Congestive Heart Failure: Literature Review (HLT-490V)

CONGESTIVE HEART FAILURE
LITERATURE REVIEW
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Institution
Congestive Heart Failure: Literature Review
The Background of the Problem
Congestive Heart Failure (CHF) is a lethal disease mostly prevalent among people older than 65 years of age. The failing of the heart within this group is especially rife among patients with a history of recurrent heart failure, requiring early admissions (Vinson et al. 1990). McMurray (2010) states that 1-2% of the population in developed countries experience congestive heart failure, with high frequency lying on individuals older than 70 years old. Additionally, Neubauer (2007) points out that 30-40% of CHF patients die within one year of receiving treatment from the disease. Heart failure presumably consists of 2% of the annual health budget in the United Kingdom, while the United States requires a whooping $28 billion annually for the treatment of the disease (Neubauer, 2007). Therefore, the lethal nature of the disease and its implications in the economy of many countries cannot be understated.
The common etiologic precursors for CHF are coronary heart disease, hypertension, genetic inheritance, abuse of alcohol and viral infection among other causes (McMurray, 2010). A study done by McKee, Castelli, McNamara and Kannel (1971) for 16 years involving 5192 patients where 142 developed CHF, revealed that hypertension contributed to 75% of the etiologic precursors. Hypertension also accompanied coronary heart disease and precursive rheumatic heart disease. The study revealed that the susceptibility to succumbing to the disease within the first five years was 62% for men and 42% for women.
Neubauer (2007) also suggests a model where the heart muscles or myofibrils failing to produce enough energy needed to pump the heart. This is because the heart requires a lot of energy every day to pump more than 10,000 liters of blood around the body. In the 10,000 times it beats during the day, it uses approximately 10Kg of Adenosine Triphosphate (ATP). The complex nature of CHF makes management difficult since the disease has a recurrent habit. Many reported cases of CHF usually undergo treatment but readmission remains to be so high. Li, Nancy, and Proctor (2004) observed this scenario where an annual mortality rate of CHF patients stood at 10% despite medical intervention to the problem.
Similarly, Proctor, Nancy, Li and Dore (2000) highlight the worrying trend of readmission among CHF patients. Many of the patients who undergo medical treatment and nursing care find themselves back in the hospital despite previously receiving treatment. A study done by Hopp, Thornton, and Martin (2010) revealed that most CHF patients face great challenges after discharge from hospitals. What contribute to their prevalence to readmission are social isolation, life disruption, and ambiguity about symptoms and prognosis. Lack of proper knowledge about the disease management, social support, and handling the dying process makes many of them susceptible to readmission in acute conditions (Stewart, Marley, & Horowitz, 1999). Additionally, lack of adherence to prescribed medicine and diet also contributes to this, accounting to almost 29-47% of readmission after three to six months after original discharge (Rich, Beckham, Wittenberg, Leven, Freedland and Carney, 1995).
Factors affecting prescription compliance
Many medical practitioners have struggled to understand and solve the puzzle of recurrent CHF. Despite patients undergoing extensive pharmacotherapy, the prognosis of CHF continued to be impoverished (McAlister, Stewart, Ferrua, & McMurray, 2004). Patients once discharged with reduced CHF conditions will return several months later in worse or very severe conditions; some succumbing to the ailment finally. The need to reduce unplanned readmissions and prolong survival of CHF patients is evident through their ineffective compliance to prescribed treatment caused by financial, psychosocial, and behavioral factors (Rich, 1999). The failure of medical practitioners to factor in the possibility of recurrence of the disease, aided in enabling negligence and ignorance among patients.
Additionally, Stewart, Pearson and Horowitz (1998) synopsis of this study shows that patients fail to comply with medical prescriptions despite counseling and knowledge of their health conditions, because they incline to irresponsibility due to insufficient monitoring. The cases are more common among older people, when one puts into perspective their need for assistance. Lack of nurse’s visitation or a call to check into the patient’s condition after discharge allowed for deterioration in patient’s health, due to lacking of authoritative monitoring.
A study done by Proctor, Nancy, and Kaplan in 1996 revealed that 40% of discharged patients failed to implement at least one discharge plan, with high discrepancies realized among low-income patients. Implementation discrepancies contributed to negative results through inadequate care, little help and greater unmet needs (Proctor et al. 1996). Therefore, the high cost associated with caring for CHF patients is due to frequent readmissions to hospital for exacerbation. According to Jerant et al. (2001), this accounts for 16-25% of total readmissions.
Multidisciplinary approach as an alternative
The escalating cost of medical services and rising numbers of deaths due to CHF exacerbations necessitate for a medical and nursing care intervention beyond the hospital walls. Several studies have proven the profitability of home care interventions. A study done by Proctor et al. in 2000, provided home care to 253 elderly patients and interviewed them in 2, 6, 10 and 14 weeks showed high reduction in readmission cases. Another study by Stewart and Horowitz in 2002 showed an increase of 817 months of survival, fewer readmissions, and lower clinical visits costs for home-based intervention patients as compared to patients in the usual care. The significance of home-based initiative towards cost reduction, reduction in mortality rate and lower readmission provides a means of improving the wellbeing of the CHF patients.
Previously there has been application of several efforts in reduction of readmission rates through involvement of nurses and other medical practitioners in a patient’s recovery. Despite using home nurses to detect and manage timely decompensation, boost family support and offer “disease and treatment education,” and reducing readmission by 56% and saving cost by $460 per patient; using these interventions costly and provide several “challenges to health systems” (Jerant et al. 2001). Therefore, in order to reduce number of visits, while at the same time monitoring patients effectively, it is imperative to utilize a multidisciplinary approach.
In their study ‘Reducing the Cost of Frequent Hospital Admissions for Congestive Heart Failure’, Jerant et al. 2001 shows that using technology such as home telecare (videoconferencing), nurse’s telephone and the normal outpatient care reduced the cost of home visits by 85% compared with patients in the usual care group. Therefore, the multidisciplinary approach is cost effective both in improving a patient’s wellbeing and nurse’s logistics. In addition to having the nurses to perform home visits and medical practitioners offering cardiology and pharmacy consultations, the multidisciplinary approach seeks to involve family members and other non-medical stakeholders in implementation of the HBI. HBI aids in reduction of hospitalization and improvement in morbidity rates “among the elderly patient with severe form of CHF” (Kornowski, Zeeli, Averbuch, Finkelstein, Schwartz, Moshkovitz, & Levo, 1995). The aim of HBI is to improve the quality of life among the patients having CHF and provide...