Patients benefit from frequent formal evaluation in a specialized center or monitoring in a management program. Assessment should be made at each visit of the ability of a patient to perform routine and desired activities of daily living. Assessment should be also made of the fluid status and weight of the patient. Careful history of current use of alcohol, tobacco, illicit drugs, alternative therapies, and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit. Repeat measurement of ejection fraction and assessment of the severity of structural remodeling can provide useful information in patients with heart failure who have had a change in clinical status, or who have experienced or recovered from a clinical event, or received treatment that might have had a significant effect on cardiac function. The value of serial measurements of B-type natriuretic peptide to guide therapy for patients is still not well established. [ ] Data suggest that natriuretic-guided therapy reduces hospitalization due to heart failure and that in patients younger than 75 years of age, it also provides a survival benefit. However, one randomized trial found that in high-risk patients with heart failure, natriuretic-guided therapy was not more effective than optimal medical therapy alone in improving outcomes. The use of telemonitoring to monitor patients remotely is an emerging strategy, but requires further evaluation. [ ] [ ] [Evidence A]
Wireless pulmonary hemodynamic monitoring in patients with chronic heart failure results in significant reduction in heart failure hospitalizations.
Structured telephone support and noninvasive home telemonitoring can reduce the risk of mortality and heart failure-related hospitalizations.
Invasive hemodynamic monitoring, however, is not routinely used in clinical practice, but may be of use in individual patients, particularly those with recurrent heart failure.
In one study of patients with New York Heart Association class III heart failure, wireless implantable hemodynamic monitoring compared with control led to a significant reduction of heart failure-related hospitalizations.
Exercise training and rehabilitation
In patients with heart failure, cardiac rehabilitation and exercise training improves exercise tolerance and quality of life with decreased morbidity and mortality. [ ] Patients with stable heart failure are therefore encouraged to do regular aerobic exercise and it is recommended that they are enrolled in a multidisciplinary care management program. [ ] One consensus paper provides a detailed description of exercise training in heart failure.
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