Level 1 Evidence NHMRC – Systematic Review
This systematic review conducted by Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M, (2012) sourced twenty-five trials, and the overall number of people of the collective trials included was 5,942. Interventions were classified and assessed using the following headings.-
Takeda, Taylor, Khan, Krum, & Underwood. (2012) states ‘(1) case management interventions (intense monitoring of patients following discharge often involving telephone follow up and home visits); (2) clinic interventions (follow up in a CHF clinic) and (3) multidisciplinary interventions (holistic approach bridging the gap between hospital admission and discharge home delivered by a team). The components, intensity and duration of the interventions varied, as did the ‘usual care’ comparator provided in different trials’. (P. 2).
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
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Heart failure. (n.d.). Retrieved from http://www.heartfoundation.org.au/information-for-professionals/Clinical-Information/Pages/heart-failure.aspx.2014.
Jeon, Y., Kraus, S. G., Jowsey, T., & Glasgow, N. J. (2010). The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC Health Services Research. doi:10.1186/1472-6963-10-77
Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M. (2012). Clinical service organisation for heart failure (Review). Cochrane Database of Systematic Reviews. Issue 9. Art. No.: CD002752. DOI: 10.1002/14651858.CD002752.pub3.
Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal H, Lough F, Rees K, Singh S. Exercise-based rehabilitation for heart failure. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD003331. DOI: 10.1002/14651858.CD003331.pub4.
These causes will change the heart significantly. The pathophysiology of heart failure is described differently as: (1) an oedematous disorder, by means of which the deviations in renal hemodynamics and excretory ability lead to salt and water holding; (2) a hemodynamic disorder, considered by peripheral vasoconstriction and decreased cardiac output; (3) a neurohormonal disorder, mainly by stimulation of the renin-angiotensin-aldosterone system and adrenergic nervous system; (4) an inflammatory syndrome, related with amplified local and circulation pro-inflammatory cytokines; (5) a myocardial disease, started with an damage to the heart trailed by pathological ventricular transformation. In heart failure, the heart sustains either a sudden or longstanding structural injury. When damage occurs, sequences of firstly compensatory but consequently maladaptive mechanisms follow (Henry & Abraham, ).
The aim of this essay is to critically analyse and appraise Local and National policies surrounding Long-Term health conditions (LTC) and complex care needs, which inform community practice. It is intended to critically appraise the complex care requirements of people with Heart Failure as the chosen LTC, outlining areas of care that need to be addressed by professionals utilising contemporary research and evidence based practice. As per the Nursing and Midwifery Council (NMC) (2010) all identities of people and local trusts will be kept confidential.
Scottish Intercollegiate Guideline Network (SIGN) 95 (2007): Management of Chronic Heart Failure (Online). Available at: http://www.sign.ac.uk/pdf/sign95.pdf (Accessed 8th June 2010)
Heart failure is a major clinical, social and economic problem in the United Kingdom according to the Department of Health [DH] (2013).The National Institute for Health and Clinical Excellence [NICE] (2010) reported that about 900,000 people suffer from heart failure in the United Kingdom. The National Institute for Cardiovascular Outcomes Research [NICOR] (2011) conducted a national audit which found that one in every 20 people over the age of 65 is diagnosed with heart failure which demonstrates that it mainly affects the elderly. As a leading cause of mortality, heart failure contributes to more than 6,000 deaths each year (NICOR, 2011). Newly diagnosed cases of heart failure have a 40% risk of dying within a year (NICOR, 2011). Despite advances in therapy, mortality is still high and only half of patients are alive five years after being diagnosed with heart failure (NICE, 2010).
Standardizing The Hospital Discharge Process for Patients with Heart Failure to Improve the Transition and Lower 30 day Readmission. http://www.cfmc.org/integratingcare/files/Remington%20Report%20Nov%202011%20Standardizing%20the%20Hospital%20Discharge.pdf
Lesle, S. J., Hartswood, M., Meurig, C., McKee, S. P., & Slack, R. (2006). Clinical Decision Support Software for management of chronic heart failure: Development and Evaluation. Computers in Biology and Medicine vol. 36, 495-506.
