Drug Treatment of Heart Failure (CHF)


Workshop Outline
Heart failure (HF) encompasses pathophysiologic processes that result from impairment of either ventricular filling or ejection of blood. As a consequence, the pumping action of the heart cannot fully supply the metabolic needs of body tissues. HF is phenotypically variable and cardiac function in patients may present across a spectrum from those exhibiting HF with reduced left ventricular ejection fraction (HFrEF) to those in whom ejection fraction is preserved (HF with preserved ejection fraction (HFpEF). Regardless of phenotype, impairment of cardiac function is progressive with poor survival rates. Treatment is aimed at limiting the rate of progression and controlling symptoms, principally dyspnea, fatigue, exercise intolerance and fluid retention. Symptoms vary among patients, with some presenting without evidence of fluid overload. Hence, the term HF is now preferred over “congestive HF”. Prognosis remains poor, with mortality rates after hospitalization of 20-25% at 1 year. Coronary artery disease, myocardial infarction, arterial hypertension, and type 2 diabetes are major contributors to HF in the United States.

Learning Goals for the CHF Workshop

A. Pathophysiology of HF

  1. identify the symptoms of HF and relate them to the underlying deficiencies in the myocardium and to diseases that cause or aggravate HF,
  2. describe the significance of reduced left ventricular ejection fraction (LVEF) and myocardial structural and functional alterations that distinguish HFrEF from HFpEF,
  3. describe the mechanisms of action and effects of the pharmacologic agents used appropriately to limit progression of myocardial dysfunction in patients at risk for HFrEF

B. Therapeutic Goals

  1. based on the functional status of the patient, consider the appropriate staging of drug therapy to achieve the highest quality of life in patients with HFrEF,
  2. describe what you consider to be adequate drug responses and recognize the optimal therapeutic doses of those drugs, explain how to recognize the onset of acute, decompensated HF (ADHF) and the unique therapeutic interventions required in ADHF

C. Acute Decompensated HF

  1. describe the signs and symptoms that identify transition of a patient from stable, compensated HFrEF into ADHF,
  2. explain the origin and significance of circulating biomarkers that can be used to guide therapy in HFrEF,
  3. explain the therapeutic concern related to cardio-renal crisis and the resultant modifications to drug therapy that can be used to minimize its impact, and

D. Interprofessional Collaborative Practice

  1. identify the four core competencies of interprofessional collaborative practice in the context of management of a patient with HFrEF3.