Heart Failure And Acute Kidney Injury

Symptoms of congestive heart failure consist of fatigue, dependent edema, fluid build-up in the lungs, increase in urination because of the extra fluid, nausea, vomiting, abdominal pain, and decreased appetite (Fundukian, 2011).  Diagnosis of CHF is done first by physical examination, such as heart rate, and heart sounds or murmurs. If a physician believes more tests are needed, common ones include an electrocardiogram or chest x-ray to detect previous heart attacks, arrhythmia, or heart enlargement, and echocardiogram using ultrasound to image the heart muscle, valves, and blood flow patterns. The physician may also want to do a heart catheterization, to allow the arteries of the heart to be visualized using angiography. Upon getting a diagnosis of CHF, the physician will usually start with asking the patient to change things in their diet, such going to a low sodium diet. They may also want to prescribe medications. Types of medications could include angiotensin converting enzyme (ACE) inhibitors, which block formation of angiotensin II hormone, angiotensin receptor blockers (ARB) to block the action of angiotensin II at the receptor site, and diuretics, just to name a few (Fundukian, 2011).

Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

This study is relevant to the research question because they focused on testing n-terminal pro-b type natriuretic peptide and management of Heart Failure patients, however the patients were in a hospital in Canada. The study started with 534 patients from screening but 34 were excluded, and 17 patients did not participate after the first hospitalization, leaving 483 patients that were followed during the course of the study (Moe, Howlett, Januzzi, Zowall, 2007). The study used receiver-operating characteristic curve was used to analyze the data from the two groups (Moe, Howlett, Januzzi, Zowall, 2007). The tools used were clearly defined, reliable and valid. The researchers measured the proBNP level and physician initial diagnosis and then after they used the “logistic regression model” to predict whether knowledge of the proBNP levels aided in diagnosis and management of HF (Moe, Howlett, Januzzi, Zowall, 2007). The statistics used to analyze the date was relevant to the clinical research question. The study did not “perform age-stratified analysis” which may have an impact on the results, there was also a loss to follow up and the study was performed at multiple sites in Canada where as the patients for the clinical research question are located in Dallas service delivery area in United States of America (Moe, Howlett, Januzzi, Zowall, 2007). According to the researchers, the results of their study supported the “recently published HF consensus guidelines’” view that proBNP supports clinical diagnosis and cost effective care of patients (Moe, Howlett, Januzzi, Zowall, 2007). The implication of this study is that knowing the value of proBNP aids practitioners in the diagnosis and management of HF

Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting

Heart failure affects nearly 6 million Americans. It is the leading cause of hospitalization in people older than 65. Roughly 550,000 people are diagnosed with heart failure each year (Emory Healthcare, 2014). Heart failure is a pathologic state where the heart cannot pump enough blood to meet the demand of the body’s metabolic needs or when the ventricle’s ability to fill is impaired. It is not a disease, but rather a complex clinical syndrome. The symptoms of heart failure come from pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Individuals experience orthopnea,

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

Rising health care cost and stricter regulations for insurance reimbursement plans have pushed health care leaders to re-evaluate health care services. One focus is reducing hospital readmission rates for chronic disease process (Bos-Touwen et al, 2015). Congestive heart failure is one of the leading causes of hospital readmission (Cubbon et al, 2014). Fifteen million people worldwide have a diagnosis of CHF. In addition, 15-20% of those with the diagnosis of CHF are hospitalized yearly (Sahebi et al, 2015). In 2010, 40 billion dollars was spent on health care needs for CHF patients. Seventy percent of the resources were for hospital services (Siabani, Driscoll, Davidson, and Leeder, 2014). The need for streamline healthcare for CHF patients is imperative to improve overall patient outcomes and reduce the amount of hospital readmission rates.

Varying patients may present to their clinician or the emergency department for treatment with heart failure. It is important to understand that there is more than one type of heart failure; primarily the focus is placed on diastolic heart failure and systolic heart failure. Depending upon the cause of heart failure and what areas are affected dictates the treatment plan needed. While there are similarities with both kinds of heart failure, there are also differences that can help the clinician distinguish the diagnosis needed to fit the patient. Once a diagnosis is made the clinician can move forward in determining if the patient is at risk for use of diuretics and then look towards prescribing ACEIs, ARBs, and beta-blockers.

Heart failure (HF) is one of the leading causes of hospital admissions and readmissions in the United States (Desai & Stevenson, 2012; Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). It is a condition that accounts for a very high morbidity and mortality (Bakal, McAlister, Liu, & Ezekowitz, 2014). Every hospital admission for heart failure patients results in disease progression and poor prognosis. For chronic HF patients, a hospitalization is one of the strongest prognostic predictors for increased mortality (Gheorghiade et al., 2013). Factoring in re-hospitalizations, especially at 30-day to 90-day mark, it is increasingly detrimental to patient prognosis.

Type 2 cardiorenal syndrome is defined as “Chronic abnormalities in heart function leading to kidney injury and/or dysfunction” (7). Examples include ischemic heart disease, hypertension, congenital heart disease, chronic heart failure, left ventricular remodeling and dysfunction, diastolic dysfunction and cardiomyopathy resulting in kidney disease. (7, 8). This type is reported in 63% of patients admitted to the hospital with congestive heart failure. (11, 12).

In year 2000 and 2010, an estimated 1 million hospitalizations for Congestive Heart Failure (CHF), of which most of these hospitalizations were for those aged 65 and over, the share of CHF hospitalizations for those under age 65 increased from 23% to 29% over this time period (Hall, Levant, & DeFrances, 2012). According to Held (2009), acute decompensated heart failure (ADHF) ensues when cardiac output fails to meet the demand of the body’s metabolic needs. The fluid volume overload makes the unstable condition necessitates instant treatment for the reason that it impairs perfusion to systemic organs, endangering their function.

In patients with heart failure, hypovolemia, cirrhosis, nephrotic syndrome, or hypoalbuminemia, renal function may be further compromised. BUN, creatinine clearance, and urine output should be monitored closely (Lexi-Comp, 2016).

As the population ages heart failure is expected to increase exceptionally. About twenty-two percent of men and forty-four percent of women will develop heart failure within six years of having a heart attack. “Thirty years ago patients would have died from their heart attacks!” (Couzens)

It is noteworthy that, in addition to its discovery RDW prognosis of patients with heart failure on admission, there are found changes RDW during hospitalization cases [7], as well as discharge RDW test results [13,16] and also the prognosis of heart failure related. These studies were meta-analysis [19] showed that: RDW increased per unit (ie 1%), patients with all-cause mortality risk increased 1.1 times, but there are between existing research publication bias, indicating the existing research may exaggerate RDW prognostic value in heart failure. In addition to heart failure as a prognostic factor, RDW can also serve as a risk factor for heart failure. For example Borné et al [20] of 26 784 community residents for more than 10 years of follow-up, observed the research object of baseline RDW and the relationship between the cardiovascular events in the future. The researchers found that the correction for blood pressure, smoking, lipoprotein and other known risk factors for cardiovascular disease, RDW still closely related to the occurrence of heart failure risk, the higher performance for baseline RDW, the individual risk of future heart failure also higher. Tonelli et al [21] of 4111 patients with CHD were 6 years of follow-up found that in patients with coronary heart disease, RDW prompted increased risk in patients