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Hypertension increases the risk of heart failure 2 to 3 fold. (He, et al, 2001) The American College of Cardiology (ACC) has identified 4 stages of heart failure. (Hunt, Abraham, Chin et al, 2009). Screening patients for heart failure is sometimes controversial. Health care administrators...
The purpose of the article, “The impact of Using Nursing Presence in a Community Heart Failure Program”, is to describe the concept of nursing presence and how it can positively influence patient outcomes. Key points mentioned were that presence as the basis of intervening builds trust, which is key to developing and maintaining self-care behaviors; nursing presence is a tool for the patient to experience physical and spiritual healing; committing to true presence means the nurse will willingly listen to the patient and supporting decisions. In a way being presence, is advocating for the patient; the nurse needs to be there mentally in order to effectively and safely care for the patient. According to Anderson, some key attributes of presencing
Patients with chronic diseases do not receive established and operative treatments to help them successfully manage their condition. These complications are aggravated by an absence of organization of care for patients with chronic diseases. Nevertheless, the fundamental disintegration of the health care system is not unexpected given that health care providers do not have the imbursement support or other tools they need to interconnect and work together successfully to improve patient care (Brennan et al., 2009; Renders et al., 200;).
Katzenstein, Larry, and Ileana L. Pinã. Living with Heart Disease: Everything You Need to Know to Safeguard Your Health and Take Control of Your Life. New York: AARP/Sterling Pub. Co, 2007. Print.
A cardiac assessment: Listen to heart sounds listening for extra heart sounds, fast heartbeat, and monitor EKG looking for dysthymias. Assess vitals especially BP, BP should be kept low in heart failure patients to put less stress on the heart. Assess the patient for edema as a result of fluid retention. Listen for crackles in the lungs due to fluid built up. Watch I&O’s and weight the patient to assess for edema, ask about activity intolerance. Assess for changes in mental status, cool extremities, pale or cyanotic, fatigue, and JVD (Indications of poor perfusion) (Ignatavicius &Workman, p.756).
Primary health problems at the time of enrolment into the TCM were 43% heart failure, 25% ischemic heart disease, 13% chronic obstructive pulmonary disease, 7% diabetes and 12% other conditions. To compare ordinal data, the Wilcoxon sum tests were used, and t-tests were used for interval or ratio data. Propensity modelling was used to ensure the control and experimental groups were equally represented in demographics, socio-economic status and geographical characteristics. Study findings confirm earlier results regarding the effectiveness of the TCM in enhancing health outcomes and satisfaction with care among chronically ill older
... patients with heart failure: Impact on patients. American Journal of Critical Care, 20(6), 431-442.
(Neil Crawford Campbell et al., 1998) Four years later, patients were followed up. (P. Murchie, Campbell, Ritchie, Simpson, & Thain, 2003) On both occasions, research demonstrated the benefits of attending nurse-led clinics for the secondary prevention of CHD. The article I have chosen to annotate is the 10 year followup of the original RCT. Given the time incurred, I consider the accumulated data as strong evidence that has being reviewed and evaluated vigorously. There were only a few other studies that showed long term results, two – five years, regarding the use of nurse-led clinics for the secondary prevention of CHD. (Cupples & McKnight, 1994; Moher et al., 2001) Total mortality was less and survival of coronary events had been better, though statistically insignificant in the nurse-led group. At the 10 year follow-up, survival of coronary events, results graphically converge. Otherwise the study indicated that overall the GP and nurse-led group results were similiar for total mortality, other causes of death, coronary death and hosptial admissions for cardiac events. This research supports the notion that nurse-led clinics convincingly are as effective as seeing a Doctor for the management of symptoms and reducing cardiovascular risk