How to write an essay on Best Practices for The Treatment of Congestive Heart Failure (Solved)

How to write an essay on Best Practices for The Treatment of Congestive Heart Failure (Solved)

What is a Congenital heart failure?

Congestive heart failure or heart failure is a complex clinical condition marked by the impaired ability of cardiac muscles to pump and/or fill with blood. Physiologically, it is described as inadequate cardiac output that does not satisfy the metabolic demands and usually manifests as increased filling pressure in the left ventricle (Savarese & Lund, 2017). The most recent guidelines classify heart failure into three categories: according to the ejection fraction, the existing structural cardiac pathologies and diastolic dysfunction, and natriuretic peptide levels.

According to Savarese and Lund (2017), CHF is currently a worldwide pandemic affecting not less than 26 million people globally, with marked increasing prevalence. There is a significant health expenditure on CHF, and the amount increases with the increasing aging population, posing a huge impending economic burden. Despite advances in the treatment practices and prevention of CHF, mortality and morbidity rates remain high, with associated poor quality of life. Depending on the underlying conditions, and different clinical characteristics, there are significant geographic variations in mortality and morbidity rates, the prevalence and incidence of CHF. This research paper provides a detailed discussion of the best treatment practices of congestive heart failure among older adults (65 years and above).

Problem Area

The current statistics indicate that CHF affects nearly 26 million people globally, therefore, and is set to increase by approximately 50% by 2030 (Virani et al., 2020).  A study by Virani et al. (2020) indicates that there are about 915,000 new cases of HF annually in the U.S. leading to an incidence of 10 cases in every 1000 people among people above 65 years old. Beyond 40 years of age, the incidence is one in every five people, and it increases with age.  Despite the advancement in the treatment of CHF, there are several unmet needs. There are a significant number of hospital discharges with a diagnosis of CHF, population disease burden, and increased financial burden. In 2012, the financial expenditure on CHF was estimated to be $31 billion (£22.5 billion), which is more than 10% of all health expenditure on cardiovascular illnesses in the U.S. trends in projections show that the costs will increase by 127% by 2030 (Savarese & Lund, 2017). The increasing prevalence of the aging population impedes the global efforts in the achievement of the third sustainable development goal of good health and wellbeing. Also, the financial expenditure directed in the treatment of this condition could be channeled to other areas such as prevention and healthy lifestyles to increase life expectancy. Continuous research and increasing the availability of the most advanced treatment practices are key to managing and treating CHF. As a result, there will be reduced hospital stay and the resultant cost of treatment for the associated complications. Incorporation of the best treatment practices in the management of CHF will ensure quick recovery, prevention of complications, and reduced financial burden associated with the condition. This paper highlights the best treatment practices and protocols of CHF among adults above 65 years old.

Target Population

The target population for this research paper is adults of age 65 and older. CHF is a growing public health menace and is among the leading cause of illnesses, hospitalizations, and death in this population. Nearly 915,000 cases of CHF are diagnosed annually in the U.S., which translates to an incidence of 10 cases in every 1000 people of the geriatric population (Virani et al., 2020). The study further establishes that beyond 40 years, the incidence is 1 in every 5 people, and continues to increase with age. A study by Butrous and Hummel concurs with these findings as it establishes that the incidence of CHF of 1% at age 65 years doubles every decade thereafter. The risk of developing CHF at 80 years and 40 years of age is 20%, despite the shorter life expectancy. According to Butrous and Hummel (2016), there are several challenges in assessing and managing CHF in older patients, as they often have comorbidities, polypharmacy, diminished cognitive functions, and weakness. These four significant characteristics of geriatric patients have an impact on their health and wellbeing, and the eventual clinical outcomes. Even though the geriatric population has not been well presented in clinical trials, available data suggest that medical and device therapies following standard protocols can be used to improve health outcomes and the quality of life. essentially, clinical trials aimed at enrolling geriatric patients with comorbidities, and evaluating the functional status, quality of life, cardiovascular morbidity, and mortality should be invigorated to improve the management of CHF in this age group.

Significance of the Topic

The findings of this discussion will be applied in clinical areas to improve the health outcomes of patients diagnosed with CHF. This is significant in achieving the third sustainable development goal of good heal and wellbeing for people of all ages, as there are high incidences of this condition among older adults. Also, the government can use these findings to establish cost-effective methods in the treatment of CHF, thereby minimizing the financial expenditure it accrues. Additionally, these findings will be used to improve the knowledge base in this area of medicine, especially among students. Finally, other researchers can use the findings in this article for comparisons to their works or form a basis for further studies.

Evidence-Based Protocols for Treating CHF         

Butrous and Hummel (2016) describe “Guideline-directed medical therapy” as a group of therapies backed up with sufficient evidence from randomized controlled trials to enhance health outcomes in patients with CHF. Nonetheless, there are existing doubts about the application of these guidelines to the elderly population. This is significantly due to exclusion of older people in most clinical trials. Butroous and Hummel (2016) attribute this exclusion to medical illnesses and/or preserved left ventricular ejection fraction which are common among the elderly. In a study that assessed Medicare beneficiaries who had good health outcomes after being hospitalized for heart failure, the findings showed that not more than 25% of the elderly population would have qualified to be included in landmark studies of BB, ACEI, and mineralocorticoid antagonists (Butrous & Hummel, 2016). Despite the exclusion, several studies agree that using evidence-based protocols in the treatment of CHF improves morbidity, hospitalization, and mortality rates among the elderly.

