Monitoring

Patients benefit from frequent formal evaluation in a specialized center or monitoring in a management program.[7]​ Assessment should be made at each visit of the ability of a patient to perform routine and desired activities of daily living. Assessment should also be 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.[316]​ Repeat measurement of ejection fraction and assessment of the severity of structural remodeling can provide useful information in patients with HF 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. [ Cochrane Clinical Answers logo ] ​ Data suggest that natriuretic-guided therapy reduces hospitalization due to HF and that in patients younger than 75 years of age, it also provides a survival benefit.[317] However, one randomized trial found that in high-risk patients with HF, natriuretic-guided therapy was not more effective than optimal medical therapy alone in improving outcomes.[318]

Patients who have a left ventricular ejection fraction (LVEF) measurement of >40% on follow-up after treatment are considered to have HF with improved EF (HFimpEF). These patients should continue with guideline-directed medical therapy to prevent relapse of HF and LV dysfunction.[7][9]​

Validated questionnaires, such as the Kansas City Cardiomyopathy Questionnaire, may be used to assess the patient's perception of their health status and can be useful to provide incremental information for patient functional status, symptom burden, and prognosis.[7][319]

The use of telemonitoring to monitor patients remotely is an emerging strategy that has been shown to reduce the risk of mortality and HF-related hospitalizations, but requires further evaluation.[320][321][322][323]​​ [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ] [Evidence A]

Invasive hemodynamic monitoring is not routinely used in clinical practice, but may be of use in individual patients, particularly those with recurrent HF hospitalization.[324]​[325]​[326]​[327]​[328]​ 

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