Early Hospital Management Strategies For Acute Heart Failure In Patients Aged 50 Or Above

Background and rationale

The primary aim of this paper is to identify the early hospital management strategies for individual aged 50 and above so that the risk of congestive heart failure could be understood who are admitted in the X healthcare facility. Further, using this diagnosis, the paper will develop a clinical audit plan so that the above mentioned literatures could be used to manage the patient conditions admitted in the healthcare  facilities for early care management (Numan et al., 2012). This paper will be divided into two parts, in which the part A will contain the rationale to the topic and its importance in current settings, Further, a clinical audit related question will be developed which will be followed by a PICO question so that the research could be directed towards a specific direction (Myhill, Booth & McLaren-Howard, 2013). A specific search strategy will be used to search and identify relevant research literatures and after that the research findings will be rated against the Joana Briggs level of evidence so that the actual meaning and effectiveness of the situation can be understood. This portion will further include the clinical bottom line as a summary and critique to the evidence collected from the search strategy and as per this, the standard of best practices will be presented and graded in the assignment properly.

Acute heart failure is the condition in which, the healthcare  physicians, nursing professionals, intensivists, cardiologists and other healthcare  professionals have to work in coordination so that the patient could be helped with a rapid intervention. It requires a rapid assessment of the situation as in such health condition, healthcare  professionals need to take treatment decisions depending on expert consensus rather that any available evidence (Authors/Task Force Members, McMurray et al., 2012). Therefore, it is important for the healthcare professionals to be aware of the healthcare management strategies which should be implemented after the hospitalization of individual affected with acute heart failure. Further the importance of these strategies increases with the increasing age of patients affected with acute heart failure as people above the age of 50 years are prone to be affected with congestive heart failure and hence, they require proper preventive and management strategies so that appropriate care can be implemented (Teerlink et al., 2013).

The importance of healthcare interventions and nursing professionals cannot be denied in this scenario. Observational reassessment is conducted so that mental and physical concerns of the patients can be addressed and therefore the healthcare  interventions should be able to change the clinical status of the care process. As mentioned by Ponikowski et al. (2016), all the healthcare  professionals and nursing professionals should be aware of the early healthcare  interventions for patients affected with acute heart failure so that their heart congestions can be treated properly within time.

Application of PICO format

PICO format is used in clinical audit scenario to identify the audit question and its associated population, intervention, identified problem and its expected outcomes. This helps to direct the research in correct direction with proper data base search.

The clinical audit question for this assessment will be regarding the compliance of the healthcare facilities members and its multi-disciplinary teams regarding the acute heart failure and associated early healthcare  interventions. This is important to find out as it helps in the surgical risk reducing strategies for people aged over 50 years who are suffering from acute heart failure and has increased risk of congestive heart failure.

For this assessment different online databases were assessed and from those databases such as PubMed, google scholar, Cochrane and CINAHL a set of different terminologies, with proper combinations were searched and from those papers related to acute heart failure and early healthcare inventions as a preventive and effective measure were selected. a total of 23 papers were found that matched the inclusion criteria, however depending on the sample size, interventions used and the data collection and interpretation techniques, 4 papers were selected for critical discussion in this assignment. The details of the search strategy and findings are mentioned in the table below:

After collecting data from research articles, the level of evidence found in research were rated as per the Joanna-Briggs level of evidence for effectiveness and meaningful research.

It is evident from research articles and healthcare  experts opinion that acute heart failure is a condition to combat which, complete attention and efficiency of healthcare professionals, physicians, cardiologists and intensivists and other professionals are required so that early hospital management could help in maintaining patients stability and improving health condition (Abraham et al., 2015). There are several guidelines, using which healthcare  professionals can manage the health condition of patients in pre hospital or in hospital settings. These guidelines help in filling out the gaps present in the care process so that management of acute heart failure becomes controllable and easy to handle. One such strategy has been mentioned in the research paper of Mebazaa et al. (2013), in which the researchers mention the use of GDMT or the Guideline Directed medical Therapy in which the lifestyle related choices of patients are merged with the drug and device based therapies so that a holistic and approachable care could be provided to the patient. Further any such bad lifestyle habit is approached to modify so that optimal medical therapy could be provided to the patient. For this purpose, the USA government provide a set of regulations for evaluation and clinical assessment using imaging, physical assessment, electrocardiogram and myocardial necrosis so that the degree of heart failure could be properly assessed as accordingly management strategies are applied. However, Jauch et al. (2013) mentioned that acute heart failure is a health condition in which, no pre-planned strategies work in practical condition as every patient shows different heart and physical condition and hence, it is the experience of the healthcare  facility that decides the healthcare  interventions and its effectiveness in maintaining patient condition. However, both the research article mentioned the use and need of early hospital care and management in maintaining patient condition. O’Gara et al. (2013) also mentioned that the primary goal of the healthcare  professionals should be maintaining the recurrent symptoms and managing the ischemic electrocardiographic changes and controlling the congestive heart failure (O’gara et al., 2013).

