Case Study and Annotated Bibliography Analyses: Heart Failure

By Research Team
on May 15, 2020
in Sample Papers

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Case Study and Annotated Bibliography Analyses: Heart Failure

Instructions:

Case Study

Charlie, a 75-year old overweight man, has arrived at the general practice clinic where you are currently working. He is breathless, has visible peripheral oedema, and tachycardia. Two years ago Charlie was diagnosed with chronic heart failure as a result of ischaemic cardiomyopathy and hypertension but states that in the past few days he has felt increasingly unwell.

Based on the case, choose three references from the reference list below which you believe best summarise the evidence for the management of Charlie’s condition.

References

Faris, R. F., Flather, M., Purcell, H., Poole–Wilson, P. A., & Coates, A. J. S. (2006). Diuretics for heart failure. Cochrane Database of Systematic Reviews, 2006(1), 1-23. http://dx.doi.org/10.1002/14651858.CD003838.pub2

Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing heart failure hospital readmissions: A systematic review of disease management programs. Cardiology Research, 5, 126-138. http://dx.doi.org/10.14740/cr362w

Guo, R., Pittler, M., & Ernst, E. (2008). Hawthorn extract for treating chronic heart failure. Cochrane Database of Systematic Reviews, 2008(1), 1-31. http://dx.doi.org/10.1002/14651858.CD005312.pub2

McMurray, J. J., Adamopoulos, S., Anker, S., Auricchio, A., Bohm, M., Dickstein, K., … Zeiher, A. (2012). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal, 33, 1787-1847. http://dx.doi.org/10.1093/eurjhf/hfs105

Molloy, G. J., O’Carroll, R. E., Witham, M. D., & McMurdo, M. E. T. (2012). Interventions to enhance adherence to medications in patients with heart failure: A systematic review. Circulation Heart Failure, 5, 126-133. http://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569

Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F., & Brater, D. C. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651-658. http://dx.doi.org/10.1038/clpt.2009.7

Rees, K., Dyakova, M., Wilson, N., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews, 2013(12), 1-113. http://dx.doi.org/10.1002/14651858.CD002128.pub5

Sagar, V. A., Davies, E. J., Briscoe, S., Coates, A. J. S., Dalal, H. M., Lough, F., … Taylor, R. S. (2015). Exercise-based rehabilitation for heart failure: Systematic review and meta-analysis. Open Heart, 2, 1-12. Retrieved from http://openheart.bmj.com/content/openhrt/2/1/e000163.full.pdf

Strömberg, A., Mårtensson, J., Fridlund, B., Levin, L-A., Karlsson, J-E., & Dahlström, 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, 24, 1014-1023. http://dx.doi.org/10.1016/S0195-668X(03)00112-X

Takeda, A., Taylor, S. J. C., Taylor, R. S., Khan, F., Krum, H., & Underwood, M. (2012). Clinical service organisation for heart failure. Cochrane Database of Systematic Reviews, 2012(9), 1-158. http://dx.doi.org/10.1002/14651858.CD002752.pub3 Wu, J-R., Corley, D. J., Lennie, T. A., & Moser, D. K. (2012). Effect of a medication-taking behavior feedback theory-based intervention on outcomes in patients with heart failure. Journal of Cardiac Failure, 18(1), 1-9. http://dx.doi.org/10.1016/j.cardfail.2011.09.006

Solution

Case Study and Annotated Bibliography Analyses: Heart Failure

Part 1: Annotated Bibliography: Selected Articles

Full citation: (Faris, Flather, Purcell, Poole–Wilson, & Coates, 2006)

In this article, the researchers focused on assessing the merits and demerits of diuretics for chronic heart failure. In the study, computer-assisted searches for randomized and controlled trials as well as review papers, regarding diuretic therapies for chronic heart failure, published within years 1966-2008, were analysed in regard to the latest issue of Cochrane Central Register of Controlled Trials. The databases used included MEDLINE, HERDIN, and EMBASE. As a review, the researchers employed criteria such as; type of studies that focused on the double-blinded RCTs of diuretic treatments by comparing loop diuretics with a placebo or an open control. Additionally, the criteria included adults exhibiting chronic heart failure. The criteria also included diuretic therapy and outcomes based on mortality and morbidity as well as effects of withdrawal to worsening heart problems, effects of diuretics on individual ability to exercise, effects of diuretics on the quality of life and symptoms, side effects, hemodynamic and neuroendocrine effects of diuretic therapy. Researchers found out that in the 14 trials, composed of 525 participants, seven placebo-controlled and 7 compared diuretics contrary to other agents like ACE inhibitors, mortality rates were lower for participants under diuretic therapy compared to the placebo and there were reduced admissions of worsened heart failure cases to those under diuretics in two trials composed of 169 participants. Additionally, for 91 participants, diuretic therapy indicated an improved exercise capacity for CHF patients. Conclusively, the data analysis suggested that patients with CHF will reduce worsening of heart failure as well as the risk of death under diuretics compared to the placebo. Also, it was indicated that diuretic therapy could improve exercise capacity for CHF patients. The study had no limitations in regard to searching research articles. The implication of this study indicated the uncertainty if the conventional diuretics will be subject to future use in large-scale trials so as to assess their effects on medical outcomes for CHF patients who are stabilised with ACE inhibitors.

