Clinical Case Report:

Nutritional Management
on Congestive Heart Failure
Mabel Wu
Queens College Dietetic Intern 2017-2018
Congestive Heart Failure

 American Heart Association

 1 in 5 will develop Heart Failure
 Over 900,000 new cases diagnosed each year

 Major Risk Factors:

 Coronary artery disease
 Hypertension
 Previous heart attack
 Diabetes
 Obesity
 Smoking
Pathophysiology-Congestive Heart Failure

A chronic progressive condition in which the heart muscle

is unable to pump enough blood through to meet the
body’s needs for blood and oxygen
 Temporarily compensates by:
 Enlarging
 Developing more muscle mass
 Pumping faster

 Eventually substitute processes give out

Congestive Heart Failure

Image: www.heart.org
Congestive Heart Failure

 Overall 30-day readmission rate is about 23-26% nationwide

 Major Causes include:
 Medication non-compliance
 Smoking
 Non-compliance to sodium and fluid restriction
 Failure of documentation of discharge information and patient education
 Co-morbidities (HTN, DM, anemia, etc)

 Readmission Reduction Program- Effective October 1st, 2012

 Implement strategies to reduce hospital cost and unnecessary readmits
 Rewards acute-care hospitals with incentive payments for quality of care
 Medicare penalizes hospitals for readmissions
 Limitations- comorbidities, socioeconomic status, old age
 Comorbidities

 Hypertension
 Elevated blood pressure
 American Heart Association Guidelines: 130/80
 Lifestyle factors are the best way to treat

 Coronary Artery Disease

 Narrows the arteries, affecting blood flow
 Associated with increased risk of heart attacks
Comorbidities

 Type 2 Diabetes:
 A reversible condition through a therapeutic diet
and lifestyle changes
 Hyperglycemia and insulin resistance
 Increased risk for other health problems

 Dementia
 An irreversible decline in mental ability
 At least two of the following must be significantly
impaired to be considered dementia:
 Memory
 Communication and language
 Ability to focus and pay attention
 Reasoning and judgement
 Visual perception
Septic Shock

 Lifethreatening condition from a body-wide infection

leading to severe hypotension
 Caused by any type of bacteria
 Toxins released by bacteria may cause tissue damage leading to low
blood pressure and poor organ function

 RiskFactors include: diabetes, compromised immune

systems, recent infection, recent surgery.
 Populationat risk: The very young, very old, or in people
with weakened immune systems
Dysphagia

A swallowing disorder that

may cause difficulty
swallowing liquids, foods,
and saliva safely
 Maybe caused by a stroke,
nervous system disorder,
esophagus disorder, cancer
 Oftena challenge to take in
enough calories and fluids
to nourish the body
 Canlead to lung infections
 aspiration pneumonia
References
 Inamdar A, Inamdar A. Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine.
2016;5(7):62. doi:10.3390/jcm5070062

 Cotter G, Milo O. Faculty of 1000 evaluation for Diagnoses and timing of 30-day readmissions after
hospitalization for heart failure, acute myocardial infarction, or pneumonia. F1000 - Post-publication peer
review of the biomedical literature. 2013. doi:10.3410/f.717972999.793471777.

 Type 2. American Diabetes Association. http://www.diabetes.org/diabetes-basics/type-2/. Accessed May

2, 2018. .
 Dysphagia. National Institute of Deafness and Other Communication Disorders.
https://www.nidcd.nih.gov/health/dysphagia. Published September 6, 2017. Accessed May 2, 2018.

 Sepsis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214.

Published January 3, 2018. Accessed May 2, 2018.

 McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient. Freshwater Biology.
https://onlinelibrary.wiley.com/doi/full/10.1177/0148607115621863. Published January 14, 2016. Accessed
May 2, 2018.

 NEW 2014 Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. The National Pressure
Ulcer Advisory Panel - NPUAP. http://www.npuap.org/resources/educational-and-clinical-
resources/prevention-and-treatment-of-pressure-ulcers-clinical-practice-guideline/. Accessed May 3, 2018.

 Nutrition Care Manual. https://www.nutritioncaremanual.org/. Accessed May 2, 2018.

 Nutrition Care Process. Academy Publishing. https://www.ncpro.org/nutrition-care-process. Accessed May

3, 2018.