Heart Failure Guidelines
The 2009 revision of the ACC/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults contains a number of evidence-based updates, revised text, and a new section called "hospitalized patient" (Hunt et al. e395). These revisions are the result of a task force that convened in 2008 and represent new findings published between 2005 and 2008.
Four stages along a continuum of heart failure are described, with the first two stages representing patients having medical conditions that increase the risk of heart failure (Hunt et al. e396). Stage A patients may have atherosclerosis, diabetes, hypertension, obesity, metabolic syndrome, or have a family history of heart failure, but without structural heart disease (Hunt et al. e405-e408). Treatment strategies for Stage A patients include aggressive management of medical conditions and encouraging lifestyle changes. Stage A patients with vascular disease or diabetes may also benefit from ACE inhibitors or ARBs.
Stage B. patients have structural heart disease, but do not have heart failure (Hunt et al. e408-e410). Asymptomatic valvular disease, left ventricular remodeling, or a history of myocardial infarctions qualify patients for Stage B. classification. Treatment goals are the same as for State A patients, but may also involve the use of beta-blockers and implantable cardioverter-defibrillators (ICDs).
Stage C. And D. patients have heart failure, but most heart failure patients will be Stage C...
COPD Chronic obstructive pulmonary disease (COPD) year-old male -- pt known to me -- recently admitted to the ward with Non-STEMI & LVF. Discharged five days ago. Was found collapsed in his house by his niece. Duration not known. Could not get up from the floor, no chest pain/SOB. No dysuria/constipation -- ? Incontinence Pt was discharged with a package of care last week. Detailed history not available as the pt is confused and not answering any
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5% while 70.5% took Aspirin within six hours after reaching hospital and 76.5% of patients admitted in the NICVD were receiving Aspirin therapy." (Jaiwa, 2006, p.1) Jaiwa reports a more recent study that states findings that out of 52 patients with chest pain only 13 patients or 25% of the 52 received aspirin. The stated reason for not giving aspirin to the other 39 patients included that "chest pain was not
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