Classification
HFrEF (EF <40%): systolic. HFpEF (EF >=50%): diastolic. NYHA Class I-IV. Readmission within 30 days in 25% — education is critical.
Pharmacotherapy
Quadruple therapy: ACE/ARB, beta-blocker, aldosterone antagonist, SGLT2 inhibitor. Diuretics for volume. ARNI preferred over ACE. Avoid NSAIDs, non-dihydropyridine CCBs, most antiarrhythmics.
Patient Education
Daily weights (report 2-3 lb gain in 1 day or 5 lb in a week). Sodium <2g/day. Fluid 1.5-2L/day if severe. Medication adherence. Symptom monitoring. Immunizations (flu, pneumococcal).
Important Notes
- Daily weights are the most sensitive indicator of volume status — teach patients to report sudden weight gain immediately.
- NSAIDs cause fluid retention and worsen HF — patients should avoid ibuprofen, naproxen.
Clinical Tips
- BNP >100 suggests HF; >500 suggests severe HF.
- SGLT2 inhibitors reduce HF hospitalization by 25-30% regardless of diabetes status.
Summary
Heart failure management requires quadruple pharmacotherapy, daily weight monitoring, sodium restriction, and patient self-care education.
