Introduction
Heart failure (HF) is an increasing public health problem that is expected to exert a lot of pressure on the U.S healthcare system. When coupled with aggressive chemotherapy treatment for breast cancer, this dual diagnosis becomes even more pronounced to manage. Thus, despite the ongoing efforts to attain a better quality of care and outcomes for HF patients, the disease burden remains considerable. Unbearable costs related to HF transcend unaffordability but also increase uncontrollably, overwhelming healthcare systems and becoming unduly burdensome to patients and their families. This paper aims to explore the impact of HF on the quality of care, patient safety, and the economic burden on the healthcare system, drawing on recent data and research findings to provide a holistic view.
Impact on Quality of Care, Patient Safety, and the Costs to Patients and the System
HF has several adverse effects on the quality of care and patient safety. The disorder is associated with severe symptoms such as dyspnea, swelling in ankles and legs, and fatigue, which exacerbate over time, increasing the risk of hospitalization (Sadeq et al., 2020). HF is associated with high admission and readmission rates within 30 days, 90 days, and 1 year, ranging from 18% to 32%, 21% to 47%, and 50%, respectively (Sadeq et al., 2020). Similarly, the illness can result in fatality, with about 415,922 deaths in the United States being linked to HF each year (Bozkurt et al., 2023). Therefore, HF affects an individual’s safety and care quality because its complexity makes it difficult for healthcare providers to address all complications effectively.
HF places a significant economic burden on patients and the healthcare system. The high cost is linked to hospitalizations, readmissions, and treatment for acute complications. Each year, the cost of caring for an HF patient in the United States is approximately $30,000 (Heidenreich et al., 2022). These medical expenses place financial strain on patients and their families and, in some cases, require Medicare beneficiaries to spend more than $1000 out of pocket to buy drugs (Wang et al., 2021).
On the other hand, the healthcare system spends approximately $31 billion annually on HF care, with the cost projected to reach $50 billion by 2030 (Wang et al., 2021). Thus, HF management and treatment incur substantial costs for patients, families, and the broader healthcare system.
Dealing with a patient who has been newly diagnosed with HF would require a sensitive approach. The presentation of information would start with comprehensive information on the disorder, including its causes, signs, and treatment interventions. The use of simple, clear language, along with effective visual aids, can help communicate these ideas. Interactions with an affected patient can help an individual understand the challenges and experiences of living with HF.
Such feedback could be used to develop tailored approaches and support mechanisms further to enhance patients’ quality of life and health status. Reviewing evidence-based practice (EBP) websites and documents can help identify the most effective treatments and practices for managing HF. For example, the Food and Drug Administration’s endorsement of vericiguat appears to be a promising option for treating and alleviating the effects of HF (Trujillo et al., 2023). Thus, research can help devise effective management strategies for HF.
Exploring different aspects and policies related to HF can increase awareness. The major barriers to presenting the issue to a patient include cultural and language challenges and limited health literacy. The patient and family would agree on these problems because their presence hinders them from receiving appropriate care and treatment. Leadership and communication skills that can be used to overcome these barriers include using visual aids and local language to communicate with the patient.
In addition, encouraging open dialogue when using interpreters can help the patient and family better understand the illness. The alterations to the disease definition based on research include the effects of socioeconomic determinants on disease severity. In this case, the initial definition only comprised the nature and signs of the disorder. However, after research, the definition of HF includes the effect of socioeconomic factors on its incidence. What might have been done differently is to incorporate diverse viewpoints and include patient feedback to enhance understanding of HF.
The main approach to enhance care quality, improve patient safety, and lower medical expenses is to adopt an elaborate care coordination program. The use of multidisciplinary teams, including social workers, healthcare practitioners, and pharmacists, ensures seamless care and effective follow-up. This approach has been linked to lower readmission rates, thereby ensuring patient protection and lower costs (Shabani et al., 2022).
Additionally, remote monitoring (RM) through Telehealth devices allows patients to remain in contact with healthcare professionals, enabling effective patient education and prompt interventions to avert avoidable hospitalizations. Research shows that RM for HF patients significantly reduces rehospitalizations and deaths (Asch et al., 2022). Hence, these strategies can enhance patient safety, care quality, and lower healthcare expenses for patients and the system.
Nursing Practice Standards Affecting HF
New York State (NY) Board nursing practice standards and organizational policies are critical in healthcare delivery. The regulations, for instance, the Nursing Practice Act and those stated in Title 10 Section 4055 of the New York standards, serve as the guidelines that nursing professionals need to follow so that they can deliver consistent quality care and maintain high standards of practice (New York Codes, Rules and Regulations, 2023). In this case, they specify the development of up-to-date, holistic nursing care plans, the documentation of nursing interventions, and the administration of medication by qualified personnel.
