Heart Failure Nursing

My phenomenon of interest is: The effect of health promotion on the outcome of African- American heart failure patients. Heart failure is fast becoming prevalent among African -Americans due to high incidence of CAD and hypertension. African Americans have the highest mortality rates from chronic diseases. Evidence depicts health promotion as vital to the outcome of heart failure patients. The role of nursing in health promotion has been shown to promote positive outcomes such as adherence, knowledge of illness and improved quality of life. There is a need to decrease readmission and mortality rates in African American heart failure

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) core measures in relation to Heart Failure (HF) was examined using empirical-based nursing research. Findings suggest that lack of understanding by nurses contributes significantly to the privation of core measure implementation. A significant number of Americans suffer from HF, so patient quality of care assessment was necessitated. Identifying factors were: nurse-patient education resulting in follow-up appointments, left ventricular performance or left ventricular systolic (LVS) function, treatment medications, and smoking cessation programs. Nurses provide an important role in the education of patients with HF. The Nurse is integral in providing documentation in relation to LVS. Nurses play an important role in the administration of HF medication. Smoking, a major cause of HF, requires special nursing intervention. Nursing results in improved quality of care if HF core measures are implemented properly. Additionally, Orem’s universal requisites are fundamental in the nursing process.

This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many

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

A resident at the time saw that although there is a hearty amount of evidence that illustrates that adhering to heart failure guidelines decreases the rate of mortality and morbidity, nationally there is modest adherence to heart failure practice guidelines. Doctors have voiced a multitude of reasons to this poor participation including but not limited to time constraints in a visit, inertia of patterns in practice, lack of awareness and lack of acceptance are a few. This new web-based tool, the “Smart” Heart failure sheet is designed to help connect previously compartmentalized information. It seeks to link guidelines to their patients’ clinical and laboratory characteristics and systematize adherence to heart failure guidelines. It accomplishes this by uploading pertinent patient-specific data, including laboratory and imaging results, procedure reports and relevant medications. Additionally it also provides tools, such as a flow chart for diuretic dosage and weights. Overall this tool is useful to help physicians identify patients who may benefit from a treatment. From there it provides support tools that alert the physician to a personalized medical treatment. The “Smart” Heart Failure Sheet acts as a registry for scholarly research and also provides educational resources to expand providers’ knowledge, thereby improving patient care (Battaglia,

Heart failure (HF) is a debilitating condition that has become a public health problem. There are many debilitating effects of HF for many people that have to live with this disease. According to Hardin and Hussey (2003), recognize inadequate patient education, poor symptom control, and insufficient social support as factors that contribute to preventable HF related hospitalizations (p.p.74). Many people are frequently hospitalized because of HF exacerbation related to lack of knowledge, poor quality of life and medication non adherence. This research proposal determines the effect of Advance Practice Nurse led telephone intervention in the community and how their phone calls would improve the outcomes of patients with Heart Failure. This proposal identifies variables and measurement levels, research methodology and conclusion. The results of the research studies will support the idea that Advanced practice nurses has a positive impact on patients with HF, decreasing HF related hospital admissions and improving their quality of life.

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.

With heart failure, increasing in incidence in the United States, hospital readmission rates are being scrutinized to save money, especially for Medicare beneficiaries. Over 5 million people in the United States are living with heart failure, defined as “a condition in which the heart cannot pump enough blood and oxygen to support other organs in the body” (CDC, 2013). Heart failure affects 2.4% of the United States population with nearly 12% of both women and men 80 years and older having heart failure (Heidenreich, P. A., Albert, N. M., Allen, L. C., Bluemke, D. A., Butler, J., Morrow, G. C., Ikonomidis, J. S., et al., 2013). Heidenreich et al (2013) project that by 2030, heart failure will affect over 8 million Americans, with 2 million of those being ages 80 years and older. Heart failure is one of three conditions to be included in the Centers for Medicare and Medicaid Services (CMS) reimbursements that hospitals are penalized for if the hospital experiences an excess amount of readmissions within 30 days of the initial hospitalization due to the disease.

