Heart Failure In the Post acute and Long-Term Care Setting
Key Points
Key Points
- HF is one of the top causes of 30-day hospital readmissions. Factors such as inadequate staff training and education, provider unavailability and failure to adhere to standard guidelines for care all contribute to increased rate. Randomized control trials of Skilled Nursing Facilities with a designated program focused on, and applied interventions for, HF readmission prevention and reduction have proven to reduce 30-day readmissions rates by 20% to 40%.
- HF is a complex clinical syndrome that results from any structural or functional disorder that impairs the ability of the ventricles to fill with or eject blood at a rate commensurate with the body’s needs.
- Differentiation of patients with HF based on left ventricular ejection fraction (LVEF) is important due to different underlying etiologies, demographics, co-morbidities and response to therapies. Consequently HF has been newly classified into 3 subdvisions – HF with preserved ejection fraction (HFpEF) ≥50%, HF with mid-range ejection fraction (HFmrEF) 40–49% and HF with reduced ejection fraction (HFrEF) ≤40%.
- The AHA prevalence statistics show:
- For the 60–79 year-old age group, the following have heart failure: 7.8% of men; 4.5% of women.
- For the 80 years and older age group, the following have heart failure: 8.6% of men; 11.5% of women.
- Characteristically, patients with HF typically also have hypertension as well as other medical comorbidities, including chronic obstructive pulmonary disease, chronic kidney disease, hyponatremia, and hematologic abnormalities.
- Clinically, patients with preserved systolic function HFpEF are older and are more likely to be female, to have significant hypertension, and to have less coronary artery disease.
Table 1. Heart Failure in the Post-Acute and Long-Term Care Setting
General
Recognition
Assessment
Treatment/Intervention
Monitoring
Recognition
...cognition
STEP 1: Identify Individuals With a History o...
...Individuals Who Currently Have Symptom...
Table 2. Symptoms That May Suggest H...
.... Signs That May Suggest HFHaving troubl...
.... A Screening Tool for Caregivers (A...
STEP 3: Identify and Assess for Risk...
...mon Risk Factors for HF ExacerbationHaving troub...
Assessment
...essment
...cal Events That Can Help to Identify Pa...
...e 7. Indicators of Poor Cardiac Prognosi...
...Decide if a Workup is Appropriate...
...form Appropriate Imaging Studies to Help to Elu...
.... Imaging for HF Having trouble viewing ta...
...Decide if Interventions for Modifiable Risk Fac...
...ork Heart Association Heart FailureHaving...
Treatment
...eatment
...evelop an Individualized Care Plan and...
...P 8: Optimize Treatment for Comorbid and Contribut...
...ntable Cardioverter-Defibrillators (ICD) and Cardi...
...ctive TreatmentsHaving trouble viewing tab...
...e 1. Stages in the Developme...
...Treat Fluid Volume Overload if Present...
...le 11. Diuretic Indications and Dose EquivalentsH...
...eat HF With HFrEF...
...FrEF Stage C: Evidence-Based G...
Table 12. Drugs Commonly Used for HFrEFHavin...
...13. Medications for Treating HFrEF Having...
...s about ACE inhibitors:...
...Contraindications to the Use of ACE...
.... Adverse Effects of ACE InhibitorsHaving troub...
...Factors for Hypotension in Patient...
...oints about Beta Blockers:...
...able 17. Contraindications to the Use o...
Table 18. Potential Adverse Effects of Beta-Bl...
...Digoxin at a...
...gonists In...
...trate/Hydralazine ...
...ts (or Combinations of Treatments) That May...
...Treat HF with HFpEF...
...able 19. Medication Options for Treating HFpEFHavi...
...nitiate Cardiac Rehabilitation...
...Phases of Cardiac RehabilitationHaving trouble v...
...termine When The Patient Has End-St...
...21. Clinical Events That Can Help to Identify...
Monitoring
Monitorin...
...14: Monitor the Patient’s Condition and...
...nents of Monitoring for HF PatientsHaving t...
...or the Facility’s Management of HF...
...ample Performance Measurement IndicatorsHaving...
...ize that people who reside in PA/LTC faciliti...