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Teachable Moment
June 2018

Sensory Impairments in Heart Failure—Are We Missing the Basics?A Teachable Moment

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
  • 2Division of Clinical Epidemiology and Evaluative Science Research, Department of Medicine, Weill Cornell Medicine, New York, New York
JAMA Intern Med. 2018;178(6):843-844. doi:10.1001/jamainternmed.2018.1317

An 81-year-old man with heart failure (HF), coronary artery disease, hypertension, diabetes, and chronic obstructive pulmonary disease presented to clinic for a follow-up appointment after a recent HF hospitalization. He had experienced 3 HF hospitalizations in the last year. Medications at discharge included albuterol, aspirin, atorvastatin, carvedilol, furosemide, lisinopril, metformin, and tiotropium. On discharge, he was instructed to weigh himself daily, double his furosemide dose if he gained 2 to 3 pounds (to convert to kg, multiply by 0.45) in 1 day or more than 5 pounds per week, and maintain a diet low in salt (<2000 mg of sodium/d). Notably, his understanding of these instructions was not assessed by the medical team prior to this discharge or others. Medical record review indicated that HF exacerbations were due to medication noncompliance and were treated with intravenous diuresis and resumption of his home medications. Social work notes revealed that he lived alone and was able to care for himself but struggled with HF self-care.

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