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.

Preface

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

Hypertension

Incidence and prevalence

Diagnostic criteria for hypertension

Measuring BP

‘White Coat Hypertension

Ambulatory blood pressure monitoring (ABPM)

Prevention of hypertension

- Magnesium intake

Home blood pressure readings

Primary or essential hypertension

Secondary hypertension

Renovascular hypertension

Nocturnal blood pressure levels

Hypertension in diabetes

Hypertension and pregnancy

Hypertension and renal disease

Hypertension and cardiac disease

Hypertension and lead exposure

Echocardiography

Follow-up visits for mild to moderate hypertension

Indications for additional lab or radiologic evaluation

Isolated systolic hypertension

Malignant hypertension

Hypertension definitions – Table I.

Retinopathy

Secondary Hypertension – Table II.

History, etiologic factors

Obesity – Hypertension relationships

Physical and laboratory evaluation

Patient education

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

Pharmacologic therapy

- 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

Scientific references

Patient Resources

Hypertension-related web sites

Heart Failure

Introduction

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 ®

Viagra

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

- References
- Web resources

Customers who bought this item also bought

• Hypertension (Event Driven)
• Disease State Management Strategies I. Clinical Guidelines for Primary Care – 4th edition (2013 Update)
• Medical Review Criteria Guidelines for Managing Care (12th edition, 2013)
• Manual of Hypertension of The European Society of Hypertension
• Epidemiology: Hypertension - Rising with increasing obesity and population growth
• Problem Solving in Hypertension
• The Year in Hypertension Volume 7
• Stakeholder Opinions: Pulmonary Arterial Hypertension clinical community builds order from chaos
• Exercise and Disease Management, Second Edition
• Handbook of Hypertension