Disease Management Algorithms

Heart failure has become an epidemic that complicates many disease states and produces high morbidity and mortality. It is a complex interrelationship between precipitating etiologies and progressive ventricular dysfunction. Patients may be asymptomatic or present with various, non-specific dyspnea syndromes and fatigue, or have physical findings that suggest congestion.

Consensus algorithms for evaluation and treatment of patients with heart failure have been created and are now well accepted.

The information in the treatment guidelines were developed based on scientific literature and collective clinical expertise. The information is not intended as a replacement for the exercise of sound clinical judgment by the treating physician. All relevant individual patient attributes should be taken in account including drug allergies, age, disease severity, and co-morbidities.

The following algorithms have been developed by the Cleveland Clinic Heart Failure Disease Management Initiative:

PROGRAM OVERVIEW

• HF Diagnosis and Treatment
• Standard of Care
• Initial Evaluation of Patients with HF
• Pharmacological Management of HF
• Cardiac Function: Echo & Muga
• Usual and Minimal Physician Follow-Up Visits
• Multidisciplinary Outpatient Coordinated Care Tract
• Plan of Care / Consult Form (label)
• Telephone Interview Sheet (label)

CARE PROTOCOL / CHARTS

• Aldosterone Antagonist Algorithm
• Oral Anticoagulation Algorithm
• Beta-Blocker Therapy Algorithm
• B-NP Point of Care Testing
• Cholesterol Screening Guidelines
• Body Mass Index Ratio Chart
• Cholesterol Treatment Algorithm
• Device Therapy Algorithms - presented with a grant from Medtronic, Inc.
  • Implantable Defibrillator - ICD Algorithm
  • Resynchronization Therapy - ICD Algorithm
• Digoxin Therapy Algorithm
• Diuretic Therapy Algorithm
• Hypertension Algorithm
• Hypervolemia Algorithm (fluid overload; not currently on Diuretics)
• Intravenous Neseritide - presented with a grant from Scios, Inc.
  • Intravenous nesiritide (Natrecor®) Therapy Algorithm
  • Intravenous nesiritide (Natrecor®) Incremental Dose Schedule and Routine Monitoring
• Palliative Care Therapy Algorithm
• Potassium & Magnesium Therapy Nomogram
• Oral Vasodilator Therapy Algorithm

MEDICATIONS TABLES

• Medications Commonly Used for HF
• Medications to Treat Hypertension or High-Normal Blood Pressure
• Chart containing:
  • Beta-Blocker Dosage
  • ACE-Inhibitor Dosage
  • Angiotensin II Receptor Blocker Dosage

MULTI-DISCIPLINARY SERVICES

• Cardiac Function : Echo & Muga
• Nutrition Therapy
• CCF Education Services
• Cardiac Rehab Centers

DATA COLLECTION FORMS

• Self-Management Questionnaire (9 pages)
• Minnesota Living with HF Questionnaire ã (2 pages)
• Symptoms Data Collection Form (1 page)
• HF Data Collection Nurse Practitioner - Satellite (5 pages)
• HF Data Collection Nurse Practitioner - Database (17 pages)
• Home Health HF Data Collection Form (3 pages)
• Home Care Discharge Survey - Mail (5 pages)
• Home Care Discharge Survey - Telephone (5 pages)

PATIENT EDUCATION INFORMATION

• Medication Change Sheet
• Warfarin Dosage Change Sheet
• Health System HF Services

NURSE ON CALL PROGRAM

• Chronic Heart Failure-CCF

CCF HOME CARE HF PROGRAM

• HF Diuretic Protocol
• Care, Treatment and Services

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Click here for more Heart Failure Disease Management Information from the Cleveland Clinic Foundation (a new browser window will open)