• Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 10 p. [3 references]

This is the current release of the guideline.

This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): Texas Department of Criminal Justice, University of Texas Medical Branch; 2000 Mar. 6 p.

Chronic congestive heart failure (left ventricular systolic dysfunction)

Management
Treatment

Cardiology
Family Practice
Internal Medicine

Health Care Providers
Physicians

To provide appropriate recommendations for the treatment of chronic congestive heart failure (left ventricular systolic dysfunction)

Incarcerated offenders within the Texas Department of Criminal Justice with symptomatic and asymptomatic chronic congestive heart failure (left ventricular systolic dysfunction)

1. General measures to manage congestive heart failure (CHF) including controlling hypertension, diabetes mellitus, hyperlipidemia, weight reduction in obese; low sodium diet; pneumococcal and flu vaccination; smoking cessation; discontinuation of alcohol; avoidance of specific medications
2. Pharmacotherapy:
   • Hydrochlorothiazide (HCTZ)
   • Furosemide
   • Enalapril
   • Hydralazine
   • Isosorbide dinitrate
   • NF metoprolol succinate
   • Spironolactone
   • Digoxin
3. Monitoring (e.g. blood pressure, potassium [K+], serum creatinine; electrolytes; symptoms, such as weight gain; toxicity)

Survival, progression of heart failure, mortality, symptoms, and quality of life

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Not applicable

This guideline was adapted from the following sources:

ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001; 38:2101-13.

Heart Society of America (HFSA) Practice Guidelines. HFSA Guidelines for Management of Patients with Heart Failure Caused by Left Ventricular Systolic Dysfunction – Pharmacological Approaches. Pharmacotherapy. 2000; 20(5):495-522.

Advisory Council to Improve Outcomes Nationwide in Heart Failure (ACTION-HF). Consensus Recommendations for the Management of Chronic Heart Failure. Am J Card. 1999; 83(2A):1A-38A.

• Goals of therapy are to prolong survival or slow progression of heart failure, reduce mortality, and improve symptoms to increase patient’s quality of life
• Benefits of specific medications are listed in the original guideline document

Adverse effects of specific medications are listed in the original guideline document

Substitutions for contraindications and adverse drug reactions (ADRs) with angiotensin converting enzyme (ACE) inhibitors:

1. Cough: Angiotensin II Blocker (nonformulary)
2. Angioedema or renal stenosis (contraindications):

   Hydralazine and Isosorbide dinitrate

Contraindications

• Enalapril: May be contraindicated due to renal artery stenosis
• Metoprolol: Contraindicated in asthma, type 1 diabetes, bronchospasm, acutely ill patients
• Digoxin: acute decompensation

The pathways do not replace sound clinical judgment nor are they intended to strictly apply to all patients.

An implementation strategy was not provided.

Living with Illness

Effectiveness
Patient-centeredness

• Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): University of Texas Medical Branch Correctional Managed Care; 2003 Apr. 10 p. [3 references]

This guideline was adapted from the following sources:

ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001; 38:2101-13.

Heart Society of America (HFSA) Practice Guidelines. HFSA Guidelines for Management of Patients with Heart Failure Caused by Left Ventricular Systolic Dysfunction – Pharmacological Approaches. Pharmacotherapy. 2000; 20(5):495-522.

Advisory Council to Improve Outcomes Nationwide in Heart Failure (ACTION-HF). Consensus Recommendations for the Management of Chronic Heart Failure. Am J Card. 1999; 83(2A):1A-38A.

2000 Feb (revised 2003 Apr)

University of Texas Medical Branch Correctional Managed Care - Academic Institution

University of Texas Medical Branch Correctional Managed Care

Texas Tech University Managed HealthCare Network Pharmacy & Therapeutics Committee

Not stated

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Texas Tech University Managed Health Care Network Pharmacy & Therapeutics Committee. Chronic congestive heart failure. Conroe (TX): Texas Department of Criminal Justice, University of Texas Medical Branch; 2000 Mar. 6 p.

Print copies: Available from University of Texas Medical Branch (UTMB), 3009A HWY 30 West, Huntsville, TX, 77340.

None available

None available

This summary was updated by ECRI on April 21, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.