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Hypertension and Heart Failure - Evaluation and Management Clincial Guidelines (2013 Update)
Apollo Managed Care, Inc., February 2013, Pages: 111
Two guidelines covering complementary topics. Each has evaluation and non-pharmacologic as well as pharmacologic treatment strategies, authoritative references, and resources.
These guidelines are not to be used as fixed or rigid protocols or standards of care. Treatment must be based on meeting the documented needs of each patient. Guidelines are patient management strategies, not entirely inclusive or exclusive of all methods of reasonable care that can obtain the same results, or of those which consider the particular needs of the patient and available resources. While standards imply a rigid and mandatory adherence that make exceptions unusual and difficult to justify, guidelines are more flexible.
All guidelines, review criteria and similar materials in this manual constitute neither offers of coverage nor medical advice. Apollo Managed Care Consultants does not provide health care services and, therefore, cannot guarantee any results or outcomes. Treating providers are solely responsible for medical advice and treatment of any individual. These guidelines, review criteria and the like may be updated periodically and therefore are subject to change without notice to the purchaser.
Each guideline in this Manual must be reviewed by a medical policy (or similar) committee of representative physicians for the HMO or contracted/delegated medical group and modified and adapted as appropriate. It is strongly recommended that all applicable documents that will be used to manage medical care in the organization be sent to affected providers for review and comment prior to implementation. This will always promote an understanding of the guideline, avoid compliance issues, and frequently may improve the document by added input prior to implementation.
A trial implementation using a small number of supportive providers and staff is often useful for any new policy, procedure or guideline implementation. All proposed guidelines should be compared to others as well as the constantly evolving national standards of care.
Cost effective health care is quality driven (true quality, that is; not excessive care) and attention must always be focused on the issues that will result in optimal medical/surgical outcomes in the specific local medical environment. Guideline compliance remains a major issue. Neither CQI teams nor academic detailing have proven to be particularly effective.
Once adopted, all policies, procedures, guidelines, protocols, benefit interpretations, review criteria, pathways and the like should be reviewed at least every two years, or even more frequently, as clinically significant changes occur due to new technology, medications or practices entering the medical mainstream. The sources of the information in a guideline, whenever possible, should be included as a reference or footnote.
If the distribution of the guideline is not followed by a process that includes auditing for compliance, feedback of the results, process and other improvements where indicated, and positive reinforcement strategies, recidivism tends to occur and over time, compliance will gradually return to levels present before institution of the guideline.
Use clear and unambiguous language in a stated policy or procedure. Avoid any implications of guaranteed clinical results or promised outcomes as a result of following a particular guideline. All policies, procedures, guidelines and similar criteria should be followed consistently and be available in writing.
Hypertension + Heart Failure - evaluation and management guidelines - Tables of Contents
Incidence and prevalence
Diagnostic criteria for hypertension
‘White Coat Hypertension
Ambulatory blood pressure monitoring (ABPM)
Prevention of hypertension
- Magnesium intake
Home blood pressure readings
Primary or essential hypertension
Nocturnal blood pressure levels
Hypertension in diabetes
Hypertension and pregnancy
Hypertension and renal disease
Hypertension and cardiac disease
Hypertension and lead exposure
Follow-up visits for mild to moderate hypertension
Indications for additional lab or radiologic evaluation
Isolated systolic hypertension
Hypertension definitions – Table I.
Secondary Hypertension – Table II.
History, etiologic factors
Obesity – Hypertension relationships
Physical and laboratory evaluation
Surgery in the hypertensive patient
Therapy - nonpharmacologic
- Stress reduction
- Exercise (update 4-05, 7-05)
- Diet issues including sodium, calcium, potassium, soy, alcohol, folate, other
- Dash diet
- Mediterrean diet
- Anti-hypertensive therapy in black patients
- Dual indications for common antihypertensive agents
- Step Therapy
- Common oral antihypertensive drugs by class (table)
- Recommendations from JNC 7
Quality measures – HEDIS, AHA/AMA
Hypertension References and Resources
Hypertension-related web sites
Symptoms and signs of HF
Staging or classification of HF
Diastolic HF (update 11-06)
Electrocardiogram as a predictor
Emotional stress can precipitate severe acute reversible left ventricular dysfunction
What about alcohol?
Treatment - nonpharmacologic
- Diet – sodium, Dash diet
- Biventricular Pacing/Resynchronization - Indications for pacing
- Exercise training in HF
- Case Management – comprehensive care to avoid readmissions
Treatment – Pharmacologic (overview)
Contra-indicated drug therapy
Nesiritide, B-Type Natriuretic Peptide, Natrecor ®
Sleep apnea associated with HF
Hospital management: Admission and Discharge Criteria Guidelines
- Post-discharge care
- Case management
Quality care for heart failure
- Clinical Performance Measures
- Outcome Measures
Heart Failure References and Resources
- Web resources