Reporting Acute Diastolic /Systolic/Combined CHF on Elective outpatient TAVR's>>> Really?
Well, I knew it would happen. I have had some spirited debates with Nurse Practitioners lately who must have attended the same conference sponsored by Edwards Life Sciences or Medtronic (the makers of the Valve). They are now saying it is perfectly fine to document Acute Diastolic CHF on the day of admission and the the Stent is the RX for the CHF.
So decided to see if anyone has ever looked at how much time constitutes Defining Acute (decompensated) Heart Failure? Would documenting Acute CHF hold up (to an audit) as POA on the day of an elective surgery ?
The Term Acute
In medicine, describing a disease as acute denotes that it is of short duration and, as a corollary of that, of recent onset.
The quantitation of how much time constitutes "short" and "recent" varies by disease and by context, but the core denotation of "acute" is always qualitatively in contrast with "chronic", which denotes long-lasting disease. In addition, "acute" also often connotes two other meanings: sudden onset and severity, such as in acute myocardial infarction, where suddenness and severity are both established aspects of the meaning. It thus often connotes that the condition is fulminant, but not always. The one thing that acute MI and acute rhinitis have in common is that they are not chronic. They can happen again, but they are not the same case ongoing for months or years.
I found this bit of information interesting: What is acute decompensated heart failure? By G Michael Felker, Professor of Medicine Member in the Duke Clinical Research Institute
Acute decompensated heart failure (ADHF) is a clinical syndrome of worsening signs
or symptoms of heart failure requiring hospitalization or other unscheduled medical care.
Are there clinically important subcategories of ADHF? >this area is rapidly evolving, a few general clinical phenotypes of ADHF have emerged.
>Hypertensive acute heart failure-Symptoms often develop quickly (minutes to hours), and many such patients have little or no history of chronic heart failure. Hypertensive urgency with acute pulmonary edema represents an extreme form of this phenotype.
>Decompensated heart failure: This describes patients with a background of significant chronic heart failure, who develop symptoms of volume overload and congestion over a period of days to weeks. These patients typically have significant left ventricular dysfunction and chronic heart failure at baseline. Although specific triggers are poorly understood, episodes are often triggered by noncompliance with diet or medical therapy.
>Cardiogenic shock/advanced heart failure: they are relatively uncommon in the broader population (probably fewer than 10% of ADHF hospitalizations.
I welcome comments on this as I think CMS needs to step in NOW and offer guidance.