In the context of quality of care, patient safety, and cost, such standards as scopes of practice (SOPs) permit nurse practitioners (NPs) and physician assistants (PAs) to practice independently. These experts are typically trained in patient safety protocols and can intervene more effectively in the event of adverse events. As Flanigan (2021) and Htay and Whitehead (2021) indicated, these standards can improve care quality and patient satisfaction, as having a broad-scope NP can reduce emergency department lengths of stay. With fewer ED visits, patients’ associated costs, including copays for medication and healthcare services, can be significantly reduced. This also encompasses savings in both direct costs, such as staff time and supplies, and indirect costs, such as overhead.
Thus, by reducing the number of ED visits, hospitals can allocate their resources to other areas where they are needed, such as preventive care and chronic disease management. As a nurse, I will be guided by these standards to provide comprehensive care to patients with HF. By adhering to these standards, medication can be administered correctly and care tailored to the patient’s specific needs, thereby enhancing quality and safety while minimizing costs associated with readmissions.
Local, state, and federal policies can also affect healthcare. For instance, NY law restricts the use of the title “nurse” to licensed professionals and requires them to practice under the direction of a qualified healthcare provider (New York State Education Department, n.d.). This legislation ensures that only competent individuals provide nursing care, contributing to patient safety and the integrity of the healthcare system.
Additionally, the cost implications of these standards and policies can be seen in the prevention of unnecessary procedures and errors, which saves money that would otherwise be spent on these services (Vaismoradi et al., 2020). Additionally, mistakes resulting from unauthorized practices can be minimized, preventing potential malpractice claims and associated costs.
Conclusion
Treating HF following heavy chemotherapy, which includes heart failure, requires an integrated solution that takes into account the quality of nursing and patient safety issues, the efficiency of treatments and their side effects, and the adherence to the nursing practice standards and evidence-based practice guidelines. In this regard, improved outcomes are based on effective communication and collaboration, as well as evidence-based interventions whose ultimate goal is patient-centered care.
References
Asch, D. A., Troxel, A. B., Goldberg, L. R., Tanna, M. S., Mehta, S. J., Norton, L. A., Zhu, J., Iannotte, L. G., Klaiman, T., Lin, Y., Russell, L. B., & Volpp, K. G. (2022). Remote monitoring and behavioral economics in managing heart failure in patients discharged from the hospital: A Randomized clinical trial. JAMA Internal Medicine, 182(6), 643–649.
Bozkurt, B., Ahmad, T., Alexander, K. M., Baker, W. L., Bosak, K., Breathett, K., Fonarow, G. C., Heidenreich, P., Ho, J. E., Hsich, E., Ibrahim, N. E., Jones, L. M., Khan, S. S., Khazanie, P., Koelling, T., Krumholz, H. M., Khush, K. K., Lee, C., Morris, A. A., … Ziaeian, B. (2023). Heart failure epidemiology and outcomes statistics: A report of the heart failure society of america. Journal of Cardiac Failure, 29(10), 1412–1451.
Flanigan, J. (2021). Scope of practice reform: Cost savings and patient empowerment. The Center for Growth and Opportunity.
Heidenreich, P. A., Fonarow, G. C., Opsha, Y., Sandhu, A. T., Sweitzer, N. K., Warraich, H. J., & HFSA Scientific Statement Committee Members Chair (2022). Economic issues in heart failure in the United States. Journal of Cardiac Failure, 28(3), 453–466.
Htay, M., & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. International Journal of Nursing Studies Advances, 3, 1-22.
Khan, M. S., Sreenivasan, J., Lateef, N., Abougergi, M. S., Greene, S. J., Ahmad, T.,… & Butler, J. (2021). Trends in 30-and 90-day readmission rates for heart failure. Circulation: Heart Failure, 14(4), 450-458.
New York Codes, Rules and Regulations. (2023). Title: Section 405.5 – Nursing services.
New York State Education Department. (n.d.). Practice information for registered professional nursing.
Sadeq, A., Sadeq, A., Sadeq, A., Alkhidir, I., Aburuz, S., Mellal, A., Al Najjar, M., & Elnour, A. (2020). Risk factors for hospital readmission of patients with heart failure: A cohort study. Journal of Pharmacy and Bioallied Sciences, 12(3), 335-343.
Shabani, F., Maleki, M., Noohi, F., Taghavi, S., Khalili, Y., Shahboulaghi, F. M., Nayeri, N. D., Amin, A., Nakhaei, Z., & Naderi, N. (2022). Effect of home care program on re-hospitalization in advanced heart failure: A clinical trial. Iranian Journal of Nursing and Midwifery Research, 27(4), 274–279.
Trujillo, M. E., Ayalasomayajula, S., Blaustein, R. O., & Gheyas, F. (2023). Vericiguat, a novel sGC stimulator: Mechanism of action, clinical, and translational science. Clinical and Translational Science, 16(12), 2458–2466.
Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 1-15.
Wang, S. Y., Valero‐Elizondo, J., Ali, H. J., Pandey, A., Cainzos‐Achirica, M., Krumholz, H. M.,… & Khera, R. (2021). Out‐of‐pocket annual health expenditures and financial toxicity from healthcare costs in patients with heart failure in the United States. Journal of the American Heart Association, 10(14), 1-15.