Cardiovascular A/P Template
The following template and resources will assist you in decision-making and documentation of care of patients with cardiovascular conditions.
Helpful Resources and Links
Oral Pharm with Atrial Fibrillation
Lipid Pharmacological Therapy
Heart Failure Non-Pharmacologic Interventions
– Hypertension and lipid disorders should be controlled in accordance with contemporary guidelines to lower the risk of HF.
– Other conditions that may lead to or contribute to HF, such as obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents, should be controlled or avoided.
– Patients with HF should receive specific education to facilitate HF self-care.
– Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms.
– Continuous positive airway pressure can be beneficial to increase LVEF and improve functional status in patients with HF and sleep apnea.
– Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate, to improve functional status.
– Cardiac rehabilitation can be useful in clinically stable patients with HF to improve functional capacity, exercise duration, HRQOL, and mortality.
– Effective systems of care coordination with special attention to care transitions should be deployed for every patient with chronic HF, that facilitate and ensure effective care that is designed to achieve GDMT and prevent hospitalization.
– Every patient with HF should have a clear, detailed, and evidence-based plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team.
– Palliative and supportive care is effective for patients with symptomatic advanced HF, to improve quality of life.
Heart Failure Pharmacologic Interventions for Stage B
– In patients with a history of MI and reduced EF, ACE inhibitors or ARBs should be used to prevent HF
– In patients with MI and a reduced EF, evidence-based beta blockers should be used to prevent HF
– In patients with MI, statins should be used to prevent HF
– Blood pressure should be controlled to prevent symptomatic HF
– ACE inhibitors should be used in all patients with a reduced EF to prevent HF
– Beta blockers should be used in all patients with a reduced EF to prevent HF
– An ICD is reasonable in patients with asymptomatic ischemic cardiomyoptahy who are at least 40 days post-MI, have an LVEF <=30%, and on GDMT
– Nondihydropyridine calcium channel blockers may be harmful in patients with low LVEF
Heart Failure Pharmacologic Interventions for Stage C
– Diuretics are recommended in patients with HF with reduced ejection fraction with fluid retention
– ACE inhibitors are recommended for all patients with HFrEF*
– ARBs are recommended in patients with HFrEF who are ACE inhibitor intolerant
– ARBs are reasonable as alternatives to ACE inhibitors as first-line therapy in HFrEF
– Addition of an ARB may be considered in persistently symptomatic patients with HFrEF on GDMT
– Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful
– Use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients
– Aldosterone receptor antagonists are recommended in patients with NYHA class II-IV who have LVEF <=35%
– Aldosterone receport antagonists are recommended in patients following an acute MI who have LVEF <=40% with symptoms of HF or DM
– Inappropriate use of aldosterone receptor antagonists may be harmful
– The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III-IV HFrEF on GDMT
– A combination of hydralazine and isosorbide dinitrate can be useful in patients with HFrEF who cannot be given ACE inhibitors or ARBs
– Digoxin can be beneficial in patients with HFrEF
– Patients with chronic HF with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke should receive chronic anticoagulant therapy *
– The selection of an anticoagulant agent should be individualized
– Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke*
– Anticoagulation is not recommended in patients with chronic HFrEF wihtout AF, a prior thromboembolic event, or a cardioembolic source
– Statins are not beneficial as adjunctive therapy when prescribed solely for HF
– Omega-3 PUFA supplementation is reasonable to use as an adjunctive therapy in HFrEF or HFpEF patients
– Nutritional supplements as treatment for HF are not recommended in HFrEF
– Hormonal therapies other than to correct deficiencies are not recommended in HFrEF
– Drugs known to adversely affect the clinical status of patients with HFrEF are potentially harmful and should be avoided or withdrawn
Long-term use of an infusion of a positive inotropic drug is not recommended and may be harmful except as palliation
Calcium channel-blocking drugs are not recommended as routine treatment in HFrEF
*HFrEF: Heart failure with reduced ejection fraction
Heart Failure Pharmacologic Interventions for Stage D
Refer to cardiologist or appropriate specialist
Lifestyle Therapies on BP in HTN Adults
Dosage for HTN Drug Therapy
Anti-HTN Agents Uncomplicated HTN
Anti-HTN Agents in Special Patient Populations
Evidence-Based Dosing for HTN Drugs
CV ACE-Is / ARBs / Beta-Blockers
Initial Clinical Evaluation
Pharm Management – Newly Discovered
Pharm Management – Recurrent / Permanent
Pharm Management – Paroxysmal
Antiarrhythmic Drug Therapy
Management of Dyslipidemia
Blood Cholesterol Guide
Heart Failure Classification
Blood Pressure Management
Stable IHD Management
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