of worsening prognosis.
9. In a patient with heart failure and a progressively deteriorating clinical course:
   • Provide a realistic prognosis to patients and families
   • Introduce palliative care principles when appropriate for the patient