改善心衰预后新策略.ppt

Creating New Strategies for Improving Heart Failure Outcomes
LSUHSC/HCSD
LALLIE KEMP MEDICAL CENTER
CONGESTIVE HEART FAILURE PROGRAM
GHIATH MIKDADI, MD WENDY YOUNG, APRN
1
STATISTICS
Effects 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
2
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
3
DIANOSTIC TESTS
Chemistry panel
CBC
Lipids
TSH
B-type naturetic peptide level
CXR, EKG
ECHO/MUGA
4
TREATMENT
ACE inhibitors/ARB
Beta blockers
Diuretics
HMG Co Reductase Inhibitors
Dietary restrictions
Lifestyle modifications
Patient education, education, education!
5
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
6
LKRMC PROGRESS
Increased referrals to HF clinic
Inpatient & outpatient education program
Smoking cessation program
Improved access to procurement program
Instituted BNP level testing
7
RESULTS (n=90)
93% on Beta blockers
94% on ACE/ARB
9 hospitalizations
4 ER visits
Improved EF % (10-20%)
8
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
9
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
10