ACC's new Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized with Heart Failure addresses unresolved issues in patients hospitalized with heart failure (HF). Published Sept. 13 in the Journal of the American College of Cardiology, the document focuses on optimizing patient care and improving outcomes after HF hospitalization.

The pathway document looks at the course of HF admission – the first emergency department visit and hospital admission, trajectory check, transition to oral therapies, discharge, and the first post-discharge visit.

Of note, according to the authors, clinical trajectory of HF, evaluation of the long-term course of HF, and common comorbidities should be assessed continually throughout the patient's journey. The authors also note that the day of transition from intravenous to oral diuretic therapy "should trigger multiple considerations related to the overall regiment for discharge." Further, the first follow-up visit "should address specific aspects, including volume status, hemodynamic stability, kidney function and electrolytes, the regiment of recommended therapies, patient understanding, adherence challenges, and goals of care."

The document also includes a risk stratification algorithm, tables for assessing risk during hospitalization, a worksheet for discharge handoff, a checklist to help educate patients, families and caregivers, a checklist for communicating to continuing care providers, a checklist for a follow-up phone call, a checklist for the first post-discharge visit, and more.

"Our aim is to help clinicians consider the short- and long-term outlook for their patients with HF, to institute therapies to reduce symptoms and optimize outcomes, to ensure that those plans are conveyed clearly to caregivers after discharge, and to engage patients to share in decisions and become active participants in their care," write Steven M. Hollenberg, MD, FACC, chair of the writing committee, et al.

The writing committee adds that the document complements existing tools for outpatient management, and that moving forward, the proposed strategies "will continue to evolve as new evidence becomes available."

Keywords: Outpatients, Medication Adherence, Checklist, Caregivers, Symptom Assessment, Stroke Volume, Follow-Up Studies, Patient Handoff, Hospitalization, Heart Failure, Risk Assessment, Risk Management, Emergency Service, Hospital, Comorbidity, Electrolytes, Patient Care Planning, Diuretics

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