Full Citation: (Murray, et al., 2009)

In this article, researchers focussed on determining the associative factors with worsening of heart failure by utilizing a cohort study of 192 participants in a randomised trial in ambulatory practice at Wishard Health Services. The controlled trial was conducted from February 2001 – June 2004. Participants were older patients of age 50 years at a cardiology clinic. With the help of the electronic records from Regenstrief Medical Records System (RMRS), the researchers were able to identify their participants. The study focussed on a range of independent variables such as demographics, socioeconomic factors, health insurance, functional performance, heart function, crucial signs, quality of life, hematologic state, serum analysis, health literacy, and medication adherence. Data was analysed using a log-linear regression model in which follow-ups and admissions were tracked. It was evident that the factors associated with worsening of heart failure were associative with refill adherence and health literacy skills. As such, researchers concluded that if patients to not adhere to refill they are most likely to trigger hospitalizations of a worsened heart failure. Also, it was concluded that poor health literacy skills were associated with worsening of heart failure, as such, health care practitioners need to be cautious of the patients in regard to medication and/or therapy. The limitations to this study were several since the participants were recruited form one site making the study less generalised. Also, the cohort sample small and the number of events were scant for heart failure – emergency cases and hospitalization services use.

Full Citation: (Strömberg, et al., 2003)

In this article, the researchers focussed in evaluating the effect of follow-up at a nurse-led heart failure clinical settings in terms of self-care behaviour, morbidity, and mortality of patients who were hospitalised after a diagnosis of heart failure for twelve months after discharge. The researchers utilised 106 patients who were randomly assigned to usual or at a nurse-led follow-up heart failure clinical settings. The nurse-led clinical setting was staffed by particularly educated, and proficient cardiological nurses surrogated the responsibility for making practice-led changes in medication. In the study, the follow-up visits were done after 2-3 weeks. As such, two visits were conducted. Researchers concluded that the nurse-led follow-ups and patient education reduced the number of admissions, readmissions, and events and stay in the hospital by 55%. Also, the intervention group showed improvement in survival and self-behaviour in participants with heart failures. The limitation in this study indicates participants recruited for the study were over 75 years of age and were at were in an end-stage of heart failure or other severe illness or had a cognitive disorder. Furthermore, in regard to morbidity and mortality, it was evident that patients in the controlled group had fewer cases of death and fewer readmissions. The research was more generalised as it utilized three health care centres.

Part 2: Justification of Research Articles and Case Analysis

Prior to the case scenario, Charlie presents a case of an exacerbation of heart failure. Heart failure, also denoted to as congestive heart failure (CHF) is prevalent in 1.0 % to 2.0% in the Australian populace indicating a significant proportion of cases being hitherto undiagnosed (Sahle, Owen, Mutowo, Krum, & Reid, 2016). According to Littnerova et al. (2015), it is evident that there is a positive influence of overweight in patients who are in a long-term care of acute heart failure. As such, Charlie’s case of being overweight might have triggered or worsened the heart failure condition that he had previously developed two years ago.

Furthermore, the sources selected are relevant in this case. First, Faris, Flather, Purcell, Poole–Wilson, and Coates (2006) suggest that use of diuretic therapy for patients with heart failure can increase an individual capacity to perform exercises as well as its continued use as a medication for heart failure reduced the exacerbation of heart failure condition. This article is relevant in way that it can be used as a diagnostic tool in explaining Charlie’s condition, it might be a fact that Charlie did not rely on diuretic therapy after being diagnosed with chronic heart failure two years ago, and as such, the non-adherence to diuretic therapy might have triggered the worsening of heart failure. Arguably, Churchouse (2011) suggests that symptoms associated with heart failure include visible oedema, breathlessness, tachycardia, and retention of fluid in the body that might make an individual overweight. Subsequent to this case, it is evident that Charlie has developed another episode of heart failure. Faris, Flather, Purcell, Poole–Wilson, and Coates (2006) used participants who were older patients of age 50 years and above in searching the research articles for systematic review, as such, Charlie would be a relevant participant in the study. Furthermore, this article can be used as in administering evidence-based treatment for Charlie by suggestive deductions to diuretic therapy.

