McMurray, J., Adamopoulos, S., Anker, S., Auricchio, A., Bohm, M., Dickstein, K.,…Ponikowski, P. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33(14), 1787-1847.
In this article, McMurray et al., reported evidence based plan which will assist health professionals to analyze and treat patients suffering from chronic heart diseases. The authors attempted to compile comprehensive survey of the available evidence on problems related to chronic heart patients. Then authors developed guidelines for treatment of cardiac problems that include the most current research and recommendations to be implemented in clinical practices. The article will be useful for the physicians to select the best management strategies for a patient with chronic heart problems. The diagnosis of the patients with prevailing symptoms and treatments with recommendations will be easily accessed from the given guidelines. In the guidelines, even the recommendations with supportive evidences are provided with grades. It ensures ease for the practitioners to follow. Hence, the developed guidelines for heart related problems are blend of scientific researched recommendations, clinical expertise and patient ethics. The recommendations are only to guide practice in clinical situations. Like a properly formulated guideline, the evidence levels, recommendation grades, and the interconnection between them is explicit here. The only limitation of using guideline is, they intend to address specific clinical conditions and fail to cope up with uncertainties of existing clinical practices.
Murray, M., Tu., W, Wu, J., Morrow, D., Smith, F., & Brater, D. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85(6), 651-658.
In this paper, Murray et al. studied the factors which directly influence and aggravate health condition of heart failure patients. Due to cardiovascular problems or socioeconomic determinants, heart failures occurs which results into emergency visits to hospitals. The authors took comprehensive set 192 participants to carry out the trials and eventually found that the incidence of emergency hospitalizations was higher in patients who failed to receive medications from pharmacy. These results call attention for the need of thorough instructions to the patients about their medication. Hence, the patients with literacy skills shall be able to understand and decide upon self- management of chronic heart diseases provided, the clinically damaging factors are in check. These patients had lesser chance of hospitalization due to heart failure. The authors concluded that non-adherence to the treatment and insufficient health related knowledge such as reading prescription are the main reasons behind aggravation of heart failure. The limitation of the study is that the survey sample is not generalized but restricted to lesser number of heart failure patients. The authors specify that further thorough study need to be attempted to derive more concrete evidences for the factors related to health conditions of patients with cardiovascular problems.
Stromberg, A., Martenssen, J., Fridlund, B., Levin, L., Karlsson, J.E., & Dahlstrom, U. (2003). Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. European Heart Journal, 11, 1014-1023.
In this article, Stromberg et al. highlighted the advantages of routine follow-up at a nurse led clinic for heart failure patients. The authors studied the impact of follow up on death rate, morbidity and care of one’s ownself. Generally, one year after discharge from hospital, the patients reported mild discomfort. Thus, an emergency admission in hospitals was increasing at an alarming rate. For study, authors used total of 106 patients for a routine follow-up at hospital care units. The staffs were well trained in attending cardiac patients and adopted medication based protocol. The initial follow up was scheduled after 2-3 weeks of discharge. The findings suggested positive effects of follow up which promoted quality of life in patients. Hence, nurse led follow up was emphasized for the patients with heart failure problem. Finally, the authors concluded that regular follow up at health care set-ups enhanced survival and self-care behaviour of patients. It reduced the need of readmissions and longer stay at hospitals. Consequently, it also reduced number of deaths and requirement of hospital care for the patients. The limitation of this mode of treatment is this method is not suitable for the patients toward the end stage of heart failure.
Chronic heart diseases are a threat to worldwide population. Charlie is overweight, was diagnosed with chronic heart failure two years back and presently has complaints about cardiac problems. All the three sources selected and mentioned above in annotated bibliography aid to manage Charlie’s case in more appropriate manner. In 2012, McMurray and coworkers developed guidelines and described the immediate steps to be considered while treating heart failure patients. At first, clinical investigations like ECG, echocardiography and laboratory tests are carried out to monitor the patient’s present heart condition. The guideline gives an overview of different abnormal electrocardiogram (ECG) patterns or symptoms which indicate probable heart failure in near future. In case of abnormal reports, the procedure for necessary treatment also has been advised. Amakali reported that edema is an indication of systolic heart failure (Amakali , 2015 ). The aim of the treatment is to alleviate symptoms and signs. This paper adds the steps in diagnosis and treatment for clinical practice which can really help to treat Charlie. The quality of research is superior as it compiles all the available current evidences. The recommendations given in the guidelines are practical. They can be implemented in the clinical practices. In support to the paper, Fermann and group reported that for initial management and therapy of the patients with chronic heart failure, critical signs are used to find out the actual cause of the prevailing condition. They also highlighted that ECG plays a significant role to recognize conditions such as cardiac ischemia (Fermann et al., 2013) which is similar to Charlie’s case. Heart org is an excellent site which helps in recognizing symptoms of heart failure. (https://www.heart.org/HEARTORG/).
