• Michigan Quality Improvement Consortium. Management of adults with chronic heart failure. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Jan. 1 p.

This is the current release of the guideline.

This guideline updates a previous version: Michigan Quality Improvement Consortium. Management of adults with left-ventricular systolic dysfunction, including heart failure. Southfield (MI): Michigan Quality Improvement Consortium; 2005 Jan. 1 p.

The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.

Adults with Suspicion of Left-Ventricular Systolic Dysfunction, Including Heart Failure

Evaluation

Initial assessment should include:

• Thorough history and physical examination [C] including consideration of obstructive sleep apnea
• Chest x-ray [C]
• 12 lead electrocardiogram [C]
• Laboratory tests and other studies should include: lipid profile, complete blood count (CBC), serum electrolytes, calcium, magnesium, blood urea nitrogen (BUN), creatinine, blood glucose, liver function tests, thyroid stimulating hormone (TSH), and urinalysis. [C]
• Two-dimensional echocardiography with Doppler or radionuclide ventriculography [C]
• Assessment for coronary artery disease and risk factors
• Serial monitoring should include: weight, volume status, electrolytes, renal function, and activity tolerance

Adults Diagnosed with Left Ventricular Systolic Dysfunction, Including Heart Failure

Pharmacological Management

Note from the National Guideline Clearinghouse (NGC): Please refer to the "Contraindications" field in this summary and/or the original guideline document for more information on contraindications to these medications.

Drugs recommended for routine use:

• Angiotensin-converting enzyme (ACE) inhibitors in all patients, unless contraindicated [A]
• Recommend beta-blockers (carvedilol, sustained-release metoprolol, bisoprolol) in all stable patients, unless contraindicated [A]

Drugs recommended for use in select patients:

• Diuretics and sodium restriction for evidence of fluid retention [A]
• Spironolactone for patients with severe symptoms of heart failure, preserved renal function, and normal potassium concentration [A]
• In patients who cannot tolerate ACE inhibitors due to cough or angioedema, angiotensin receptor blockers (ARBs) are recommended. [A]
• In patients who cannot tolerate ACE inhibitors or ARBs due to angioedema, hypotension, or renal insufficiency, hydralazine and nitrate combination is recommended. [A]
• African-American patients may be candidates for adding the combination of hydralazine and isosorbide dinitrate [A]

Education, Counseling and Risk Factor Modification

Educate patient/family regarding:

• Daily self-monitoring of weight and adherence to recommended patient action plan
• Recognition of symptoms and when to seek medical attention
• Moderate dietary sodium restriction (e.g., 2,000 to 2,500 mg sodium/day)
• Risk factor modification (regular exercise 3 times per week as tolerated [B]; smoking cessation; control of blood pressure, diabetes mellitus, lipids, etc)
• Avoid excessive alcohol intake, illicit drug use, and the use of nonsteroidal anti-inflammatory drugs (NSAIDS)
• Vaccination against influenza and pneumococcal disease

Definitions:

Levels of Evidence for the Most Significant Recommendation

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational studies
4. Opinion of expert panel

None provided

• Michigan Quality Improvement Consortium. Management of adults with chronic heart failure. Southfield (MI): Michigan Quality Improvement Consortium; 2007 Jan. 1 p.

2002 Dec (revised 2007 Jan)

Michigan Quality Improvement Consortium - Professional Association

Michigan Quality Improvement Consortium

Michigan Quality Improvement Consortium Medical Director's Committee

Physician representatives from participating Michigan Quality Improvement Consortium health plans, Michigan State Medical Society, Michigan Osteopathic Association, Michigan Association of Health Plans, Michigan Department of Community Health and Michigan Peer Review Organization

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Michigan Quality Improvement Consortium. Management of adults with left-ventricular systolic dysfunction, including heart failure. Southfield (MI): Michigan Quality Improvement Consortium; 2005 Jan. 1 p.

None available

None available

This NGC summary was completed by ECRI on April 14, 2004. The information was verified by the guideline developer on July 27, 2004. This NGC summary was updated by ECRI on February 24, 2005. The information was verified by the guideline developer on February 25, 2005. This NGC summary was updated by ECRI Institute on July 11, 2007. The updated information was verified by the guideline developer on July 16, 2007.

This NGC summary is based on the original guideline, which may be reproduced with the citation developed by the Michigan Quality Improvement Consortium.