Heart Failure Treatment Choices

The NP Associates newsletter for February contains an informative article on Heart Failure and on possible treatments for the condition. According to Jennifer Cervino, MHS, PA-C, the author of the article 5 million people in the United States have heart failure and 550,000 will be diagnosed with HF this year alone. HF accounts for 15 million office visits and 6.5 million hospital visits each year for patients 65 and over. Hypervolemia is the contributing factor to HF. This leads to high re-hospitalization rates and increased health care costs. Diuretic drugs are the normal component of treatment plans. While the diuretics work at controlling the congestive systems, adaptations and resistances to the drugs normally develop as the disease progresses. In light of this, new therapies are being developed to better treat HF patients. One just technique is mechanical ultrafiltration or UF.

Ultrafiltration and Diuretics: Mechanical ultrafiltration has been used for more than 50 years in patients with end-stage renal disease requiring hemodialysis. Only within the last 25 years has UF been used and considered for HF patients who are diuretic resistant. During ultrafiltration, often called aquapheresis, blood is withdrawn from a patient with volume overload and then passed through semipermeable membrane (a hemofilter). The filter removes all the excess salt and water and then returns the blood back to the patient. UF can remove as much as 500 mL of fluid per hour. Because the extracellular fluid being removed is isotonic with the blood, serum electrolyte balance is maintained as sodium is removed.

Diuretics: Benefits, Limitations: Despite this data, the American College of Cardiology and the American Heart Association still use diuretics as the diagnosis of choice for HF patients. Diuretics are the cheaper and more readily available form of treatment for HF. There are obvious downsides to diuretics as well. Their use can actually do more harm than good if the proper care to replace key nutrients such as potassium to the body is not noted. Patients can see an increase of fluid retention which would complicated their HF problems. This problems seemed tied to  worsening renal function, prolonged length of hospital stay and increased long-term morbidity and mortality in addition to the other problems associated with HF and the use of diuretics.

Ultrafiltration: An Alternative?: The Acute Decompensated Heart Failure National Registry performed a study that looked at patients that have been hospitalized for HF and discovered that their treatments of diuretics was not solving the problem. Following that study, trials for UF have been performed. The RAPID-CHF trial showed that after 24 hours significant advances had been made to patients with decompensated HF and diuretic resistance. They had better results at a shorter interval then their normally prescribed diuretic therapy. The UNLOAD trial also concluded with results that reflected a safe and more effective way of fighting HF with the use of UF.

Questions Remain: As the use of UF is still relatively new in the field of HF and diuretic resistance patients there are still parts of UF therapy that is unknown. In addition the knowledge and understanding of UF is still not part of the main stream HF solution. One of the major inhibitors is the economic factors associated with using UF to treat HF.

For more information and the full article follow the link provided.
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Written by Brandon Kassof

Nutrition and Congestive Heart Failure

The NP Associates Newsletter for March contains an informative article about Congestive Heart Failure and how proper nutrition can stave off any possible effects of heart problems. According to Gail C. Frank, DrPH, RD, CHES, author of the article, ten percent of the United States population suffers from congestive heart failure. As people age this percentage increases within their age group. Obviously our job as NPs includes reducing the cardiac workload and swelling and improving heart functions. The article poses some easy management strategies to help your CHF patients.

Reduce Sodium: As you know, too much sodium can raise blood pressure. CHF patients should only consume .5 to 1.5 grams of sodium a day. .5 grams is all that is needed per day for normal body functions. An easy way to ween CHFs off of a high sodium diet is by slowing going in stages. As the normal American average is between 7 and 10 grams a day, you can slowly cut their sodium intake in half. Go from 10 grams to 5 grams, from 5 grams to 3 grams and from 3 grams to 1.5 grams. Encourage your CHFs to actively seek out low sodium alternatives.

Reduce Alcohol: Alcohol increases hypertension by up 10% in males. By staying away from alcohol a previous drinker can have his blood pressure reduced to that of a non drinker. Alcohol is absorbed through the gastrointestinal track and is then feed to all body tissues and organs. High fat foods and proteins can slow the absorption of alcohol while the carbon dioxide in champagne, sparkling wines, beer and carbonated mixed drinks accelerate the absorption of alcohol. The truth is that your CHF should not be consuming alcohol. It contains empty calories which hold no nutritional value, ethyl alcohol which is toxic, and stresses out the liver.

Adjust Calories: Obesity is no friend to a CHF. It is important that your CHF is eating the correct amount of calories for their body type. 

Exercise: According to the National Heart, Lung, and Blood institute, exercising 3 times a week for at least 20 minutes is necessary for a healthy living. As a NP you should confirm that your CHFs are getting the correct amount of exercise each week to keep them in a healthy state.

For more information and the full article follow the link provided.

http://bit.ly/YfT52v

Written By: Brandon Kassof