Yes/No Appropriate monitoring (one week after initiation and with any change of dose)? Yes/No Appropriate monitoring (including patient monitoring of body weight as appropriate)? Yes/No Appropriate monitoring? Yes/No Drug therapy for failure with LV systolic dysfunction (circle all agents prescribed): ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify) Rationale/comments re. initial and subsequent drug therapy: Rationale/comments re. monitoring/adverse events: Other comments: Patient 3 (add initials/NHI): ACE inhibitor used as first-line agent (or ARB if not tolerated) Yes/No BP, serum potassium and renal function checked before initiation of drug therapy? Yes/No Appropriate monitoring (one week after initiation and with any change of dose)? Yes/No Diuretic therapy - appropriate agent and dose? Yes/No/NA Appropriate monitoring (including patient monitoring of body weight as appropriate)? Yes/No Drug therapy intensification consistent with recommended titration and treatment regimens Yes/No Appropriate monitoring? Yes/No Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed): ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify)
ACE inhibitor used as agent (or ARB if not tolerated) Yes/No BP, serum potassium and renal function checked before initiation of drug therapy? Yes/No Appropriate monitoring (one week after initiation and with any change of dose)? Yes/No Diuretic therapy - appropriate agent and dose? Yes/No/NA Appropriate monitoring (including patient monitoring of body weight as appropriate)? Yes/No Drug therapy intensification consistent with recommended titration and treatment regimens Yes/No Appropriate monitoring? Yes/No Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed): ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify) Rationale/comments re. initial and subsequent drug therapy: Rationale/comments re. monitoring/adverse events: Other comments: Patient 7 (add initials/NHI): ACE inhibitor used as first-line agent (or ARB if not tolerated) Yes/No BP, serum potassium and renal function checked before initiation of drug therapy? Yes/No Diuretic therapy - appropriate agent and dose? Yes/No/NA Appropriate monitoring (including patient monitoring of body weight as appropriate)? Yes/No Drug therapy intensification consistent with recommended titration and treatment regimens Yes/No Appropriate monitoring? Yes/No
Rationale/comments re. monitoring/adverse events: Other comments: Patient 9 (add initials/NHI): ACE inhibitor used as first-line agent (or ARB if not tolerated) Yes/No BP, serum potassium and renal function checked before initiation of drug therapy? Yes/No Appropriate monitoring (one week after initiation and with any change of dose)? Yes/No Diuretic therapy - appropriate agent and dose? Yes/No/NA Appropriate monitoring (including patient monitoring of body weight as appropriate)? Yes/No Drug therapy intensification consistent with recommended titration and treatment regimens Yes/No Appropriate monitoring? Yes/No Drug therapy for heart failure with LV systolic dysfunction (circle all agents prescribed): ACE inhibitor beta-blocker ARB spironolactone thiazide diuretic loop diuretic other (specify) Rationale/comments re. initial and subsequent drug therapy: Rationale/comments re. monitoring/adverse events: Other comments: