Strategies to Reduce Congestive Heart Failure
Strategies to Reduce Congestive Heart Failure
Congestive heart failure (CHF) is a condition that involves the weakening of the heart muscle thereby affecting its ability to pump blood normally (Hosenpud, & Greenberg, 2013). Concisely, the ventricles change in size and shape through thickening an element that alters their ability to contract or relax. The consequent outcome is fluid retention in such parts of the body as lungs, abdomen, and legs (Hosenpud, & Greenberg, 2013). The causes of the disease include coronary heart disease a condition that affects the blood vessels that supply materials to the heart. A person with some history of a heart attack is also susceptible to the complication. Additionally, individuals with abnormal heart muscle, a condition termed, as cardiomyopathy are also vulnerable to the disease. A fourth cause is in the form of high blood pressure where the flow of blood assumes a pressure above the normal range (Better Health Channel, 2015). While the causes are independent conditions, some aspects are known to aggravate the risk factors of the condition. Some elements like obesity and smoking complicate coronary heart disease making patients affiliated with such conditions more vulnerable to CHF. Congestive heart failure is a prevalent complication, and the treatment procedures applied on patients has seen the rise of frequent re-hospitalization calling for the evidence-based nursing practice to enhance the recovery of the patients.
Patients with CHF
Patients with congestive heart failure portray unique symptoms that are used for diagnostic parameters. Earlier symptoms include affected breath especially in the middle of physical activity. Patients have reported waking up in the mid of their sleep due to shortened breath. Heart palpitations accompany this where the patient has a case of irregular pulse rate. The heartbeat could be rapid with a characteristic pattern where a feeling of physical agitation becomes evident (Better Health Channel, 2015). Moreover, there are cases of discomfort particular in the region around the chest. This comes with chest pain and characteristic wheezing. Some patients have been found to cough with no proper explanations. This and other symptoms are possible manifestations of congestive heart failure.
Apparent Problem: Prevalent readmissions after CHF Treatment
While the causes and symptoms of CHF may appear obvious, many patients are experiencing cases of readmission after treatment. This has led to a heated discussion that has questioned the quality of healthcare and follow-ups on patients. A thorough investigation reveals the leading causes of CHF rehospitalization.
Research suggests that some of those readmitted go through evidence-based treatment procedures and even attend post-discharge visits as instructed (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). In an attempt to establish the actual causes of the readmissions, patients are put into categories. For instance, some reasons for re-hospitalization are cited as cardiovascular in nature while some are not related to cardiovascular complications. An element that has been found to have close correlation with readmission is weight gain. Patients who gain weight in the first three months after discharge develop complications that alter the recovery process (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). Such complications are associated with cardiac factors that commonly affect the functioning of the heart.
While weight gain signals high chances of readmission, medication non-adherence has been mention as a prevalent cause of re-hospitalization. The tendency of the patients to ignore prescriptions issued and post-discharge procedures tend to affect the recovery process negatively. A consequent outcome is a deteriorated situation such that the patient seeks medical attention. Additionally, iatrogenic factors have been found to affect recovery. For instance, patients who use non-steroidal anti-inflammatory drugs after discharge have frequent cases of complications (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). This could be worsened in the event of limited access post-discharge care and treatment. Another aspect that could lead to re-hospitalization is wrong of choice diet. A diet short of sodium can affect the recovery process. An additional cause of readmission is the quality of treatment offered by the health care programs. Misinformed nursing care strategies have adverse outcomes.
Intervention: Strategies to reduce CHF Readmission
A critical approach to curbing the leading causes of CHF readmission has clinical teaching strategies to improve nursing care and practice (Gaberson, Oermann, & Shellenbarger, 2014). Education of the nursing fraternity would serve to better services extended to patients during the treatment phase. While such training is critical, Robin P. Newhouse et al. suggest a model that is inspired by evidence-based practice in nursing care (Dearholt, & Dang, 2007). This allows informed prognosis procedure that is supported by evidence that leads to informed treatment.
Another strategy involves the application of a mechanistic approach to check for cardiac abnormalities (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). Assessment is done to identify conditions that are attributed to heart failure complications. With increased awareness of such elements, the patient is well attended to during the discharge period.
While an intensive check on cardiac abnormalities may minimize readmission, an adjustment of the post-discharge period should be done to address the vulnerable phase (Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). Follow-ups after discharge are critical in the overall recovery. Apparently, a transition of the post-care procedure would serve to create room for an early post-discharge visit an element that would pinpoint possible cases of cardiac abnormalities during the recovery process. The overall transition can be achieved through the participation in the family. The immediate progress of the patient can be easily monitored, and any necessary medical attention is called for with the help of the family.
Possible Outcomes of Appropriate Intervention Measures
As we suggest the a list of strategies to address persistent re-hospitalization of CHF patients, research and studies reveal that informed health care has positive outcomes on the recovery of patients. One beneficial outcome is reduced mortality among CHF patients. Practically, quality health care is attained through thorough testing and comparison of various approaches available for treatment of CHF. For instance, Peck et al. investigated the most efficient approach to Medical therapy and implantable cardioverter-defibrillator (ICD) in addressing cardiac complications among patients with heart failure (2014). Their findings would change the face of outcomes of informed and educated nursing care as drug therapies were found more efficient in reducing sudden cardiac deaths.
While reduced mortality is an appealing result, cost-effectiveness and economic implications of prevalent readmissions of CHF patients has been evaluated. Treatment and management of CHF cost the government billions of dollars annually. Families involved are also financially strained. The situation gets worse and more expensive when a CHF patient is re-hospitalized. In fact, research suggests that readmissions cost more than the initial treatment (Amin, Jhaveri & Linc, 2012). This can be devastating to health care institutions and families. With the suggested intervention specialist-managed programs have proved cost effective in the long run, can be established. In such a society as the UK, they have been found to save the economy thousands of pounds annually (Stewarts & Horowitz, 2003).
Correlation between CHF Readmission and Re-hospitalization Time
As the healthcare system is conscious of evidence-based approaches in the treatment of CHF, management of the last phase of CHF is a determining factor on the chances of readmission. A prevalent case has been readmission with 30 days after discharge. Research suggest that patients who are availed with informed follow-up immediately after discharge have a low tendency of being re-hospitalized within the first 30 days of being released (Hernandez, et al., 2010). The case is different for patients who receive low or no care after being discharged. This provides an informed piece of evidence on how to address and manage the last stage of CHF. For a successful recovery, intensive follow-up models have to be structured. This would reduce readmissions, and cut costs related to CHF hospitalization. Additionally, it would reduce mortality among CHF patients.
In the overall, CHF suggests weakened heart muscles such that the heart cannot thrust blood everywhere in the body normally (Better Health Channel, 2015). The symptoms are treated through various procedures to restate the normal condition of the heart attributed to some causes. Apparently, despite treatment, there have been frequent cases of readmissions of patients with CHF. This is attributed to such factors as non-adherence to medication, and cardiac abnormalities. Such strategies as proper training of nurses and use of evidence-based procedures can reduce the cases of CHF readmission. Reduced readmission would cut costs and check on mortality rate among CHF patients. An important aspect of achieving this is through informed and intensive follow-ups soon after CHF patients are discharged.
Amin, A. N., Jhaverib, M., & Linc, J. (2012). Temporal pattern and costs of rehospitalization in atrial fibrillation/atrial flutter patients with one or more additional risk factors. Journal of medical economics, 15(3): 548-55.
Better Health Channel. (2015, Oct 26). Congestive heart failure (CHF). Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_(CHF)?open
Dearholt, S. L., & Dang, D. (2007). John Hopkins nursing evidence-based practice model and guidelines. Indianapolis: Sigma Theta Tau International.
Gaberson, K. B., Oermann, M., & Shellenbarger, T. (2014). Clinical teaching strategies in nursing. New York: Springer Publishing.
Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization of heart failure: Problems and perspectives. Journal of the American College of Cardiology, 61(4), 391- 403.
Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., et al. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17): 1716-22.
Hosenpud, J. D., & Greenberg, B. H. (2013). Congestive heart failure: Pathophysiology, diagnosis, and comprehensive approach to management. New York: McGraw-Hill.
Peck, K. Y., Lim, Y. Z., Hopper, I., & Krum, H. (2014). Medical therapy versus implantable cardioverter -defibrillator in preventing sudden cardiac death in patients with left ventricular systolic dysfunction and heart failure: A meta-analysis of >35,000 patients. In International Journal of Cardiology, 173(2): 197-203.
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