Heart Failure
Guidelines
Stevenson LW; Massie BM, Francis GS. Optimizing therapy for complex or refractory heart failure: A management algorithm. Proceedings of the Advanced Heart Failure Group meetings. Am Heart J. 1998; 135(6 Pt 2):S293-S309. [Link]
Most of the hospitalizations, deaths, and costs associated with heart failure are incurred by a relatively small minority of patients with advanced disease. These patients may be described as having "complex," "advanced," "refractory," or "end-stage" heart failure, but in essence they are patients who have moderate or severe symptoms or who experience recurrent hospitalizations or emergency department visits despite therapy with diuretics, ACE inhibitors, and dioxin. Improving the treatment of this group of patients by optimizing their medical regimen, monitoring aggressively, and providing early intervention to avert decompensation can reduce their morbidity, mortality, and cost of care. This article provides a management algorithm for these patients.
ACC/AHA Task Force on Practice Guidelines. Guidelines for the evaluation and management of heart failure. J Am Coll Cardio. 2005 Sep 20;46(6):e1-82. [Link]
These guidelines were developed by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. The guidelines were based primarily on a comprehensive review of published reports. In cases where the data do not appear conclusive, recommendations are based on the consensus opinion of the group.
Agency for Health Care Policy and Research Clinical Practice Guidelines. Heart failure: Evaluation and care of patients with left-ventricular systolic dysfunction. AHCPR Publication No. 940612. June 1994; Rockville, MD. U.S. Dept. of Health and Human Services. [Details]
This document describes the range of diagnostic and management strategies that the guideline panel considers appropriate for heart failure patients with left-ventricular systolic dysfunction. The recommendations are based where possible on evidence obtained from extensive literature reviews. Where evidence was lacking, recommendations were based on the consensus opinion of the panel, as formulated after receiving input and suggestions from dozens of consultants around the country. The guideline is organized around a clinical algorithm, designed to provide assistance with decision-making strategies for patients and practitioners on a case-by-case basis. Copies can be ordered from AHCPR Publications Clearinghouse.
Primary Care Interventions
A comprehensive review of the published literature on heart failure disease management programs. The impact of disease management on clinical outcomes and costs are described, and the limitations of currently available data are discussed. 48 references.
Dauterman, DW; Massie, BM, Gheorghiade, M. Heart failure associated with preserved systolic function: A common and costly clinical entity. Am Heart J. 1998;135(6 Pt 2):S310-319. [Link]
Patients with CHF and preserved systolic function are surprisingly common, representing 20% to 50% of all patients with the diagnosis of CHF. Yet the effective treatment of patients with CHF caused by diastolic dysfunction remains speculative, because there have not been any conclusive outcome studies. This article reviews the mechanisms, epidemiology, and therapy of CHF with preserved systolic function.
Gheorghiade M, et al. Current medical therapy for advanced heart failure. Proceedings of the Advanced Heart Failure Group meetings. Am Heart J. 1998;135(6 Pt 2):S231-48. [Link]
Schulman KA, Mark DB, Califf RM. Outcomes and costs within a disease management program for advanced congestive heart failure. Am Heart J. 1998;135(6 Pt 2):S285-92. [Link]
Disease management programs offer the potential to improve the care of patients with advanced congestive heart failure, to provide accountability on the part of managed care programs to payers and employers for the care of these patients, and to improve the efficiency of MCOs.
Uretsky BF, Pina I, Quigg RJ, et al. Beyond drug therapy: Nonpharmacologic care of the patient with advanced heart failure. Proceedings of the Advanced Heart Failure Group meetings. Am Heart J. 1998;135(6 Pt 2):S264-84. [Link]
Notwithstanding the tremendous importance of drug therapy, non-pharmacologic approaches to the care of the heart failure patient become increasingly important as the severity of heart failure advances. This article presents a comprehensive framework for the variety of useful and important non-pharmacologic treatments for heart failure and describes how efficient and effective care can be delivered to the patient with advanced heart failure.
Scott J, Gade G, McKenzie M, Venohr I. Cooperative health care clinics: A group approach to individual care. Geriatrics. 1998;53(May):68-81. [Link]
Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998 May;158(10):1067-72. [Link]
Beck A, Scott J, Williams P, et al. A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic. JAGS. 1997; 45: 543-549. [Link]
Fonarow GC, et al. Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol. 1997;30:725-32. [Link]
A comprehensive heart failure management program led to improved functional status and an 85% decrease in the hospital readmission rate for enrolled patients. The potential to reduce both symptoms and costs suggests that referral to a heart failure program may be appropriate for medical management of persistent functional class III and IV heart failure.
Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190-95. [Link]
Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA . 1992;267:1788-1793. [Link]
Self-Management Interventions
Brown JE, Glasgow RE, Toobert DJ. Integrating dietary self-management counseling into the regular office visit. Practical Diabetol. 1996 Dec: 16-22. [Link N/A]
Systems Interventions
Vogt TM, Hollis JF, Lichtenstein E, Stevens VJ, Glasgow R, Whitlock E. The medical care system and prevention: the need for a new paradigm. HMO Practice. 1998; 12(1): 5-13. [Link]
Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Eff Clin Pract.1998;1:2-4. [Link]
Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Inter Med. 1997; 127: 1097-1102. [Link]
Wagner EH. The promise and performance of HMOs in improving outcomes in older adults. JAGS. 1996;44:1251-1257. [Link]
Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996; 74(4): 511-544. [Link]
Comprehensive discussion of the model for improving chronic illness care.
Payne TH, Galvin MS, Taplin SH, Austin B, Savarino J, Wagner EH. Practicing population-based care in an HMO: Evaluation after 18 months. HMO Practice. 1995;9:101-106. [Link]