Second, Murray et al. (2009) suggest that factors that can lead patients to have repetitive episodes of worsened heart failure relate to the refill adherence and health literacy skills of nurse practitioners as well as patients in regard to the initial therapies for heart failure. This article is relevant in this case scenario in that the physician and the nurse handling the patient must realize the importance of advising the patients to adhere to refills as well as educating the patient on the full process of interventions as well as follow-up strategies in both episodes. As such, the article is imperative in ensuring Charlie’s intervention will be effective and trigger better patient outcomes. According to Cajita, Cajita, and Han (2016), it is evident that a lot of patients with heart failure problems is predisposed to exacerbation of the CHF due to low health literacy. As such, low health literacy skills act as a barrier for effective disease self-management behavior in cases of chronic heart failure which require complicated self-care interventions. Also, this article utilized a cohort study in a health care centre with older patients exhibiting chronic CHF making it a suitable evidence-based resource on handling the 75-year old Charlie’s condition

Third, Strömberg et al. (2003) suggest that follow-ups in nurse-led clinical settings are imperative in better patient outcome in cases of heart failure. Charlie’s condition might have been triggered by poor nurse-led follow that did not manage to treat him fully resulting in worsening of his previous condition. Furthermore, the article is relevant in relation to stipulating intervention for Charlie. Exercise is one of the intervention processes that can help in fighting heart failure (Selig, et al., 2010). Charlie would have engaged in a regular exercise to create a more affinity of oxygen for better supply in the heart in order to lessen the heart failure condition during the initial intervention process. Also, the article can be a useful resource for creating awareness to health care practitioners when it comes to its results that nurse-led follow-ups are imperative when treating patients with both acute and chronic CHF. The article clearly outlines that nurse -led interventions in the study yielded fewer readmissions and events of death for patients with either worsened heart failure or acute heart failure.

Part B: Recommendation for Charlie

It is evident that Charlie exhibits symptoms of an exacerbated heart failure. Research suggests that heart failure needs an interdisciplinary care which is long term to reduce the chances of sudden death and improve morbidity (Hisashige, 2013). Regarding medication, physicians treat heart failures with a combination of medications (Hisashige, 2013). Use of diuretics or water pills can be effective as suggested in one of the selected articles-#1 as it would make Charlie decrease fluid in the lungs to breathe more easily (Faris, Flather, Purcell, Poole–Wilson, & Coates, 2006). An example of diuretic that will be recommended in this case is furosemide (Lasix) which decrease fluid in the lungs. Also, use of Angiotensin-converting enzyme inhibitors can be recommended to help Charlie to live longer by enlargement of the blood vessels to lower blood pressure and enhance blood flow hence reducing the heart’s load to function. Furthermore, the patient should be given a proper diet made of low cholesterol food types (Rees, et al., 2013). Also, nurse-led follow-up can be useful for the patient to reduce readmissions and sudden death (Strömberg, et al., 2003).

References

Cajita, M. I., Cajita, T. R., & Han, H.-R. (2016). Health Literacy and Heart Failure: A Systematic Review. The Journal of Cardiovascular Nursing,, 31(2), 121–130. doi:10.1097/JCN.0000000000000229

Churchouse, W. (2011, November 30). Heart failure: managing breathlessness and Oedema. British Journal Of Primary Care Nursing: Cardiovascular Disease, Diabetes & Kidney Care, 8(4), 175-178. Retrieved April 11, 2017, from https://www.bjpcn.com/browse/editorial/item/1464-heart-failure-managing-breathlessness-and-oedema.html

Faris, R. F., Flather, M., Purcell, H., Poole–Wilson, P. A., & Coates, A. J. (2006). Diuretics for heart failure. Cochrane Database of Systematic Reviews, 2006(1), 1-23. doi:10.1002/14651858.CD003838.pub2

Hisashige, A. (2013). The Effectiveness and Efficiency of Disease Management Programs for Patients with Chronic Diseases. Global Journal of Health Science, 5(2), 27–48. doi:10.5539/gjhs.v5n2p27

Littnerova, S., Parenica, J., Spinar, J., Vitovec, J., Linhart, A., Widimsky, P., & Fojt, R. (2015). Positive Influence of Being Overweight/Obese on Long Term Survival in Patients Hospitalised Due to Acute Heart Failure. Plos ONE, 10(2), 1-15. doi:10.1371/journal.pone.0117142

Rees, K., Dyakova, M., Wilson, N., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews, 2013(12), 1-113. doi:10.1002/14651858.CD002128.pub5

Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016, February 6). Prevalence of heart failure in Australia: a systematic review. BMC Cardiovascular Disorders, 16, 32. doi:10.1186/s12872-016-0208-4

Selig, S. E., Levinger, I., Williams, A. D., Smart, N., Holland, D. J., Maiorana, A. J., . . . Hare, D. L. (2010, May). Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. Journal of Science and Medicine, 13(3), 288-294. doi:10.1016/j.jsams.2010.01.004

Strömberg, A., Mårtensson, J., Fridlund, B., Levin, L.-A., Karlsson, J.-E., & Dahlström, 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, 24, 1014-1023. doi:10.1016/S0195-668X(03)00112-X

Case Study and Annotated Bibliography Analyses: Heart Failure

Solution

Case Study and Annotated Bibliography Analyses: Heart Failure

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