DRG Category: 292

Mean LOS: 4.6 days

Description MEDICAL: Heart Failure and Shock with CC

classification section:



Heart failure (HF) occurs when the heart is unable to pump sufficient blood to meet the metabolic needs of the body. It is the most common nonfatal consequence of cardiovascular disorders and is the only major heart disease that is increasing significantly throughout the world.

The result of inadequate cardiac output (CO) is poor organ perfusion and vascular congestion in the pulmonary or systemic circulation. In the United States, HF is the fastest-growing cardiac disorder, and it affects 2% of the population. Almost 1 million hospital admissions occur each year for acute decompensated HF, and the rehospitalization rates during the 6 months following discharge are as much as 50%. In spite of recent advances in the treatment of HF, the 5-year estimated mortality rate is almost 50%.

HF may be described as backward or forward failure, high- or low-output failure, or right- or left-sided failure. In backward failure, the ventricle fails to eject its contents, which results in pulmonary edema on the left side of the heart and systemic congestion on the right. In forward failure, an inadequate CO leads to decreased organ perfusion. High-output failure is the inability of the heart to meet the increased metabolic demands of the body despite a normal or high CO. Low-output failure occurs when the ventricle is unable to generate enough CO to meet the metabolic demands of the body. This type of failure consists of impaired peripheral circulation and compensatory vasoconstriction. Right-sided failure occurs when the right ventricle is unable to maintain an adequate CO, and systemic congestion occurs. When the left ventricle is unable to produce a CO sufficient to prevent pulmonary congestion, left-sided failure occurs. Complications of HF include pulmonary edema, renal failure, cerebral insufficiency, myocardial infarction, and cardiac dysrhythmias.