Another 2009 article of Murray and coworkers guide us for the possibility of lack of adhesion towards proper treatment. In Charlie’s case where a past history of chronic heart failure did exist, his condition aggravated because of irregularity in following the course of medication. Thus, this paper highlights a very common problem with cardiac patients. For such patients, this paper suggests the importance of adhering to the planned medication scheme and maintaining it. Negligence toward one’s health may have been caused due to socioeconomic issues, improper literacy skills, and unawareness of the health disorder symptoms. Process of hospitalization and healthcare is expensive and people struggle to cope up with the cost. The use of health services is highest among people suffering from chronic illness (Edwards et al., 2014). Keeping in mind the health cost, new concepts have to be designed for delivery of health services, alternative options to manage chronic diseases, and teaching modes promoting self-care to the patients. Though managing heart failure has altered tremendously with new drugs and advanced tools introduced in the health care industry (Komajda, 2015) which promise to improve quality of life and reduce death rate (Sieck, 2012). Patients have to be guided to follow prescribed medicine and maintain its usage according to the physician’s advice. In case of non-availability of particular medicine, alternative option has to be followed strictly without any delay. Adherence to medicine is one way to deal with the diseases and taking medicine is a perception which relatively depends on the success of disease management (Lo et al., 2016).
The most important guideline for clinical practice was proposed in 2006 by Stromberg et al. As per this guideline, for accurate monitoring of health conditions, it is most important to be in regular contact with the healthcare professionals even after a fixed time period from discharge. It also works in favor of Charlie’s case. The burden of hospitalization and re-hospitalization constantly remains as an issue in elderly patients with chronic heart failure. Alternatives to reduce hospital processes are timely diagnosis, proper treatment and follow-up and more importantly self-monitoring (Pericas et al., 2013). Special trainings and education programs must be introduced for nurses, so as to provide ‘proper healthcare’ to the chronic heart patients. Patient centric approach might help patients to enhance self-care confidence and self-management. It has been reported that poor understanding of the patient regarding condition of his own disease increases negative emotional beliefs. The patients assume that the disease is out of control; hence self-care management does not actually help (Goodman et al., 2013). Anxiety and depression disorders are found to be higher in heart failure patients than compared to others (Morgan et al., 2014; Costa et al., 2016).
Clinical nurses have to first design and then enforce a care plan with treatment to moderate the symptoms. Patients are to be educated regarding self-assessment and to promote self-care practice among them. We have to make sure that close follow-ups are scheduled for patients with physicians. Thus, improving symptoms and proper assessment to minimize death rate and morbidity enhances stability among chronic heart patients (Fermann et al., 2013). Throughout life, a nurse vows to work for the welfare, comfort and safety of the patients. Care of chronic heart patients will be more meaningful, if a nurse is more prompt in early identification of symptoms, prudent toward the diagnosis, and active in promoting self-care among patients.
Self-care by monitoring weight is recommended so as to keep the weight in check. For the positive health outcome of the patients, nurse has to advice modifications in the lifestyle of patients. Wadden and coworkers reported that lifestyle modification comprising of a blend of diet plan, exercise, and psychological therapy for behavioral modification is measured as the initial step for weight administration (Wadden et al., 2013). Diet modifications have to be planned consulting with the dietician and to be included in care plan.
Amakali, K. (2015). Clinical care for the patient with heart failure: A nursing care perspective. Cardiovascular Pharmacology, 4, 142.
Costa, E.C.V., Vale, S., Sobral,M., & Graca Pereira M. (2016). Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain. Psychology Health & Medicine, 21(4,) 483-495.
Edwards, L., Thomas, C., Gregory, A., Yardley, L., O'Cathain, A., Montgomery, A. A., & Salisbury, C. (2014). Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey. Journal of Medical Internet Research,16(5), e123
Fermann, G. J., & Collins, S. P. (2013). Initial Management of Patients with Acute Heart Failure. Heart Failure Clinics, 9(3), 291–vi.
Goodman, H., Firouzi, A.,Banya, W., Lau-Walker, M., & Cowie, M. R. (2013). Illness perception, self-care behaviour and quality of life of heart failure patients: A longitudinal questionnaire survey. International Journal of Nursing Studies, 50(7), 945-953.
Komajda, M. (2015). Current challenges in the management of heart failure. Circulation Journal, 79, 948-953.
Lo, S. H. S., Chau, J. P. C., Woo, J., Thompson, D. R., Choi, K. C. (2016). Adherence to Antihypertensive medication in older adults with hypertension. Journal of Cardiovascular Nursing, 31(4), 296-303.
Morgan, K., Villiers-Tuthil A., Barker, M., & McGee, H. (2014). The contribution to illness perception to psychological distress in heart failure patients. BMC Psychology, 2, 50.
Pericas, J. M., Aibar, J., Soler, N., Lopez-Soto, A., Sanclemente-Anso, C., & Bosch, X. (2013). Should alternatives to conventional hospitalization be promoted in an era of financial constraints? European Journal of Clinical Investigations, 43(6), 602-615.
Sieck, S. (2012). The economics and reimbursement of congestive heart failure. In: W. F. Peacock (Eds,). Short stay management of acute heart failure. (pp.9-32). New York: Humana Press.
Wadden, T. A., Volger, S., Tsai, A. G., Sarwer, D. B., Berkowitz, R. I., Diewald, L., Carvajal, R., Moran, C. H., & Vetter, M. (2013). Managing Obesity in Primary Care Practice: An Overview and Perspective from the POWER-UP Study. International Journal of Obesity, 37(0 1), S3–11.
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