Contemporary Cardiology Series Editor: Christopher P. Cannon W. Frank Peacock Editor Short Stay Management of Acute Heart Failure Third Edition Contemporary Cardiology Series editor Christopher P. Cannon Boston, Massachusetts, USA For more than a decade, cardiologists have relied on Chris Cannon's Contemporary Cardiology series to provide them with forefront medical references on all aspects of cardiology. Each title is carefully crafted by world-renown cardiologists who comprehensively cover the most important topics in this rapidly advancing field. With over 60 titles in print covering everything from diabetes and cardiovascular disease to the management of acute coronary syndromes, the Contemporary Cardiology series has become the leading reference source for the practice of cardiac care. More information about this series at http://www.springer.com/series/7677 W. Frank Peacock Editor Short Stay Management of Acute Heart Failure Third Edition Editor W. Frank Peacock Department of Emergency Medicine Baylor College of Medicine HOUSTON Texas USA ISSN 2196-8969 ISSN 2196-8977 (electronic) Contemporary Cardiology ISBN 978-3-319-44005-7 ISBN 978-3-319-44006-4 (eBook) DOI 10.1007/978-3-319-44006-4 Library of Congress Control Number: 2016963565 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Humana Press imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Heart failure is the most common reason for patients over the age of 65 to be hospi- talized. It is the most common reason for their re-hospitalization within the next 30 days, and after an emergency department visit that results in hospitalization for acute heart failure, the 2-year mortality rate approaches 50 %. This is not a disease anyone wants to have, and it is occurring more frequently at an alarming rate. Heart failure is the final common pathway of an aging population and a consequence of the remarkable success that has been attained in managing the other chronic cardio- vascular diseases that historically resulted in an early mortality before the presence of heart failure could be realized. Heart failure is expensive. In fact, it is the number one most expensive diagnosis, as reported by the Centers for Medicare and Medicaid Studies. As a country, the United States spends more on heart failure than any two cancers combined, a fact that just represents the financial costs. From a quality of life perspective, patients with advanced heart failure are miserable. Symptoms include shortness of breath with the slightest effort, sleeping disorders, and the inability to eat or drink nor- mally. This is not a symptom constellation that is easily ignored or appreciated. Short Stay Management of Acute Heart Failure, Third Edition, presents opportu- nities for improving the management of patients likely to have, and ultimately be diagnosed with, acute heart failure. Few patients wish to be in the hospital. It is only when the severity of their illness makes it impossible to stay at home do they present and ask for help. By focusing on rapid diagnosis, early intervention, and stabiliza- tion, followed by symptom relief and optimization of life-prolonging therapies, a short stay strategy has the potential to maximize the quality of life for the patient. Quality of days alive and outside of the hospital is the measure by which patients will judge our successes in their care. The authors of this text hope that you will find it useful in providing the best outcomes possible for your heart failure patients. Houston, TX, USA W. Frank Peacock, MD, FACEP, FACC v Contents Part I Administrative and Regulatory Issues 1 Society of Cardiovascular Patient Care Heart Failure Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Maghee Disch 2 The Economics and Reimbursement of Congestive Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Sandra Sieck 3 Regulatory Requirements in Acute Heart Failure . . . . . . . . . . . . . . . . . 29 Nancy M. Albert 4 Quality and Operational Metrics in Heart Failure . . . . . . . . . . . . . . . . 45 Donna Hunn, Phillip D. Levy, Matthew A. Wheatley, and Maghee F. Disch 5 Interaction of Performance Measurements, Staffing, and Facility Requirements for the Heart Failure Observation Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Valorie Sweigart and Karen Krechmery Part II Pathophysiology and Demographics 6 Heart Failure: Epidemiology and Demographics . . . . . . . . . . . . . . . . . 69 Karina M. Soto-Ruiz 7 P athophysiology of Acute Decompensated Heart Failure . . . . . . . . . . . 81 Ezra A. Amsterdam, Sandhya Venugopal, and Angela Thinda Part III Emergency Medical Services and Emergency Department Assessment and Treatment of Acute Heart Failure 8 T he Out-of-Hospital Management of Acute Heart Failure . . . . . . . . . . 91 Andrew M. McCoy, Richard B. Utarnachitt, and Marvin A. Wayne vii viii Contents 9 Dyspnea Assessment and Airway Management in Acute Heart Failure Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Gina DiAntonio Swartzel and Peter S. Pang 10 Volume Assessment in Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Anna Marie Chang and Alfred B. Cheng 11 Emergency Department Ultrasound as a Diagnostic and Therapeutic Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Jennifer Carnell 12 Diagnostic and Prognostic Biomarkers in Emergency Department Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Yang Xue, Arrash Fard, Navaid Iqbal, Alan Maisel, and Nicholas Wettersten 13 Emergency Department Therapy of Acute Heart Failure . . . . . . . . . 165 Carlos E. Velasco, Deborah Diercks, and Phillip D. Levy Part IV Observation Unit Treatment and Disposition 14 O bservation Unit Admission Inclusion and Exclusion Criteria . . . . . 187 Jason M. Hogan, Sean Collins, and Gregory J. Fermann 15 A cute Decompensated Heart Failure in the Observation Unit: Treatment Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 John Pease 16 E ducation Elements in the Observation Unit for Heart Failure Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Brad P. Mayeux and Robin J. Trupp 17 E mergency Department and Observation Unit Discharge Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Kevan E. Meadors and Deborah B. Diercks 18 E ffective Discharge Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Sudha P. Jaganathan, Ginger Conway, and Stephanie Dunlap 19 O utpatient Medication Titration in Acute Heart Failure . . . . . . . . . . 243 Juan R. Vilaro and David E. Winchester Part V Complications and Future Research 20 D rugs to Avoid in Acute Decompensated Heart Failure (ADHF): Contraindicated Medications and Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Lindsey Aurora and James McCord Contents ix 21 Implications of Atrial Fibrillation in Heart Failure Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 Chad E. Darling and David D. McManus 22 Cardiac Implantable Electronic Devices . . . . . . . . . . . . . . . . . . . . . . . . 285 Brian Hiestand 23 Heart Failure and Kidney Disease: Management in the Short-Stay Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Shahriar Dadkhah and Korosh Sharain Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Contributors Nancy M. Albert, PhD, CCNS, CCRN, NE-BC, FAHA Nursing Research and Innovation, Nursing Institute and Clinical Nurse Specialist, Kaufman Center for Heart Failure, Cleveland, OH, USA Ezra A. Amsterdam, MD Division of Cardiovascular Medicine, Department of Internal Medicine, Davis Medical Center, University of California, Sacramento, CA, USA Jennifer Carnell Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA Anna Marie Chang, MD, MSCE Thomas Jefferson University, Philadelphia, PA, USA Alfred B. Cheng Cooper University Hospital, Camden, NJ, USA Ginger Conway, RN, MSN, CNP Division Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, USA Shahriar Dadkhah, MD, FACC Section of Cardiology, Presence Saint Francis Hospital, Evanston, IL, USA Chad E. Darling, MD Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA Deborah B. Diercks, MD, MSc, FACEP Department of Emergency Medicine, University of California, Davis Medical Center, Sacramento, CA, USA Maghee F. Disch, MSN, RN, CNL, CHFN, AACC Society of Cardiovascular Patient Care, Dublin, OH, USA Stephanie Dunlap, DO Advanced Heart Failure Program, University of Cincinnati Medical Center, Cincinnati, OH, USA Arrash Fard, MD VA San Diego Healthcare System, San Diego, CA, USA Gregory J. Fermann, MD Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA xi