monitoring response to therapy

Last edited 10/2018

All patients with chronic heart failure require monitoring. This monitoring should include:

• a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status
  
  
• a review of medication, including need for changes and possible side effects
  
  
• serum urea, electrolytes, creatinine and eGFR
  • note that this is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an mineralocorticoid antagonist (e.g. spironolactone)

The frequency of monitoring should depend on the clinical status and stability of the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure.

People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration

Notes:

over-diuresis causes:
• postural hypotension
• malaise
• thirst
• the JVP should return to normal in the well-diuresed patient
• weight may be used as a measure of treatment in severe congestive heart failure:
  • set a realistic target weight
  • if severe congestive heart failure then may aim to lose approximately 1 kg per day
• blood pressure - note that vasodilators may cause hypotension
• electrolytes:
  • many of the drugs used to treat heart failure may cause derangement of serum electrolytes
  • abnormal potassium levels predispose the patient to e.g. arrhythmias and digoxin toxicity

Reference:

• 1) NICE (September 2018). chronic heart failure