Heart%20failure%20-%20chronic Management

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)

• 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
• 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