Outcome Evaluation Of Chronic Hf

• The evaluation of therapy is influenced by the ability of treatment to successfully reduce symptoms, improve quality of life, decrease frequency of hospitalizations for AHF, reduce disease progression, and prolong survival (Fig. 6-1).

• The major outcome parameters focus on: (a) volume status; (b) exercise tolerance; (c) overall symptoms/quality of life; (d) adverse drug reactions; and (e) disease pro gression and cardiac function. Assess quality of life by evaluating patients' ability to continue their activities of daily living.

• Assess symptoms of HF such as dyspnea on exertion, orthopnea, weight gain, and edema, and abdominal manifestations such as nausea, bloating, and loss of appetite.

• If diuretic therapy is warranted, monitor for therapeutic response by assessing weight loss and improvement of fluid retention, as well as exercise tolerance and presence of fatigue.

• Once therapy for preventing disease progression is initiated, monitoring for symptomatic improvement continues.

• It is important to keep in mind that patients' symptoms of HF can worsen with P-blockers, and it may take weeks or months before patients notice improvement.

• Monitor BP to evaluate for hypotension caused by drug therapy.

• To assess for prevention of disease progression, practitioners may utilize serial echocardiograms every 6 months to assess cardiac function and evaluate the effects of drug therapy.

• Occasional exercise testing is conducted in order to ascertain disease prognosis or suitability for heart transplant. Even though these tests can demonstrate improvement in heart function and therefore slowed disease progression, patient symptoms may not improve.

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