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Medical Management
The prognosis for patients with HF has improved with the use of evidencebased protocols for patient management. Specific interventions are based on
the stage of HF (Yancy et al., 2013; Yancy et al., 2016; Yancy et al., 2017).
The management goals of HF include the following (Cyrille & Patel, 2017):
Improvement of cardiac function with optimal pharmacologic
management
Reduction of symptoms and improvement of functional status
Stabilization of patient condition and lowering of the risk of
hospitalization
Delay of the progression of HF and extension of life expectancy
Promotion of a lifestyle conducive to cardiac health
Treatment options vary according to the severity of the patient’s condition,
comorbidities, and cause of the HF, and may include oral and intravenous (IV)
medications, lifestyle modifications, supplemental oxygen, and surgical
interventions, including implantation of cardiac devices, and cardiac
transplantation (see Chapter 24).
Managing the patient with HF begins with providing comprehensive
education and counseling to the patient and family. The patient and family
must understand the nature of HF and the importance of their participation in
the treatment regimen, including side and adverse effects of pharmacologic
therapies. Lifestyle recommendations include restriction of dietary sodium;
avoidance of smoking, including secondhand smoke; avoidance of excessive
fluid and alcohol intake; weight reduction when indicated; and regular
exercise. The patient must also know how to recognize signs and symptoms
that need to be reported to the primary provider.
Pharmacologic Therapy
Several types of medications are routinely prescribed for patients with HF. The
cornerstone of therapy for patients with HFrEF (systolic HF), which is the
most common type of HF, includes a diuretic, an angiotensin system blocker,2200
and a beta-blocker (Table 25-3). Many of these medications, particularly
angiotensin system blockers and beta-blockers, improve symptoms and extend
survival. Others, such as diuretics, improve symptoms but may not affect
survival (Meyer, 2019b). The patient with HFpEF (diastolic HF) may be
prescribed a diuretic, most commonly an aldosterone antagonist (see Table 25-
3), and may also be prescribed an angiotensin system blocker and/or a betablocker and find symptomatic relief; however, these drugs are not necessarily
associated with improved survival in those patients (Borlaug & Colucci, 2019).
Target doses for these medications and alternative medications for treating
heart failure are identified in the ACC/AHA guidelines. Nurses, primary
providers, and pharmacists work collaboratively toward achieving effective
dosing of these medications (Yancy et al., 2013; Yancy et al., 2016; Yancy et
al., 2017).