Overview
Congestive Heart Failure (CHF) is one of the common health challenges in aging persons. The health condition is one of the major causes of deaths and health complications for individuals that above sixty five years. Congestive Heart Failure is not only a major cause of health complication and death in aging individuals but also contribute high number of re-admission among aging person.
Moreover, treating Congestive Heart Failure cost a fortune and is a major challenge to families with a CHF patient. Considering its significance to the health of aging persons, Health care provision for aging persons should therefore consider CHF management.
Because of increased cases of CHF and its health and cost implications, various recent research studies have focused towards coming up with better CHF management (Whalley, et a., 2002; Ross, J., et al., 2010; Goldberg, et al., 2005; Colonna, et al., 2003).
Congestive Heart Failure as an area of research is not fully exhausted despite of many research studies dedicated to it. This paper will discuss the process involved in coming up with a topic for research study, resources for information, search strategy and summary, and evaluation of sources.
Problem Statement
The major challenge in management of Congestive Heart Failure is frequent re-admission of CHF patients. Considering health risk and treatment cost implication, re-admission of CHF patients have high implication to the patients, their families and health care providers. The cause of frequent re-admission of CHF patients have been a subject to many researchers.
Among the frequently proposed causes of re-admission, include narrow understanding of the health condition among patients and poor adherence to treatment and diet.
Other proposed causes of re-admission include poor management of other health conditions such as respiratory infection and hypertension. In addition, poor discharge and planning and poor follow up of patients are cited as possible factors that contribute to increased CHF re-admission cases (Reis, et al., 1997; Jaarsma, et al., 1998).
Most of literature addressing hospitalization of CHF patients agree that much can be done reduce re-admission cares and improve quality of life of CHF (Kornowski, Zeeli, Averbuch, et al. 1995; Smith, Fabbri, Pai, et al.,1997; Rich, Beckham, Wittenberg, et al., 1995). This study will revisit re-admission of CHF patients in relation to medication compliance, diet modification and community health programs.
The study will also explore the role of case management in mitigating re-admission. In order to address the problem, the study will seek to provide answers to the question: What are the reasons why Congestive Heart Failure cases have high number of admissions?
Problem Symptoms or Evidence
Congestive heart failure refers to a health condition where the heart is unable pump enough blood to other body parts especially critical body organs. CHF is a major health issue in United States as well as other parts of the world. The health conditions incapacitate patients and can lead to death (Schocken, Arrieta, Leaverton & Ross, 1992).
In United States, about three million people suffer from congestive heart failure. As the number of elderly people increase, without better management programs CHF a major health challenge in the future. Currently, treating congestive heart failure cost as much as ten thousand US dollars.
The cost is definitely very expensive to majority of people and a heavy burden to health care providers and health insurance companies. Apart from the high cost of treating congestive heart failure, the health condition has low mortality at an average of about five years.
Congestive heart failure is a major health challenge and cause of hospitalization for individuals above sixty five years. Symptoms to congestive heart failure include progressive shortness of breath for long, fluid retention in the body, weight gained within three days, loss of appetite, and swollen feet, legs and ankle before admission.
The health condition is correlated to other health issues such as diabetes (Nichols, et al., 2004; Dokainish, et al., 2004). For instance, diabetes patients are almost twice as vulnerable to CHF compared to other individuals.
Literature Search
Keywords
A search strategy is required for a successful research study. Important to a search strategy is keywords. Key words refer to words or phrase that, when used, can help a researcher to identify the appropriate sources and information for a research study. Key word ought to capture the topic under study and direct a researcher towards most appropriate literature. There could be many sources related to a research study.
As a good researcher, one has to sort out the many sources to come up with the most relevant and appropriate sources. The key words that were used for the study were related to congestive heart failure and re-admission. Below is a list of the key words that were used to search for appropriate sources for the study.
- Heart failure
- Cardiac health
- Heart diseases
- Cardiac Edema
- Shortness of Breath
- Cardiovascular diseases
- Congestion
- Congestive heart failure
- Types of heart diseases
- Cardiac Risk Factors
Among the search terms “Congestive heart failure” was found to be the most resourceful. Searches using the keyword provided important results related to research problem.
Resources
Resources of a research study have high contribution to quality of a study. A good resource should provide wide range of information on a research topic. In addition to wide range of information, a research resource should be reliable. For the study, two primary resources were identifies:
- Google Search
- CINAHL
Modification of Keyword Searches
In order refine results from searches using keywords, modification of search terms was necessary. Modification of search terms helped in identifying specific information and sources to the research problem. Boolean operations were very helpful in modifying the search terms.
