改善心衰预后新策略 .pptVIP

* Creating New Strategies for Improving Heart Failure Outcomes LSUHSC/HCSD LALLIE KEMP MEDICAL CENTER CONGESTIVE HEART FAILURE PROGRAM GHIATH MIKDADI, MD WENDY YOUNG, APRN * STATISTICS Effects 4.8 million persons in US Costs society $20 billion annually 400,000 to 700,000 diagnosed each year Hospitalizations increased 155% over the last 20 years Expected to worsen over next decade * PROGNOSIS Frequent hospitalizations Poor quality of life Increased morbidity Overall 5 year survival 50% Less than 25% receive proper medications and education LA one of lowest ranked states in HF treatment * DIANOSTIC TESTS Chemistry panel CBC Lipids TSH B-type naturetic peptide level CXR, EKG ECHO/MUGA * TREATMENT ACE inhibitors/ARB Beta blockers Diuretics HMG Co Reductase Inhibitors Dietary restrictions Lifestyle modifications Patient education, education, education! * GOALS Early identification of at risk populations Proper treatment modalities Treat co-morbid conditions Decrease hospitalizations/ER visits Improve quality of life Reduce morbidity/mortality * LKRMC PROGRESS Increased referrals to HF clinic Inpatient outpatient education program Smoking cessation program Improved access to procurement program Instituted BNP level testing * RESULTS (n=90) 93% on Beta blockers 94% on ACE/ARB 9 hospitalizations 4 ER visits Improved EF % (10-20%) * PLANS Update patient database Promote networking opportunities Improved control of co-morbid conditions Discontinuation of offensive medications Outpatient IV Lasix protocol Increased community awareness Participation in Optimize HF Database * PREVENTION Tight BP control Aggressive treatment of cholesterol Optimal care of diabetes Prevent MI, CAD Treat underlying causes Beta blockers in MI survivors regardless of EF * *