SLIDE 8 2/12/2020 8
Zuckerberg San Francisco General
Discharge Diuretics
▪ Convert active IV diuretic dose to oral dose then reduce dose by one half to estimate maintenance, outpatient diuretic dose ▪ Approximate outpatient diet and fluid intake and monitor patient in the hospital for 24 hours ▪ If the patient is negative 500-1000 ml in the 24-hour period you have identified the maintenance, oral diuretic dose
Zuckerberg San Francisco General
Early Follow-up Decreases Hospital Readmission
Hernandez et al. JAMA. 2010;303(17):1716-1722
Early Follow-up = Within 7 days of discharge
Zuckerberg San Francisco General
ZSFG Heart Failure Discharge Planning Tool
Volume Status Medications Follow-up
Edema present? JVP visible above the clavicle at 90 degrees? IVC < 2.1 cm and > 50% collapsible?
Yes
Euvolemic HFrEF Guideline Directed Medical Therapy Patient on a STABLE dose of ORAL diuretics with net
1000ml over the last 24 hours? EF <40%? Patient prescribed carvedilol or metoprolol XL? Patient prescribed ACEI
Patient prescribed spironolactone?
No Ye s Ye s Ye s Ye s Ye s Yes Yes No No No No No No
Dry weight clearly documented in discharge summary?
No Ye s
Cardiology follow up within 7 days? PCP follow up within 7 days? Prescription for 30 days of medications?
Ye s Ye s No No No Ye s
Discharge
Patient MRN: Discharge Date: Service Attending: Primary Care Provider: If all are criteria are NOT met prior to discharge please briefly explain on the reverse of this sheet No
Zuckerberg San Francisco General
Best Practices for Outpatient Management of Heart Failure
