• New-onset HF (regardless of EF): Refer for evaluation of etiology, guideline-directed evaluation and management of recommended therapies, and assistance in disease management, including consideration of advanced imaging, endomyocardial biopsy, or genetic testing for primary evaluation of new-onset HF

• Chronic HF with high-risk features, such as development of 1 more of the following risk factors:

   

  • Need for chronic IV inotropes

  • Persistent NYHA functional class III-IV symptoms

  • Systolic blood pressure =90 mm Hg or symptomatic hypotension

  • Creatinine =1.8 mg/dl or BUN =43 mg/dl

  • Onset of atrial fibrillation, ventricular arrthymias, or repetitive ICD shocks

  • Two or more ED visits or hospitalizations for worsening HF in prior 12 months

  • Inability to tolerate optimally dosed beta-blockers and/or ACI/ARB/ARNU and/or aldosterone antagonists

  • Clinical deterioration, as indicated by worsening edema, rising biomarkers (BNP, NT-proBNP, others), worsened exercise testing, decompensated hemodynamics, or evidence of progressive re-modeling on imaging

  • High mortality risk using a validated risk model for further assessment and consideration of advanced therapies, such as Seattle Heart Failure Model

• To assist with management of GDMT, including replacement of ACEI or ARB therapy with ARNI for eligible patients or to address comorbid conditions such as chronic renal disease or hyperkalemia, which may complicate treatment.

• Persistent reduced LVEF at or below 35% despite GDMT for at least 3 months for consideration of device therapy in those patients without prior placement of ICD or CRT, unless device therapy contraindicated or inconsistent with overall goals of care

• Annual review of patients with established advanced HF in which patients/caregivers and clinicians discuss current and potential therapies for both anticipated and unanticipated events, possible HF disease trajectory and prognosis, patient preferences, and advanced care planning.

• Assessment of patient for possible participation in a clinical trial

Find a cardiologist

HFpEF treatment focuses on maintaining euvolemia and effectively managing associated comorbidities (coronary artery disease, hypertension, atrial fibrilation, diabetes mellitus, obstructive sleep apnea)

Read the Mount Sinai Heart Failure Pathway for in-depth, evidence-based guidelines for managing your heart failure outpatients

Explore Team-Based Care services available to you and your practice as a member of MSHP's Clinically Integrated Network

Get a print-friendly version of this page

Need a consult? Connect with our experts.