Guideline:
Chronic congestive heart failure
Bibliographic Source(s)
- Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 10 p. [3 references]
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): Texas Department of Criminal Justice University of Texas Medical Branch; 2000 Mar. 6 p.
Guideline Category
Management
Treatment
Intended Users
Health Care Providers
Physicians
Guideline Objective(s)
To provide appropriate recommendations for the treatment of chronic congestive heart failure (left ventricular systolic dysfunction)
Target Population
Incarcerated offenders within the Texas Department of Criminal Justice with symptomatic and asymptomatic chronic congestive heart failure (left ventricular systolic dysfunction)
Interventions and Practices Considered
- General measures to manage congestive heart failure (CHF) including controlling hypertension diabetes mellitus hyperlipidemia weight reduction in obese; low sodium diet; pneumococcal and flu vaccination; smoking cessation; discontinuation of alcohol; avoidance of specific medications
- Pharmacotherapy:
- Hydrochlorothiazide (HCTZ)
- Furosemide
- Enalapril
- Hydralazine
- Isosorbide dinitrate
- NF metoprolol succinate
- Spironolactone
- Digoxin
- Monitoring (e.g. blood pressure potassium [K+] serum creatinine; electrolytes; symptoms such as weight gain; toxicity)
Major Outcomes Considered
Survival progression of heart failure mortality symptoms and quality of life
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Not stated
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Not stated
Description of Method of Guideline Validation
Not applicable
Major Recommendations
The major recommendations are provided in the form of an algorithm for: Chronic Congestive Heart Failure (Left Ventricular Systolic Dysfunction).
Refer to the original guideline document for healthcare provider and patient education on general measures of care medications physical exams warning signals and goals of therapy.
Clinical Algorithm(s)
An algorithm is provided for: Chronic Congestive Heart Failure (Left Ventricular Systolic Dysfunction).
Type of Evidence supporting the Recommendations
This guideline was adapted from the following sources:
ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001; 38:2101-13.
Heart Society of America (HFSA) Practice Guidelines. HFSA Guidelines for Management of Patients with Heart Failure Caused by Left Ventricular Systolic Dysfunction – Pharmacological Approaches. Pharmacotherapy. 2000; 20(5):495-522.
Advisory Council to Improve Outcomes Nationwide in Heart Failure (ACTION-HF). Consensus Recommendations for the Management of Chronic Heart Failure. Am J Card. 1999; 83(2A):1A-38A.
Potential Benefits
- Goals of therapy are to prolong survival or slow progression of heart failure reduce mortality and improve symptoms to increase patient’s quality of life
- Benefits of specific medications are listed in the original guideline document
Potential Harms
Adverse effects of specific medications are listed in the original guideline document
Contraindications
Substitutions for contraindications and adverse drug reactions (ADRs) with angiotensin converting enzyme (ACE) inhibitors:
- Cough: Angiotensin II Blocker (nonformulary)
- Angioedema or renal stenosis (contraindications):
Hydralazine and Isosorbide dinitrate
Contraindications
- Enalapril: May be contraindicated due to renal artery stenosis
- Metoprolol: Contraindicated in asthma type 1 diabetes bronchospasm acutely ill patients
- Digoxin: acute decompensation
Qualifying Statements
The pathways do not replace sound clinical judgment nor are they intended to strictly apply to all patients.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Clinical Algorithm
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 10 p. [3 references]
Adaptation
This guideline was adapted from the following sources:
ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001; 38:2101-13.
Heart Society of America (HFSA) Practice Guidelines. HFSA Guidelines for Management of Patients with Heart Failure Caused by Left Ventricular Systolic Dysfunction – Pharmacological Approaches. Pharmacotherapy. 2000; 20(5):495-522.
Advisory Council to Improve Outcomes Nationwide in Heart Failure (ACTION-HF). Consensus Recommendations for the Management of Chronic Heart Failure. Am J Card. 1999; 83(2A):1A-38A.
Source(s) of Funding
University of Texas Medical Branch Correctional Managed Care
Guideline Committee
Texas Tech University Managed HealthCare Network Pharmacy & Therapeutics Committee
Composition of Group that Authored the Guideline
Not stated
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): Texas Department of Criminal Justice University of Texas Medical Branch; 2000 Mar. 6 p.
Guideline Availability
Print copies: Available from University of Texas Medical Branch (UTMB) 3009A HWY 30 West Huntsville TX 77340.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This summary was updated by ECRI on April 21 2004.
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This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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