Heart Failure In The Post-Acute And Long-Term Care Setting

Publication Date: October 1, 2015

General

Clinicians should avoid prescribing non-steroidal anti-inflammatory drugs (NSAIDs) to patients with heart failure (HF) since they may increase blood pressure and promote sodium and water retention. ( Strong , Moderate )
704
Use of the calcium channel blockers verapamil and diltiazem should be avoided in patients with HF with reduced ejection fraction. (These agents' negative inotropic effects may exacerbate HF). ( Strong , Moderate )
704
Treatment of anemia in congestive heart failure (CHF)
Use conservative blood-transfusion strategy (threshold transfusion of hemoglobin (Hgb) 7–8 g/dL in stable HF). ( Weak , Low )
704
Do NOT use erythropoiesis-stimulating agents in patients with mild to moderate anemia and HF. ( Strong , Moderate )
704
Intravenous iron carboxymaltose may be used in patients with stable HF. ( Weak , Moderate )
704
All patients with HF should receive counseling/education regarding self-care. ( Strong , Moderate )
704
Clinicians should discuss goals of care with patients with HF and their families. ( Strong , Low )
704
Patients with HF or advanced HF should receive palliative and supportive care as part of a comprehensive care plan designed to improve quality of life. Patients with Stage D HF should be offered palliative care and hospice enrollment. (Strong, Low)
704
All patients with HF who smoke should be counseled about smoking cessation. ( Strong , High )
704
Clinicians should individualize decisions about fluid and sodium restriction, balancing patient preferences, quality of life, and the objective benefit of relief of congestive symptoms. ( Weak , Moderate )
704
Cardiac rehabilitation may improve functional capacity and quality of life in patients with HF. ( Strong , Moderate )
704
Nutritional supplements should NOT be used as adjunctive therapy in patients with chronic HF. ( Strong , Moderate )
704
Effective systems of care coordination, with special attention to care transitions, should be deployed for every patient with chronic HF. ( Strong , Moderate )
704
When reviewing a patient's goals of care, clinicians should discuss deactivating pacemakers and implanted cardioverter defibrillators (ICDs). ( Strong , Low )
704
Clinicians should identify depression and treat it to remission to improve quality of life in patients with HF. ( Strong , Low )
704

Recognition

Unexplained weight gain in a patient may indicate new or worsening CHF. ( Strong , Moderate )
704
Unexplained tachycardia or hypoxemia in a patient may indicate new or worsening CHF. ( Strong , Moderate )
704

Assessment

Measurement of brain natriuretic peptides (BNP or NT-proBNP) may be useful to support a clinical diagnosis of HF in the setting of clinical uncertainty. ( Strong , High )
704
Measurement of BNP or NT-proBNP levels may be useful to assess disease severity or establish prognosis in chronic HF. ( Strong , High )
704

Treatment/Intervention

Loop diuretics should be used to improve symptoms in patients with HF and evidence of fluid retention. ( Strong , Low )
704
Angiotensin-converting enzyme (ACE) inhibitors are recommended to reduce mortality in patients with HF with reduced left ventricular ejection fraction (HFrEF). ( Weak , High )
704
Angiotensin-receptor blockers (ARB) should be prescribed to patients with HFrEF who are intolerant of ACE inhibitors. ( Strong , High )
704
Unless contraindicated, beta blockers are recommended to reduce morbidity and mortality in patients with HFrEF. ( Weak , High )
704
Unless contraindicated, aldosterone antagonists are recommended to reduce morbidity and mortality in patients with HF and ejection fraction of ≤35%. ( Weak , High )
704
The combination of hydralazine and isosorbide nitrates may decrease mortality or morbidity in African American patients with HFrEF. ( Weak , High )
704
Unless contraindicated, digoxin may decrease hospitalization for HF in patients with HFrEF. ( Weak , High )
704

Monitoring

For consistency, patients with HF should be weighed at the same time of day. ( Weak , Low )
704
Serum electrolytes and kidney function should be monitored regularly in patients with HF who are receiving diuretics. ( Strong , Low )
704
Nurses and aides should be educated about possible symptoms and signs of HF in order to better recognize and monitor patients with HF. ( Strong , Low )
704

Recommendation Grading

Disclaimer

Overview

Title

Heart Failure In The Post-Acute And Long-Term Care Setting

Authoring Organization

Publication Month/Year

October 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Long term care

Intended Users

Social worker, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Treatment

Keywords

heart failure, congestive heart failure (CHF)

Source Citation

AMDA - The Society for Post-Acute and Long-Term Care Medicine. 10500 Little Patuxent Parkway,Suite 210, Columbia, MD 21044. Heart Failure in the Post-Acute and Long-Term Care Setting Clinical Practice Guideline. AMDA 2015.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS,Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN,Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;000:e000–e000. DOI: 10.1161/CIR.0000000000000509. Copublished in the Journal of the American College of Cardiology and the Journal of Cardiac Failure.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR,Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP,Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members;Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronicheart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 Aug;18(8):891-975.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA,Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013 Oct 15;128(16):e240-327.

Harrington CC, Schoenfelder DP. Assessing heart failure in long-term care facilities. J Gerontol Nurs. 2013;39(7):23-28. doi:10.3928/00989134-20130415-03.