Collaborative Care for Heart Failure Patients With the Metabolic Syndrome

Inclusion Criteria: Individuals with heart failure of ischemic or non-ischemic etiologies Age ≥18 years Admitted to the hospital with a primary diagnosis of heart failure (need not be their first admission for heart failure) Meets the modified Framingham criteria for the diagnosis of heart failure (2 major OR 1 major / 2 minor are required): MAJOR: paroxysmal nocturnal dyspnea (sudden shortness of breath at night), orthopnea (shortness of breath when supine), elevated jugular venous pressure, rales, the presence of an S3 heart sound, cardiomegaly on chest X-ray, pulmonary edema on chest X-ray MINOR: lower extremity edema, night cough, dyspnea on exertion, hepatomegaly, pleural effusion on chest X-ray, heart rate > 120 bpm, weight loss > 10 pounds in 5 days while in hospital • Meets the National Cholesterol Education Panel criteria for the metabolic syndrome (3 of 5 criteria must be present): waist > 40 in for men, 35 in for women blood pressure ≥ 130/85 mmHg or hypertension triglycerides ≥150 mg/dL fasting glucose ≥ 100 mg/dL or diabetes high density lipoprotein level (HDL) < 40 mg/dL for men, <50 for women Exclusion Criteria: Patients will be excluded if they do not meet the definitions for heart failure and the metabolic syndrome listed above. Also, heart failure patients admitted for a diagnosis other than acute heart failure exacerbation will not be included. Other exclusion criteria include: A condition, other than heart failure, that limits a patient's survival (such as cancer, active hepatitis, advanced HIV infection etc.) Factors that may limit adherence to interventions or affect conduct of the trial Unable or unwilling to given informed consent Mental incapacity that limits patient's ability to live independently and benefit from patient education