Heart failure: management of patients with left-ventricular systolic dysfunction.

Abstract

More than 2 million Americans have heart failure, and about 400,000 new cases are diagnosed each year. Mortality is high, with 5-year mortality in the range of 50 percent. Many of the almost 1 million hospitalizations each year for heart failure might be prevented by improved evaluation and care. This Quick Reference Guide for Clinicians summarizes major recommendations in Heart Failure: Evaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11. The document was prepared by RAND, a nonprofit research and policy organization, and a private-sector panel of experts and consumers. Guideline recommendations are intended for use by a broad range of health care practitioners. The guideline recommendations are based on a combination of evidence obtained through extensive literature reviews and on expert judgment where evidence was lacking. Specific recommendations are made in the following areas: Prevention of heart failure with asymptomatic left-ventricular systolic dysfunction. Approaches to diagnosis and initial evaluation of suspected heart failure. Hospital admission and discharge criteria. Pharmacological management. Patient counseling and education. Exercise and rehabilitation. Evaluation for myocardial revascularization. Patient monitoring and followup evaluation.