Heart%20failure%20-%20chronic Management
Prevention
Immunization
- Pneumococcal vaccination and annual influenza vaccination are recommended in all patients with HF in the absence of known contraindication
- Pulmonary congestion and pulmonary hypertension increase the risk of respiratory infections (one of the major causes of acute decompensation, especially in the elderly)
Prognosis
- Assessment of prognosis provides better information for the patients and their families to plan for their futures
- Helps in the identification of patients in whom cardiac transplantation or mechanical device therapy should be considered
Conditions Associated with a Poor Prognosis in Heart Failure
- Decreasing LVEF
- Worsening NYHA functional status (Class III-IV)
- Chronic hypotension
- Widened QRS on 12-lead ECG
- Tachycardia and Q waves
- Resting tachycardia
- Left ventricular hypertrophy and complex ventricular arrhythmias
- Marked elevation of brain-type natriuretic peptide (BNP)/N-terminal-pro-BNP (NT-proBNP)
- Elevated biomarkers of myocardial fibrosis (soluble ST2 receptor, galectin-3, high sensitivity cardiac troponin) and neurohormonal activation
- Iron deficiency with or without anemia
- Anemia is independently associated with the severity of HF and iron deficiency seems to be uniquely associated with a reduction in exercise capacity
- Iron deficiency in HF patients is associated with a worse prognosis
- Anemia is independently associated with the severity of HF and iron deficiency seems to be uniquely associated with a reduction in exercise capacity
- Hyponatremia
- Decreasing peak exercise O2 uptake
- Renal insufficiency or failure
- Intolerance to therapy
- Refractory volume overload
- Advanced age
- Ischemic etiology
- Resuscitated sudden death
- Prior HF hospitalization