Cardiology Corner: Guidelines on Heart Failure Management

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Ian L. -

There are some that believe that the majority of presentations of heart failure are worsening chronic heart failure and that there is fluid overload and not much pulmonary edema and a diuretic is first line management . This will be a common presentation in Primary Care particularly rural and remote . Can patients with mild exacerbations of known chronic heart failure as manifested by Shortness of Breath and Bilateral leg swelling be treated with diuretics on an outpatient basis ? McDonagh TAet al European Heart Journal 2021

Amal M. -

if you are not worried about ACS or something more serious as a cause; and you are fairly convinced that the AHF is due to medication or dietary noncompliance, they you can probably just diurese and send home once they are doing well (e.g. ambulation trial in the ED); however, if you are uncertain why the AHF episode happened, it is a bit risky to just diurese and send home; not saying you can't do it, but it is risky, and there are not really good, validated decision instruments that can reliably predict which patients can safely go home; the Ottawa Heart Failure Risk Score is probably the best, but not sure if it has been externally validated yet;

Stephen S. -

I’ve been comfortable with initiating high dose nitro for a while. I’d like some help knowing when to stop the drip that’s working well. How do I know I can d/c the infusion and, in relative safety, send the pt to Tele instead of ICU?

Amal M. -

once the patient is doing well, and especially once they start diuresing, we can slowly turn down the drip and see how they tolerate it; in the meantime, you can probably also restart the patient's ACEI (if they are on it) and that will provide some continued afterload reduction

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