Diagnosis Protocol

Vital signs and evidence of clinical congestion should be assessed at each encounter to guide overall management, including adjustment of diuretics and other medications.

Clinical factors indicating the presence of advanced HF should be sought via the history and physical examination.

A 3-generation family history should be obtained or updated when assessing the cause of the cardiomyopathy to identify possible inherited disease.

A thorough history and physical examination should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management.

A thorough history and physical examination should be obtained and performed to identify cardiac and noncardiac disorders, lifestyle and behavioral factors, and social determinants of health that might cause or accelerate the development or progression of HF.

The specific cause of HF should be explored using additional laboratory testing for appropriate management.

Laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, glucose, lipid profile, liver function tests, iron studies, and thyroid-stimulating hormone to optimize management.

A 12-lead ECG should be performed at the initial encounter to optimize management.

Measurement of B-type natriuretic peptide (BNP) or N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is useful to support a diagnosis or exclusion of HF.

Measurements of BNP or NT-proBNP levels are recommended for risk stratification.

Measurement of BNP or NT-proBNP levels at admission is recommended to establish prognosis.

BNP or NT-proBNP-based screening followed by team-based care, including a cardiovascular specialist, can be useful to prevent the development of LV dysfunction or new-onset HF.

A predischarge BNP or NT-proBNP level can be useful to inform the trajectory of the patient and establish a postdischarge prognosis.

Genetic screening and counseling are recommended to detect cardiac disease and prompt consideration of treatments to decrease HF progression and sudden death.

Referral for genetic counseling and testing is reasonable to identify conditions that could guide treatment for patients and family members.

A chest x-ray should be performed to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient's symptoms.

Transthoracic echocardiography (TTE) should be performed during initial evaluation to assess cardiac structure and function.

Repeat measurement of EF, degree of structural remodeling, and valvular function are useful to inform therapeutic interventions.

Alternative imaging (eg, cardiac magnetic resonance [CMR], cardiac computed tomography [CT], radionuclide imaging) is recommended for assessment of LVEF.

CMR can be useful for diagnosis or management.

An evaluation for possible ischemic heart disease can be useful to identify the cause and guide management.

Noninvasive stress imaging (stress echocardiography, single-photon emission CT [SPECT], CMR, or positron emission tomography [PET]) may be considered for detection of myocardial ischemia to help guide coronary revascularization.

Routine repeat assessment of LV function is not indicated.

Endomyocardial biopsy may be useful when a specific diagnosis is suspected that would influence therapy.

Invasive hemodynamic monitoring can be useful to guide management.

Routine use of invasive hemodynamic monitoring is not recommended.

Endomyocardial biopsy should not be performed because of the risk of complications.

The usefulness of wireless monitoring of PA pressure by an implanted hemodynamic monitor to reduce the risk of subsequent HF hospitalizations is uncertain.

Assessment and documentation of NYHA functional classification are recommended to determine eligibility for treatments.

Cardiopulmonary exercise testing (CPET) is recommended to determine appropriateness of advanced treatments (eg, LVAD, heart transplant).

Performing a CPET or 6-minute walk test is reasonable to assess functional capacity.

CPET is reasonable to evaluate the cause of dyspnea.

Validated multivariable risk scores can be useful to estimate subsequent risk of mortality.

Vital signs and evidence of clinical congestion should be assessed at each encounter to guide overall management, including adjustment of diuretics and other medications.

Clinical factors indicating the presence of advanced HF should be sought via the history and physical examination.

A 3-generation family history should be obtained or updated when assessing the cause of the cardiomyopathy to identify possible inherited disease.

A thorough history and physical examination should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management.

A thorough history and physical examination should be obtained and performed to identify cardiac and noncardiac disorders, lifestyle and behavioral factors, and social determinants of health that might cause or accelerate the development or progression of HF.

The specific cause of HF should be explored using additional laboratory testing for appropriate management.

Laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, glucose, lipid profile, liver function tests, iron studies, and thyroid-stimulating hormone to optimize management.

A 12-lead ECG should be performed at the initial encounter to optimize management.

Measurement of B-type natriuretic peptide (BNP) or N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is useful to support a diagnosis or exclusion of HF.

Measurements of BNP or NT-proBNP levels are recommended for risk stratification.

Measurement of BNP or NT-proBNP levels at admission is recommended to establish prognosis.

BNP or NT-proBNP-based screening followed by team-based care, including a cardiovascular specialist, can be useful to prevent the development of LV dysfunction or new-onset HF.

A predischarge BNP or NT-proBNP level can be useful to inform the trajectory of the patient and establish a postdischarge prognosis.

Genetic screening and counseling are recommended to detect cardiac disease and prompt consideration of treatments to decrease HF progression and sudden death.

Referral for genetic counseling and testing is reasonable to identify conditions that could guide treatment for patients and family members.

A chest x-ray should be performed to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient's symptoms.

Transthoracic echocardiography (TTE) should be performed during initial evaluation to assess cardiac structure and function.

Repeat measurement of EF, degree of structural remodeling, and valvular function are useful to inform therapeutic interventions.

Alternative imaging (eg, cardiac magnetic resonance [CMR], cardiac computed tomography [CT], radionuclide imaging) is recommended for assessment of LVEF.

CMR can be useful for diagnosis or management.

An evaluation for possible ischemic heart disease can be useful to identify the cause and guide management.

Noninvasive stress imaging (stress echocardiography, single-photon emission CT [SPECT], CMR, or positron emission tomography [PET]) may be considered for detection of myocardial ischemia to help guide coronary revascularization.

Routine repeat assessment of LV function is not indicated.

Endomyocardial biopsy may be useful when a specific diagnosis is suspected that would influence therapy.

Invasive hemodynamic monitoring can be useful to guide management.

Routine use of invasive hemodynamic monitoring is not recommended.

Endomyocardial biopsy should not be performed because of the risk of complications.

The usefulness of wireless monitoring of PA pressure by an implanted hemodynamic monitor to reduce the risk of subsequent HF hospitalizations is uncertain.

Assessment and documentation of NYHA functional classification are recommended to determine eligibility for treatments.

Cardiopulmonary exercise testing (CPET) is recommended to determine appropriateness of advanced treatments (eg, LVAD, heart transplant).

Performing a CPET or 6-minute walk test is reasonable to assess functional capacity.

CPET is reasonable to evaluate the cause of dyspnea.

Validated multivariable risk scores can be useful to estimate subsequent risk of mortality.