The search started by tying the word heart failure, and all the topics related to Congested Heart Failure came out. By putting the word CHF + the word specifically needed such as medication, diet, signs and symptoms, the search brought in specific articles necessary for the study. Below is modification of search terms that were most resourceful
Heart failure OR congestive heart failure
Congestive heart failure AND re-admission
Heart failure+ causes and symptoms
Congestive heart failure AND edema
Congestive heart failure AND diabetes
Congestive heart failure AND mortality
Congestive heart failure+ medication compliance
Congestive heart failure AND diet modification
Most Useful Keywords
The most useful word in the search made is Congestive heart failure. A very broad topic to search but with the help of the Boolean sign it narrows down to specific search.
Citation of Sources
Nichols, G., Gullion, C., Koro, C., Ephross, S. & Brown, J. (2004). The Incidence of Congestive Heart Failure in Type 2 Diabetes. Diabetes Care 27(8)
Reis, S., Holubkov, R. Edmundowicz, D., McNamara, D., Zell, K., Detre, K. & Feldman A. (1997). Treatment of patients admitted to the hospital with congestive heart failure: specialty-related disparities in practice patterns and outcomes. J Am Coll Cardiol 30(3), 733-738
Schocken, D., Arrieta, M., Leaverton, P. & Ross, E. (1992). Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 20, 301-306
Jaarsma, T., Halfens, R., Huijer, H., Dracup, K., Gorgels, T., Van Ree, J. & Stappers, J. (1998). Effect of education and support on self-care and resource utilization in patients with heart failure. European Heart Journal 20(9), 673-682
Dokainish, H., Zoghbi, W., Lakkis, N., Ambriz, E., Rajnikant, P., Quinones, M. & Nagueh, S. (2004). Incremental predictive power of B-type natriuretic peptide and tissue Doppler echocardiography in the prognosis of patients with congestive heart failure. Journal of the American College of Cardiology 45(8), 1223-1226
Whalley, G., Doughty, R., Gamble, G., Wright, S., Walsh, H., Muncaster, S. & Sharpe, N. (2002). Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. Journal of the American College of Cardiology 39(11), 1787-1795
Ross, J., et al. (2010).Recent National Trends in Readmission Rates after Heart Failure Hospitalization. Circulation 122, 1645-51
Goldberg, R., Farmer, C., Spencer, F., Pezzella, S. & Meyer, T. (2005). Use of nonpharmacologic treatment approached in patients with heart failure. International Journal of Cardiology 110(3), 348-353
Colonna, P., Sorino, M., Agostino, C., Bovenzi, F., De Luca, L. Arrigo, F. & de Luca, I. (2003). Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration. American Journal of Cardiology 91(9), 41-50
Kornowski R, Zeeli D, Averbuch M, et al. (1995). Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure. American Heart Journal 129, 162–6.
Smith L., Fabbri S. Pai R., et al. (1997). Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic. Clin Cardiol 20, 949–54
Rich M, Beckham V, Wittenberg C, et al. (1995). A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333, 1190–5
CARS Evaluation table
Annotated Bibliography
Nichols, G., Gullion, C., Koro, C., Ephross, S. & Brown, J. (2004). The Incidence of Congestive Heart Failure in Type 2 Diabetes. Diabetes Care 27(8)
The purpose of the study was to explore prevalence of congestive heart failure in type 2 diabetic patients. Two sample of 8,231 and 8845 of individuals with type 2 diabetes and non-diabetic congestive heart failure patients, respectively, were used for the study. From the study, diabetic patient were found to be more likely to contract congestive heart failure at a rate of 2.5. The authors concluded that there was need to control risk factors such as blood pressure, hyperglycemia and obesity in managing congestive heart failure.
Reis, S., Holubkov, R. Edmundowicz, D., McNamara, D., Zell, K., Detre, K. & Feldman A. (1997). Treatment of patients admitted to the hospital with congestive heart failure: specialty-related disparities in practice patterns and outcomes. J Am Coll Cardiol 30(3), 733-738
The objective of this study was to explore differences in specialty treatment of congestive heart failure patient and their effect on treatment outcome. The authors compared treatment and result for patients in a university hospital for six months. The focus for study was patients cared for by general physicians and those whose treatment was guided by a cardiologist. From the study, the authors observed that congestive heart failure patients that were cared for by generalists had high chance of readmission as compared to those whose treatment was guided by a cardiologist. The study confirmed the importance of specialist care in successful management of congestive heart failure.
Schocken, D., Arrieta, M., Leaverton, P. & Ross, E. (1992). Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 20, 301-306
The purpose of the study was to investigate prevalence and mortality rate of CHF in non-institutionalized individuals in United States. The authors aimed at providing reliable national data related to congestive heart failure. The authors relied on National Health and Nutrition Examination Survey for data on prevalence and mortality rate. From the study, the author found prevalence of congestive heart failure to be between 1.1% and 2%. The authors concluded that congestive heart failure had significant mortality rate and prevalence and was a noteworthy health challenge in United States.