Search strategy and findings

Another guideline was presented by researchers Amsterdam et al. (2014) in which the discussion related to ESC or the European Society of Cardiology as well as its Committee for Practice Guidelines policy or the CPG policy was discussed. The primary role of these guidelines are not only including the recent research outcomes in the healthcare  practice but also including several educational tools and implementation programs so that while caring for patients, they could be provided with educational sessions so that they can also take art in their care and help the healthcare  professionals by complying with their instructions (O’gara et al., 2013). However, these guidelines do not override the responsibilities of healthcare professionals but with this also includes the carer or family members of the patient in the care process so that the role of healthcare  professionals and their duties can be verified by the patients and their relatives (Howlett et al., 2016). This guideline mainly focuses on the three main aspect of acute heart failure which is pain, breathlessness and anxiety and using appropriate interventions targets these three aspects so that instant relief from pain and anxiety could be provided to the patients aged over 50 as they are physically and psychologically vulnerable to such acute pain. However, () provides a critique to this statement as there are cases in which patients symptoms are not presented at correct time and delay in onset of symptoms are observed (Authors/Task Force Members, Steg et al., 2012). Therefore, early hospital management becomes more important in this case, with the help of early hospital management, the professionals will be able to identify common symptoms which can lead patient to congestive heart failure or similar critical condition. Further in such condition utilization of STEMI diagnosis is also preferred as it will help in identifying the interventions which can help patient in controlling acute heart failure related condition (Howlett et al., 2016).

Therefore, from these above-mentioned discussions it is evident that patients who are suffering from acute heart failure should be provided with early hospital management and early intervention support, backed by several guidelines so that diagnosis and prognosis of the care process becomes easier and appropriate care can be provided to the patient in short span of time (Fleisher et al., 2014).

This section discusses the critically appraised topics or CATs used in this assessment paper. In this, Clinical Bottom Line is used in which summary of the used evidences are included and using that internal, external and statistical validity to the research is provided. In this clinical audit assignment, evidences are presented as a subsequent set of best practice standards.

Critique to the clinical audit related topic

The first article selected presents the evidences that mentions that risk of congestive heart failure or other critical outcomes of acute heart failure is reduced if the healthcare  facilities uses the GDMT guidelines for patients above the age of 50 years. (Abraham et al., 2015; Howlett et al., 2016; Russo et al., 2013; O’Gara  et al., 2013; Fleisher  et al., 2014 Level II 2; level III 1; ungraded 2)

Evidences also suggests that usage of early hospital management is helpful in reducing the risk of congestive heart failure in patients affected with acute heart failure and role of nursing professionals are important in managing such condition. (Abraham et al., 2015; Howlett et al., 2016; Russo et al., 2013 Level II 1, Level III 1, unrated 1)

Evidences recommends that patient centered and family centered care is an important tool in managing such condition as involvement of family in care enhances the patient’s chances to attain health improvement (Hudon et al., 2012; barr et al., 2013; Rathert, Wyrwich & Boren, 2013; Inzucchi et al., 2015; Barry & Edgman-Levitan, 2012, level III 2, unrated 3).

Most of the evidences indicated to the fact that managing patient condition is much more helpful in implementing pharmacological care in this case as interventions require patients lifestyle related, diet and other habits so that health improvements can be witnessed (Hudon et al., 2012; barr et al., 2013; Rathert, Wyrwich & Boren, 2013; Inzucchi et al., 2015; Jauch et al., 2013; level I 1, level II 2, unrated 1).

In this section it should be mentioned that the standard best practices which are helpful in maintaining patient condition has been included in the appendix section and is presented in a tabular form as per the Joanna-Briggs grades of recommendations (Ponikowski et al., 2016).

Early hospital management is recommended by most of the healthcare  professionals and is stated in research articles so that patients affected with acute heart failure can be managed and their risk related to congestive heart failure could be eliminated by implementing health improvement strategies. Further, the treatment should be person centered as well as family centered so that healthcare  intervention could be holistic and using such approach the quality of life, psychosocial factors and patients preferences could be identified (Authors/Task Force Members, McMurray et al., 2012).

Further as mentioned in the research by Amsterdam et al. (2014), the healthcare  process should be inclusive of educational tools and sessions so that while providing healthcare  interventions patients can also be provided with educational session. This will help in enhancing their healthcare  educational knowledge and they will be able to take part in the healthcare  interventions with healthcare  professionals by following their instructions and by controlling their personal habits that can affect the positive healthcare  outcomes (Ponikowski et al., 2016). Therefore, these are the outcomes that should be recommended to the X healthcare  facility caring for patients affected with acute heart failure above 50 years of age.

Conclusion

Acute heart failure is the healthcare  condition in which, healthcare  facilities professionals and nursing staffs are unable to use any preset strategies or interventions to manage or control patient condition as every patient shows different diagnosis and prognosis of the condition. Therefore, it requires healthcare  staffs, multidisciplinary staffs, surgeons, carers, counsellors and other nursing professionals to be alert and active while caring for such patients above the age of 50. Further it is the responsibility of the healthcare  professionals to maintain the physical as well as the psychological wellbeing of patients, using their interventions. In this clinical audit assignment, this topic was chosen as the topic of discussion as it will help in the identification of steps or recommended interventions that could help in management of patient’s situations. A PICO question was formed in this purpose, and using that a clinical audit question was decided. Further, using several internet databases, 4 research articles were selected that complied with the research question and then depending on that recommendations were provided. Further, using the Joanna-Briggs critical appraisal tools, all those evidences and data were graded and ranked as per their level of evidence and clinical audit topic.

References

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