Congestive Heart Failure (CHF) and Heart Failure (HF) are serious problems in regards to hospital re-admissions especially regarding the sixty-five year old population. Data demonstrates approximately over 670,000 individuals each year are diagnosed with CHF, along with that there are 6 (six) million Americans affected with CHF. Hersh, Masoudi, and Allen (2013) described readmissions of patients with CHF is increasing by 25% within thirty days of discharge from the hospital. This creates a huge impact on the taxpayers and patients due to the increasing percentages being re-admitted into the hospitals (Post discharge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Re-admission, 2013). The problem is to identify a plan to decrease the CHF/HF hospital re-admissions into the especially regarding the 65 (sixty-five) year olds and older, in spite of efforts from the hospital staff providing guidelines and nursing education regarding CHF/HF signs and symptoms.

Nationally 21.9% percent HF patients were readmitted within the thirty days of hospital discharge (30-day readmissions & deaths by medical condition, 2016). According to Walvaren, et al. (2011) up to 75% of the 30-day readmissions are preventable. HF hospital readmissions at Oklahoma University Medical Center (OUMC) are higher than the national rate. When compared to more than 1000 teaching hospitals the most recent records from OUMC show HF readmission rates excluding chemotherapy, dialysis, radiotherapy, rehab, mortality, transfer to other facility, and AMA, at 26.39% ("% 30 Day Readmissions," 2016). Unplanned 30-day readmissions in patients with heart failure lead to poor patient prognosis, deterioration of patient health

The corresponding author, Dr. Hernandez of Duke Clinical Research Institute and Department of Medicine, conducted a study examining the relationship between physician follow-up care and 30-day hospital readmission rates in heart failure patients. Fonarow, Heidenreich, Yancy, Peterson, and Curtis, all doctors in specialized cardiac hospitals, along with researchers, Ms. Greiner and Mr. Hammill, contributed in the undertaking of this study. The intended audiences are clinicians and nurses assisting in the transitional care from hospital to home in heart failure patients. This was a qualitative, observational analysis examining the Medicare claims of physician visits within seven days of hospital discharge and readmission claims within 30 days of discharge. The strengths of this study include the large population of over 30,000 patients and the 225 hospitals, which allow for a more identifiable relationship of variables. A weakness of the study that could affect readmission rates would be the lack of consideration of patients involved in remote health-monitoring programs, a form of follow-up care. Even with this limitation, results prove that patients seen by a physician within seven days of discharge were less likely to be readmitted. This study confirms that nurses and clinicians should design discharge plans that include promptly scheduled appointments with a physician following discharge. Making this appointment for the patient and confirming it with them during their discharge teaching will aid in more compliant follow-up care, and ultimately reduce the risk for readmission.

The authors of this article explore the importance of and latest advances in transitions of care programs for patients with Heart Failure (HF). The authors paint a clear picture about the scope of the problem and go on to discuss some of the most well-known and researched transitions of care interventions in current practice. Although many of these interventions have been successful, the authors report fact that programs vary in organizational framework, team composition, and program focus. Programs are also noted to differ based on population size and care

Literature suggests that nurses may not be knowledgeable in self-management by patients with heart failure. Sterne and her colleagues (2014) conducted a study to assess nurse’s knowledge of heart failure by reviewing test scores and evaluating the 30-day readmission rate for patients with heart failure before and after the educational program. The conclusion of this study was that the nurses gained knowledge from the program and the 30-day readmission rate for patients with heart failure decreased (Sterne et al., 2014). Educating providers will have a positive impact of patient

The chronic disease burden has increased the need for a statewide and national approach in its detection, prevention, and treatment of heart failure. In the state of Indiana heart disease is shown to be leading the way with a total of 13,394 individuals who have died in 2013 (Indiana State, 2013). The health indicators show that although the mortality rate has decreased from 42.3 per 100,000 in 2001 to 37.3 per 100,000 hospitalization rates have increased (Center for Disease, 2011). Heart failure rehospitalization rate has increased from 2007-2011 especially in those who are over the age of 85. In 2011, there were a total of 41.9 per 1,000 hospitalizations due to heart failure. This is gradually increasing from the Healthy People 2020

A great amount of time, money and resource is devoted to improving the transition to home from hospital in the heart failure patient (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). With extensive research available on heart failure and readmission, this study will focus on four main categories. This four category approach allows the clinician to best formulate and prepare for practice in the outpatient setting. The four categories will include various articles based upon evidenced based practice approaches with ultimate goal of reducing admission by implementing successful outpatient care. The four categories are as follows: Frequent monitoring or reporting to the PCP; Medication and Diet compliance; Predictors of