In caring for hospitalized patients with decompensated heart failure (HF), clinicians should apply the major components of treatment: diuresis, optimization of guideline-directed medical therapy (GDMT), and close follow-up after discharge, according to the authors of an In the Clinic article.
“Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs,” the authors write. “Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of [GDMT], adequate diuresis, and appropriate discharge planning.…
“Diuresis should target resolution of symptoms and signs of congestion and should not be guided by serial … measurements {of natriuretic peptides (B-type natriuretic peptide [BNP] or its precursor, N-terminal pro-BNP [NT-proBNP])}. GDMT should not be routinely stopped and can be safely initiated in the hospital. Patients who are discharged on optimal GDMT have improved outcomes. Multidisciplinary collaboration between nurses and clinicians along with patient and caregiver education is necessary to optimize quality of life and reduce the risk for future hospitalizations.… Other specialists, including pharmacists, dietitians, mental health clinicians, and social workers, could be available for consultation on a case-by-case basis.”