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 rates in the range of 50 percent. Many of the almost 1 million hospitalizations that occur each year for this condition might be prevented by improved evaluation and care.

Recommendations in this Clinical Practice Guideline concern management of patients with heart failure due to reduced left-ventricular systolic function. It is intended for use by a broad range of health care practitioners. Referral for consultation and assistance with management is advised when patients remain symptomatic despite appropriate care or experience significant adverse effects, or when invasive management is contemplated. Specific recommendations regarding consultation and referral are made.

Guideline recommendations are based on a combination of evidence obtained through extensive literature reviews and on the consensus of expert opinion where evidence was lacking. Specific patient management recommendations are made in the following areas:

• Prevention of heart failure in patients 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.

Contents

• [Inside Front Cover]
• Guideline Development and Use
• Foreword
• Panel Members
• Project Staff, RAND
• Acknowledgments
• Executive Summary
• 1. Overview
  • Introduction
  • Practice Variations
  • Common Errors in Management
  • Scope of Guideline
  • Methodology for Guideline Development
  • Literature Quality-Rating System
  • Recommendations for Future Research
• 2. Prevention in Asymptomatic Patients
• 3. Initial Evaluation
  • Symptoms Suggestive of Heart Failure
  • Physical Examination
  • Diagnostic Testing
  • Hospital Admission and Discharge Criteria
• 4. Assessment of Left-Ventricular Function
  • Interpretation of Left-Ventricular Function Testing
  • Diastolic Dysfunction
  • Determination of Specific Etiologies for Left-Ventricular Systolic Dysfunction
• 5. Patient and Family Education and Counseling
  • General Counseling
  • Activity Recommendations
  • Dietary Recommendations
  • Discussion of Prognosis
  • The Problem of Noncompliance
• 6. Pharmacological Management
  • Initial Pharmacological Management
  • Additional Pharmacological Management
• 7. The Role of Revascularization
  • Heart Failure and Coronary Artery Disease
  • Benefits of CABG
  • Risks of CABG
  • Benefits and Risks of PTCA
  • Patient Counseling and Decisionmaking
  • Physiologic Testing for Ischemia
  • Evaluation for Heart Transplantation
• 8. Assessment of Outcomes and Patient Followup
• Contributors
• Glossary
• Acronyms
• Back Cover
• References

Suggested citation:

Konstam M, Dracup K, Baker D, et al. Heart Failure: Evaluation and Care of Patients With Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11. AHCPR Publication No. 94-0612. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. June 1994.