Monitoring
Heart Failure Patients
Once the nature and cause of the
structural abnormalities leading the development of
Heart Failure (HF) have been defined, physicians should
focus on the clinical assessment of patients, both during
the initial presentation and during subsequent visits.
This clinical assessment should identify symptoms and
their functional consequences and should evaluate the
short- and long-term risks of disease progression and
death whenever appropriate. This ongoing review of the
patient’s clinical status is critical to the appropriate
selection and monitoring of treatments.1
A number of approaches have been
used to quantify the degree of functional limitation
imposed by HF. The most widely used scale is the NYHA
functional classification, but this system is subject
to considerable interobserver variability and is insensitive
to important changes in exercise capacity. These limitations
may be overcome by formal tests of exercise tolerance.1
For more information on the NYHA
classification, click
here.
It is critically important for physicians
to evaluate the fluid or volume status of patients with
HF during the initial visit and during each subsequent
follow-up examination. This assessment plays a pivotal
role in determining the need for diuretic therapy and
in detecting sodium excesses or deficiencies that may
limit the efficacy and decrease the tolerability of
drugs used to treat HF. The physical examination is
the primary step in evaluating the presence and severity
of fluid retention in patients with HF.1
For more information on treating
heart failure patients, click
here.
Serum electrolytes and renal function
should be monitored routinely in patients with HF. Of
particular importance is the serial measurement of serum
potassium concentration, because hypokalemia is a common
adverse effect of treatment with diuretics and may increase
the risk of digitalis toxicity. Conversely, hyperkalemia
may complicate therapy with angiotensin converting enzyme
(ACE) inhibitors and spironolactone. Worsening renal
function may require adjustment of the doses of digoxin
or diurectics.1
The role of periodic invasive or
noninvasive hemodynamic measurements in the management
of HF remains uncertain. Most drugs used for the treatment
of HF are prescribed on the basis of their ability to
improve symptoms or survival rather than on their effect
on hemodynamic variables. With that said, invasive hemodynamic
measurements may assist in the determination of volume
status and in distinguishing HF from other disorders
such as pulmonary diseases and sepsis, that may cause
circulatory instability. As a determinant for cardiac
transplantation, measurements of cardiac output and
pulmonary wedge pressure through a pulmonary artery
catheter have also been used in end-stage HF to assess
pulmonary vascular resistance.1
Assessment of Prognosis
Physicians, patients and their families
are all interested in defining the prognosis of an individual
patient with HF; however, the likelihood of survival
can be determined reliably only in populations and not
in individuals. Once HF is advanced, survival may be
estimated to guide the timing of transplantation or
other treatments that are reserved for patients with
very severe disease. For patients with end-stage HF,
an estimated survival less than 6 months increases the
options for hospice care, although such predictions
are inherently unreliable.1
For more information, please click
on the following subjects:
Heart Failure: A Significant
Problem
Clinical
Assessment of Patients with Heart Failure
Treating
Heart Failure Patients
Monitoring Heart Failure Patients
Delivering a More Comprehensive Cardiac Solution
Enhancing the Diagnosis of CHF with NT-proBNP
References
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