[Front Matter]

Heart Failure: Management of Patients With Left-Ventricular Systolic Dysfunction
Quick Reference Guideline Number 11
AHCPR Publication No. 94-0613: June 1994
National Library of Medicine DOCLINE Information: MED/94282113

Attention Clinicians

The Clinical Practice Guideline on which this Quick Reference Guide for Clinicians is based was developed by an multidisciplinary, non-Federal panel comprising health care professionals and consumer representatives. Panel members were:

Marvin A. Konstam, MD (Co-chair)

Kathleen Dracup, DNSc, RN (Co-chair)

Michael B. Bottorff, PharmD

Neil H. Brooks, MD

Robert A. Dacey

Sandra B. Dunbar, DSN, RN

Anne B. Jackson, MA, RN

Mariell Jessup, MD

Jerry C. Johnson, MD

Robert H. Jones, MD

Robert J. Luchi, MD

Barry M. Massie, MD

Bertram Pitt, MD

Eric A. Rose, MD

Lewis J. Rubin, MD

Richard F. Wright, MD

For a description of the guideline development process and information about the sponsoring agency (Agency for Health Care Policy and Research [AHCPR]), see the Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11 (AHCPR Publication No. 94-0612). To receive copies of the Clinical Practice Guideline, Quick Reference Guide for Clinicians (AHCPR Publication No. 94-0613), and Patient and Family Guide (AHCPR Publication No. 94-0614), call toll-free (800) 358-9295 or write the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907.

AHCPR invites comments and suggestions from users for consideration in development and updating of future guidelines. Please send written comments to Director, Office of the Forum for Quality and Effectiveness in Health Care, AHCPR, Willco Building, Suite 310, 6000 Executive Boulevard, Rockville, MD 20852.Note: This Quick Reference Guide for Clinicians presents summary points from the Clinical Practice Guideline. The latter provides a thorough analysis and discussion of the available research, critical evaluation of the assumptions and knowledge of the field, more complete information on evaluating and treating heart failure, considerations for patients with special needs, and references. Decisions to adopt particular recommendations from any publication must be made by practitioners in light of available resources and circumstances presented by individual patients.

Purpose and Scope

Heart failure is a clinical syndrome or condition characterized by (1) signs and symptoms of intravascular and interstitial volume overload, including shortness of breath, rales, and edema or (2) manifestations of inadequate tissue perfusion, such as fatigue or poor exercise tolerance.

Heart failure is a major public health problem. The National Heart, Lung, and Blood Institute estimates that over 2 million Americans have heart failure and that about 400,000 new cases of heart failure are diagnosed each year. Heart failure claims the lives of over 200,000 people in the United States every year. Almost 1 million hospitalizations occur each year for patients with this condition, at an estimated cost of over $7 billion. Total treatment costs for heart failure, including physician visits, drugs, and nursing home stays, were over $10 billion in 1990.

This Quick Reference Guide for Clinicians provides recommendations concerning the outpatient evaluation and care of patients with heart failure due to left-ventricular systolic dysfunction, which is the most common cause of heart failure. It does not address the management of patients with heart failure occurring despite normal ventricular systolic performance or due to surgically correctable valvular disease.

This Quick Reference Guide for Clinicians is intended for use by a broad range of health care practitioners, including family physicians, physician assistants, nurse practitioners, internists, cardiologists, cardiac surgeons, and clinical nurse specialists. Consultation is advised when patients remain symptomatic despite appropriate care or experience significant adverse effects, or when invasive management is contemplated.

The most significant recommendations in the Clinical Practice Guideline are described here. To place these recommendations in a logical framework, this publication is organized around a clinical algorithm. These recommendations are presented in a very abbreviated form. Readers should refer to the text of the Clinical Practice Guideline for supporting discussion, including citations and levels of evidence for each recommendation.

The clinical algorithm is not intended as a rigid pathway that must be followed in all cases. The algorithm visually shows the conceptual organization, procedural flow, decision points, and preferred management pathways discussed in the guideline.

When applied to the individual patient, this algorithm should be adapted to accommodate patient preferences and overall patient goals. Numbers in the algorithm indicate the desired sequence of diagnostic, treatment, and management decisions and interventions.