Results from observational studies suggest that the recommended treatment options for systolic heart failure work similarly in both younger and older patients. The first option is pharmacological treatment. The first line of therapy for systolic heart failure is beta-blockers. To avoid the common adverse effects of hypotension and bradycardia, it is advisable to start therapy with the lowest recommended dose and increase the dosage at intervals of at least two weeks towards achieving the target dose (Guerra et al., 2017). Also, adequate evidence suggests the efficacy of angiotensin-converting enzyme inhibitors (ACEIs) in elderly patients. Ruling out allergy and intolerance, all elderly patients with CHF should be treated with ACEIs beginning with low doses. Angiotensin receptor blockers (ARBs) are an option for those who are intolerant to ACEIs. Guerra et al. (2017) recommend a new study that combines sacubitril with losartan, which is better than using enalapril alone. Cautious use of mineralocorticoids in elderly patients is recommended due to their side effects of hyperkalemia, hypotension, and renal impairment. Finally, digoxin has demonstrated significant benefits in the treatment of CHF. However, due to the high risk of toxicity and withdrawal effect, the serum concentration should be maintained at 0.5 to 0.9ng/ml during therapy.

The second protocol is the treatment of anemia and iron deficiency. Anemia is widely reported among patients with chronic HF. This is due to iron deficiency, renal dysfunction, and comorbidities (Guerra et al., 2017). Studies reveal that mortality among the elderly with CHF doubles over three years due to anemia. Particularly, patients with high hematocrit values are more likely to succumb to sudden cardiac death, while those with low hematocrit values to exacerbated CHF. Intravenous therapy to correct anemia and iron deficiency, for four months, has been deemed effective in establishing improved clinical status in patients with CHF. Particularly, the use of ferric carboxymaltose has demonstrated significant benefits in boosting iron stores in the body.

Additionally, the use of implantable cardiac defibrillators (ICD) has a significant benefit in preventing sudden cardiac death in patients with symptomatic CHF, with impaired systolic function. According to Butrous and Hummel (2016), when used for secondary prevention, there is a significant reduction in mortality as compared to when used for primary prevention. Essentially, physicians should consider the following factors when deciding to implant an ICD in elderly patients: their functional status, the burden of co-existing illnesses, goals of care, estimated survival, and risk of ventricular arrhythmia. It is also recommended that an evaluation of probable risks such as infections, inappropriate shocks, and device deactivation when the battery is not replaced is conducted.

Another recommendation from the current guidelines for the treatment of symptomatic CHF is the use of cardiac resynchronization therapy (CRT). Some of the associated benefits include reduced left ventricular volumes, increased left ventricular ejection fraction, reduced clustered and unclustered ventricular arrhythmias, peak oxygen consumption, and the quality of life. additionally, it does not need uptitration, and is not affected by poor compliance or drug interaction. The only downside is that it needs advanced facilities and quality time for out-of-hospital assistance.

Impact on Nursing Practice

CHF continues to affect millions of people globally. Many patients die prematurely due to increased hospital readmissions, and a poor quality of life. the time after discharge from the hospital is considered the most vulnerable. Therefore, in addition to the treatment practices, the guidelines recommend a multidisciplinary approach to improve outcomes, relieve suffering, and improve the quality of life for CHF patients (Riley & Masters, 2016). Strategies aimed at addressing the management of comorbidities, through various specialists, should be enhanced in hospitals to ensure patients can access the care they need regardless of their location.

The establishment of an acute CHF pathway that crosses organizational boundaries to optimize the treatment and management of CHF patients is critical in achieving timely recovery. The recommended treatment guidelines can only have maximum benefit when initiated early, following the initial diagnosis. The acute pathway in this case can triage patients from the ER to CCU, cardiology ward, internal medicine, or geriatric ward directly (Riley & Masters, 2016). Apart from improving quality of care, timely commencement of these evidence-based treatment practices, and collaboration with relevant specialists including CHF specialist nurse addresses individual patient needs, reduces hospital readmissions, associated mortalities, the cost of treatment and hospital length-of-stay.

Conclusion

CHF is a complex clinical condition that commonly affects the elderly. Its prevalence increases with age, especially after 65 years. Despite the underrepresentation of elderly patients with CHF in clinical trials, there are various treatment practices recommended for this population ranging from pharmacological to non-pharmacological treatments. The non-pharmacological treatment options include devices, exercises, and dietary modification, through which quality nursing care along with other specialties is required for enhanced health outcomes.  Considering factors associated with CHF such as comorbidities, frailty, economic and social backgrounds, and the quality of life, treatment options should be individualized. Consequently, there will be improved health outcomes achieved through cost-effective methods and quality patient care.

References

Butrous, H., & Hummel, S. L. (2016). Heart failure in older adults. Canadian Journal of Cardiology, 32(9), 1140-1147.

Guerra, F., Brambatti, M., Matassini, M. V., & Capucci, A. (2017). Current therapeutic options for heart failure in elderly patients. BioMed Research International, 2017.

Riley, J. P., & Masters, J. (2016). Practical multidisciplinary approaches to heart failure management for improved patient outcome. European Heart Journal Supplements, 18(suppl_G), G43-G52.

Savarese, G., & Lund, L. H. (2017). Global public health burden of heart failure. Cardiac failure review, 3(1), 7.

Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., … & American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9), e139-e596.

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