A key goal in the management of a patient with heart failure is to prevent decompensation and readmission to the hospital. This can become increasingly difficult as the disease progresses.

Cardiac factors associated with an increased risk for decompensation:

(1) advanced heart failure (NYHA Class III or IV)

(2) uncontrolled hypertension

(3) coronary artery disease with angina

(4) presence of a bradycardia or tachyarrhythmia


Comorbid conditions associated with an increased risk of decompensation:

(1) anemia

(2) pulmonary disease (pneumonia, COPD, other)

(3) deterioration in renal function

(4) poorly controlled diabetes

(5) infection


Patient factors associated with an increased risk for decompensation:

(1) poor quality of life and/or depression

(2) poor adherence with medications

(3) poor adherence with diet and with restriction of sodium and water

(4) therapy with a drug associated with sodium retention

(5) alcohol or cocaine abuse


Factors associated with a reduced risk for decompensation:

(1) monitoring the patient closely with aggressive followup

(2) adjusting medications and drug dosages to minimize side effects

(3) teaching the patient about the importance of diet, medications, exercise and restrictions

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