改善心衰预后新策略

1、Creating New Strategies for Improving Heart Failure OutcomesLSUHSC/HCSD LALLIE KEMP MEDICAL CENTERCONGESTIVE HEART FAILURE PROGRAMGHIATH MIKDADI, MD WENDY YOUNG, APRN1STATISTICSEffects 4.8 million persons in USCosts society $20 billion annually400,000 to 700,000 diagnosed each yearHospitalizations i

2、ncreased 155% over the last 20 yearsExpected to worsen over next decade2PROGNOSISFrequent hospitalizationsPoor quality of lifeIncreased morbidityOverall 5 year survival 50%Less than 25% receive proper medications and educationLA one of lowest ranked states in HF treatment3DIANOSTIC TESTSChemistry pa

3、nelCBCLipidsTSHB-type naturetic peptide levelCXR, EKGECHO/MUGA4TREATMENTACE inhibitors/ARBBeta blockersDiureticsHMG Co Reductase InhibitorsDietary restrictionsLifestyle modificationsPatient education, education, education!5GOALSEarly identification of at risk populationsProper treatment modalitiesTr

4、eat co-morbid conditionsDecrease hospitalizations/ER visitsImprove quality of lifeReduce morbidity/mortality6LKRMC PROGRESSIncreased referrals to HF clinicInpatient & outpatient education programSmoking cessation programImproved access to procurement programInstituted BNP level testing7RESULTS (n=90

5、)93% on Beta blockers94% on ACE/ARB9 hospitalizations4 ER visitsImproved EF % (10-20%)8PLANSUpdate patient databasePromote networking opportunitiesImproved control of co-morbid conditionsDiscontinuation of offensive medicationsOutpatient IV Lasix protocolIncreased community awarenessParticipation in

6、 Optimize HF Database9PREVENTIONTight BP controlAggressive treatment of cholesterolOptimal care of diabetesPrevent MI, CADTreat underlying causesBeta blockers in MI survivors regardless of EF10USE WITH CAUTIONCalcium channel blockersNSAIDSTricyclic antidepressantsMuscle relaxantsThiazolidinedionesMetformin11Staff MembersTymple Miller, DietitianKerri Ardillo, RN, Utilization ManagerKeri Blanchard, Patient EducatorGhiath Mikdadi, MD Medical