Jaarsma, T., Halfens, R., Huijer, H., Dracup, K., Gorgels, T., Van Ree, J. & Stappers, J. (1998). Effect of education and support on self-care and resource utilization in patients with heart failure. European Heart Journal 20(9), 673-682
Self-care plays important role in management of heart failure cares. In the article, the authors investigate the role of education success of self-care. A sample of 179 was used for the study. From the study, the authors found education and support from health care workers especially a nurse to have positive effect on success of self-care. In conclusion, the authors propose integrated education and support for successful heart failure management.
Dokainish, H., Zoghbi, W., Lakkis, N., Ambriz, E., Rajnikant, P., Quinones, M. & Nagueh, S. (2004). Incremental predictive power of B-type natriuretic peptide and tissue Doppler echocardiography in the prognosis of patients with congestive heart failure. Journal of the American College of Cardiology 45(8), 12223-1226
Prediction of congestive heart failure is among the first steps to successful prevention and management. In the article, the authors investigate effectiveness of B-type natriuretic peptide and early diastolic velocity in predicting congestive heart failure relative to conventional methods. Observations were made on a sample of 116 congestive heart failure patients. The authors found B-type natriuretic peptide and early diastolic velocity to have incremental predictive power on CHF patients.
Whalley, G., Doughty, R., Gamble, G., Wright, S., Walsh, H., Muncaster, S. & Sharpe, N. (2002). Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. Journal of the American College of Cardiology 39(11), 1787-1795
The author’s main objective was to examine whether pseudonormal filling contributed to hospitalization and deaths in congestive heart failure patients. 115 CHF patients were investigated for the study. The study found pseudonormal filling to be correlated with hospitalization and deaths in CHF patients.
Ross, J., et al. (2010).Recent National Trends in Readmission Rates after Heart Failure Hospitalization. Circulation 122, 1645-51
The authors aimed at investigating rate of readmission of congestive heart failure patients. The authors used data from Medicare administration for beneficiaries of fee-for-service program that were discharged from hospital. For a period of six years of observation, the authors found that the average rate of readmission was 30 days. The authors conclude that there was no improvement in management of congestive heart failure since the rate of readmission did not change over the period of study.
Goldberg, R., Farmer, C., Spencer, F., Pezzella, S. & Meyer, T. (2005). Use of nonpharmacologic treatment approached in patients with heart failure. International Journal of Cardiology 110(3), 348-353
Managing congestive heart failure is challenging and calls for more than use of medicine. In this article, the authors explore alternative treatment and management approaches for congestive heart failure. The authors focus on effectiveness of counseling, community settings and patient education in managing congestive heart failure.
The authors found the alternative treatment and management approaches to have positive effect on congestive heart failure patients. They recommend hospital counseling as an effective approach in managing heart failure.
References List
Nichols, G., Gullion, C., Koro, C., Ephross, S. & Brown, J. (2004). The Incidence of Congestive Heart Failure in Type 2 Diabetes. Diabetes Care 27(8)
Reis, S., Holubkov, R. Edmundowicz, D., McNamara, D., Zell, K., Detre, K. & Feldman A. (1997). Treatment of patients admitted to the hospital with congestive heart failure: specialty-related disparities in practice patterns and outcomes. J Am Coll Cardiol 30(3), 733-738
Schocken, D., Arrieta, M., Leaverton, P. & Ross, E. (1992). Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 20, 301-306
Jaarsma, T., Halfens, R., Huijer, H., Dracup, K., Gorgels, T., Van Ree, J. & Stappers, J. (1998). Effect of education and support on self-care and resource utilization in patients with heart failure. European Heart Journal 20(9), 673-682
Dokainish, H., Zoghbi, W., Lakkis, N., Ambriz, E., Rajnikant, P., Quinones, M. & Nagueh, S. (2004). Incremental predictive power of B-type natriuretic peptide and tissue Doppler echocardiography in the prognosis of patients with congestive heart failure. Journal of the American College of Cardiology 45(8), 12223-1226
Whalley, G., Doughty, R., Gamble, G., Wright, S., Walsh, H., Muncaster, S. & Sharpe, N. (2002). Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. Journal of the American College of Cardiology 39(11), 1787-1795
Ross, J., et al. (2010).Recent National Trends in Readmission Rates after Heart Failure Hospitalization. Circulation 122, 1645-51
Goldberg, R., Farmer, C., Spencer, F., Pezzella, S. & Meyer, T. (2005). Use of nonpharmacologic treatment approached in patients with heart failure. International Journal of Cardiology 110(3), 348-353
Colonna, P., Sorino, M., Agostino, C., Bovenzi, F., De Luca, L. Arrigo, F. & de Luca, I. (2003). Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration. American Journal of Cardiology 91(9), 41-50
Kornowski R, Zeeli D, Averbuch M, et al. (1995). Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure. American Heart Journal 129, 162–6.
Smith L., Fabbri S. Pai R., et al. (1997). Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic. Clin Cardiol 20, 949–54
Rich M, Beckham V, Wittenberg C, et al. (1995). A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333, 1190–5