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Prognosis: Prognosis depends on the patient's age, NYHA
class, and stage of disease progression. With all patients, life
expectancy is about five years with advanced disease with more
than 80% dying within a year. It is a progressive disease and that's
why early diagnosis and treatment is crucial. A multidisciplinary
approach and following guideline-based care can still give an HF
patient many years of productive life.

HF management is complex and requires a team approach.
One can simplify management by focusing on the algorithm
above. Algorithms are guidelines and should not substitute for
the numerous scenarios one can be presented with in assessing the
patient with heart failure.

HF treatment needs a multidisciplinary approach. At Penn
Medicine Chester County Hospital all specialties including
cardiology, nephrology, CV surgery, nursing, dietary, and
pulmonary medicine are involved in the patient's care. Protocols
have been established in both the hospital during acute episodes
and a close follow up as outpatient. The use of intravenous
inotropes, diuretics and having the availability of advanced
devices like Bi-V pacers are used in the treatment of HF.
Chester County Hospital participates with the American Heart
Association, Get with the Guidelines and they are receiving Silver
Plus Award this year.
This form below is used by the AHA to help patients manage
their heart failure and it is beneficial for patients to be involved in
their care.

Pharmacologic treatment focuses on the Stages of Heart
Stage A: Treat those risk factors that put the patient at risk
for heart failure in future ie. CAD, HTN, Hyperlipidemia,
Cardiotoxic Drug Exposure in certain malignancies.
Stage B: Prevent Heart Failure symptoms in those that have
structural heart disease preventing further myocardial remodeling
ie. B-Blockers and ACE inhibitors.
Stage C: Decongest if necessary with diuretics to decrease
preload and maximize therapy with ACE inh/ARBs/B-Blockers/
Aldosterone Receptor Ant/Sacubitril all to decrease mortality.
Consider consultation with Advanced Heart Failure Center. Device
therapy considered early if EF is less than 35%.
Stage D: In addition to Stage C Management, assess patient's
goals of care incorporating palliative care and consult with
Advanced Heart Failure Center.
Lifestyle modification should be a big part of treatment with
an importance placed on salt, fluid restriction and monitor weight
closely is a priority. Proper diet and exercise program should be a
part of every HF program.

SUMMER 2019 | CHESTER COUNT Y Medicine 13


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