CHF Exacerbation Assessment & Plan Template

TL;DR

When to use this template:

• Admissions for acute on chronic heart failure exacerbation
• Daily progress notes for CHF patients requiring diuresis
• Discharge summaries documenting heart failure management

What it includes:

• HF classification with EF documentation
• Structured volume status assessment with exam findings
• GDMT status table aligned with ACC/AHA 2022 guidelines
• Weight tracking with goal-directed therapy
• Disposition planning with follow-up coordination

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The Template

Copy the block below and customize for your patient:

# Acute on chronic [systolic/diastolic] heart failure exacerbation ([HFrEF/HFpEF], EF [XX]%)

**Etiology:** [Ischemic/Non-ischemic cardiomyopathy, details]
**Precipitant:** [dietary indiscretion / medication non-adherence / infection / arrhythmia / ischemia / unclear]

**Current volume status:** [Hypervolemic/Euvolemic/Hypovolemic]
- JVP: [XX cm at 45°]
- Peripheral edema: [X+ bilateral LE edema to level]
- Lungs: [crackles location / clear]
- Weight: [XX.X kg] (Admission: [XX.X kg], Goal: [XX kg])
- I/O: [Net +/- X L over past 24h]

**Diuretics:**
- [Current regimen with dose]
- Target: [net negative X L/day until goal weight]
- Plan: [Transition to PO when ...]

**GDMT Status (per ACC/AHA 2022 Guidelines):**
| Class | Medication | Status | Notes |
|-------|------------|--------|-------|
| ARNI/ACEi/ARB | [Drug dose] | [On/Starting/Holding] | [Reason] |
| Beta-blocker | [Drug dose] | [On/Starting/Holding] | [Reason] |
| MRA | [Drug dose] | [On/Starting/Holding] | [K+ level] |
| SGLT2i | [Drug dose] | [On/Starting/Holding] | [eGFR, notes*] |

**Disposition:**
- Target discharge: [when goal weight achieved, euvolemic on PO]
- Follow-up: [Cardiology in X weeks, PCP in X days]
- Education: [Heart failure education by nursing, dietary counseling]

*SGLT2i thresholds: Per FDA labeling, dapagliflozin and empagliflozin may be initiated for HF at eGFR ≥20 mL/min/1.73m² and continued until dialysis/transplant. Verify current labeling for specific agent.

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Why This Works

1. EF and HF Classification Matter for Treatment

Specifying HFrEF vs HFpEF and the ejection fraction is not academic documentation. It directly determines which therapies have mortality benefit:

• HFrEF (EF ≤40%): All four GDMT pillars (ARNI/ACEi/ARB, beta-blocker, MRA, SGLT2i) have Class I indications per ACC/AHA 2022 guidelines
• HFpEF (EF ≥50%): SGLT2i has Class I indication (ACC/AHA 2023 focused update, based on EMPEROR-Preserved and DELIVER trials); diuretics for congestion; other agents have less robust mortality evidence
• HFmrEF (EF 41-49%): ACC/AHA 2022 supports GDMT optimization similar to HFrEF

Anyone reading your note (consultants, night float, outpatient providers) immediately knows the treatment framework.

2. Volume Status Documentation Drives Daily Decisions

The structured volume assessment (JVP, edema, lungs, weight, I/O) creates a trackable trajectory. This matters because:

• Diuretic dosing depends on response trends, not single data points
• Discharge readiness requires documented euvolemia
• Readmission risk correlates with inadequate decongestion

Consistently documenting these five elements creates a clear narrative of decongestive progress.

3. The GDMT Table Prevents Omissions

A table format forces explicit documentation of all four medication classes. This prevents the common failure of optimizing familiar drugs while neglecting newer evidence-based therapies (especially SGLT2i).

The “Status” and “Notes” columns capture why a medication is held. This is critical information for the next provider titrating therapy.

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Filled Example

[SYNTHETIC EXAMPLE - Not a real patient]

Here’s a synthetic example showing how this template looks in practice:

# Acute on chronic systolic heart failure exacerbation (HFrEF, EF 30%)

**Etiology:** Ischemic cardiomyopathy s/p LAD stent 2022
**Precipitant:** Dietary indiscretion + medication non-adherence (ran out of furosemide)

**Current volume status:** Hypervolemic, improving
- JVP: 10 cm at 45° (down from 14 cm on admission)
- Peripheral edema: 2+ bilateral LE to mid-shin (improved from 3+)
- Lungs: Clear (previously bibasilar crackles)
- Weight: 94.2 kg (Admission: 99.0 kg, Goal: 90 kg)
- I/O: Net -1.5 L over past 24h

**Diuretics:**
- Furosemide 80 mg IV BID (was 40 mg PO daily at home)
- Target: net negative 1-2 L/day until goal weight
- Plan: Transition to PO furosemide 60 mg BID when euvolemic x24h

**GDMT Status (per ACC/AHA 2022 Guidelines):**
| Class | Medication | Status | Notes |
|-------|------------|--------|-------|
| ARNI/ACEi/ARB | Sacubitril-valsartan 24-26 mg BID | On, at low dose | Uptitrate after discharge |
| Beta-blocker | Carvedilol 6.25 mg BID | On | Held day 1-2, restarted |
| MRA | Spironolactone 25 mg daily | On | K+ 4.2, Cr 1.1 |
| SGLT2i | Dapagliflozin 10 mg daily | Starting today | eGFR 68, new addition |

**Disposition:**
- Target discharge: Tomorrow if euvolemic on PO diuretics x24h
- Follow-up: Cardiology in 2 weeks, PCP in 5 days, HF clinic call in 48h
- Education: Heart failure education completed, 2g sodium diet reviewed, daily weights emphasized

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Checklist

Before finalizing your note, confirm:

• EF and HF type (HFrEF/HFpEF/HFmrEF) documented
• Precipitant identified or explicitly noted as unclear
• Volume status with specific exam findings (JVP, edema, lungs)
• Weight trend with admission weight and goal weight
• GDMT status for all 4 pillars with rationale for any holds
• Diuretic plan with target and transition criteria
• Disposition plan with follow-up appointments

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Related Reading

Learn the clinical reasoning behind this template structure:

CHF Assessment & Plan: A Framework for Documentation - A detailed look at the evidence supporting each section of this template, including landmark trials and guideline recommendations.

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Last reviewed: 2026-01-20. Clinical content based on society guidelines, FDA labeling, and pivotal trials available at review date. Verify against current sources before clinical use.