Page 7 - The 5-Minute Clinical Consult 2021 29th Edition

In patients with HFrEF and secondary moderate to severe mitral regurgitation (MR),
transcatheter edge-to-edge mitral leaflet repair device (MitraClip) may be used to reduce MR
by improving the coaptation of the anterior and posterior mitral leaflets. The optimum patient
selection has not been fully defined.

SURGERY/OTHER PROCEDURES
Heart valve surgery if defective heart valve is responsible; mitral valve repair especially
helpful if mitral regurgitation is the primary issue and not functional
Advanced therapies such as cardiac transplantation and LV assist device (LVAD) implantation
can be considered in patients with HF refractory to conventional medical/device therapies
without other disqualifying medical and psychosocial conditions. Cardiac transplantation is
generally considered for patients ≤70 years old with a predicted 1-year survival worse than
that afforded by transplantation. Consideration can be made for patients >70 years with few
comorbid conditions. Indications for LVAD implantation are generally similar to cardiac
transplantation but are evolving.

ADMISSION, INPATIENT, AND NURSING CONSIDERATIONS
See “Heart Failure, Acutely Decompensated.”
Admit patients with hemodynamic/respiratory compromise, hypoxia/hypoxemia, change in
mental status, acute renal insufficiency, significant volume overload, and significant
electrolyte abnormalities (e.g., hyponatremia).
Discharge criteria: subjective improvement, euvolemia on clinical assessment, resting HR
<100 bpm, systolic BP >80 mm Hg, HF outpatient education performed

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS
Critical patient education performed at all outpatient and inpatient physician visits
Rapid office follow-up (7 days) after hospitalization

Patient Monitoring
Home health monitoring by specially trained nurses have been shown to decrease frequency of
hospitalizations. Readmissions remain problematic.
DIET
Reduce sodium load (<1.5 to 2.0 g/day). Optimal level is unknown.

PATIENT EDUCATION
AHA: www.americanheart.org
PROGNOSIS
After diagnosis: 1-year survival ~75%, 5-year survival <50%, and 10-year survival <25%

COMPLICATIONS
Sudden death (arrhythmic), acute pulmonary edema, death, progressive pump failure

REFERENCES