Download POST-TEST/Rationale 1. Hospitalizations account - Power

Update on Heart Failure Management: A Primer for Pharmacists
Upon completion of this activity, participants should be better able to:
1. Describe the prevalence, pathophysiology, and etiologies of heart failure (HF).
2. Review recent changes in recommendations for the treatment of HF, particularly involving
current research findings and newer/investigational approaches to HF.
3. Discuss approaches to decreasing hospital readmission rates for HF through discharge planning
and patient education.
4. Address individual patient and disease characteristics to educate patients about appropriate care
for HF.
5. Describe the rationale for individualizing the approach to HF management, taking into account
newer management approaches.
POST-TEST/Rationale
1. Hospitalizations account for what percentage of the direct medical care costs for patients
with heart failure in the United States?
A. 25%
B. 40%
C. 50%
D. 80%***
Correct Answer: D
Hospitalizations account for 80% of the direct medical care costs associated with heart failure.
2. The most common cause of heart failure in the Unites States is:
A. Valvular heart disease
B. Alcoholism
C. Coronary artery disease***
D. Obesity
Correct Answer: C
In the United States, coronary artery disease and myocardial infarction are the most common
causes of heart failure.
3. Patients with ACC/AHA Stage D heart failure (HF) are characterized by:
A. The presence of structural heart disease but no current symptoms
B. Being at high risk for heart disease but without structural heart disease or symptoms of HF
C. The presence of structural heart disease with prior symptoms
D. Refractory HF requiring specialized interventions***
Correct Answer: D
Patients with refractory HF requiring specialized interventions are classified as ACC/AHA Stage
D.
4. Which of the following drugs has not been shown to reduce mortality in patients with
heart failure with reduced ejection fraction?
A. Digoxin***
B. Angiotensin-converting enzyme inhibitors
C. Beta-blockers
D. Aldosterone receptor antagonists
Correct Answer: A
Digoxin was evaluated in a large outcomes trial; the results indicated that the drug had a
neutral effect on mortality in heart failure patients.
5. In a patient receiving an angiotensin-converting enzyme inhibitor (ACEI), which of the
following washout periods is required prior to initiation of sacubitril/valsartan?
A. 24 hours
B. 48 hours
C. 36 hours***
D. The washout period depends on the dose of the ACEI
Correct Answer: C
In patients already taking an ACEI, ACEI therapy needs to be discontinued for 36 hours prior to
initiation of sacubitril/valsartan.
6. The adverse event that led to a significantly greater rate of drug discontinuation with
ivabradine compared to placebo in the SHIFT study was:
A. Hypotension
B. Bradycardia***
C. Phosphenes
D. Atrial fibrillation
Correct Answer: B
Bradycardia was the only adverse event that was associated with a significantly greater rate of
treatment discontinuation with ivabradine than with placebo.
7. Patients with HF should be able to demonstrate an understanding of the content of their
education concerning heart failure treatment using:
A. A post-interview quiz
B. The Morisky scale
C. The “teach back” technique***
D. Adherence on the basis of refill records
Correct Answer: C
Patients should be able to demonstrate an understanding of their education about diet,
exercise, medications, and disease processes using the “teach back” technique.
8. Guideline-directed medical therapy for a patients with ACC/AHA Stage A heart failure
should include:
A. Angiotensin converting enzyme inhibitor and beta-blocker***
B. Ivabradine
C. Sacubitril/valsartan
D. Aldosterone receptor antagonist
Correct Answer: A
For patients with Stage A HF, therapy is directed at reducing the risk factors for the
development of HF.
9. Factors associated with improved medication adherence in patients with heart failure (HF)
include:
A. Cognitive decline and/or depression
B. High education level***
C. High baseline heart rate
D. Increased severity of HF
Correct Answer: B
Factors that improve adherence to HF treatment include age older than 65 years, more years of
education, current use of other cardiovascular medications, patient knowledge of correct
medication use, prior use of HF medications, adequate heath literacy, satisfactory reading
ability, and being married.
10. According to the Heart Failure Society of America, patients who should be referred to a
heart failure (HF) disease management program include:
A. Patients with poor adherence to guideline-directed medical therapy
B. Patients discharged after a HF hospitalization***
C. Patients with atrial fibrillation requiring warfarin monitoring
D. Patients with low health literacy
Correct Answer: B
The HFSA recommends that referral to an HF disease management program (DMP) should be
considered in patients who have been hospitalized for HF. Although many patients would
benefit from enrollment in an education or medication management program, including those
with poor adherence, those who require substantial medication therapy monitoring, or those
with low literacy, the HFSA does not specifically note that these patients have specific risk
factors that necessitate enrollment in a DMP.