Heart Failure Management

the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print

currently work on an Interventional Cardiac floor and most of our patients are repeat patients. One of the largest readmission diagnosis is Congestive Heart Failure. In 2009, their were over 750,000 patients admitted for CHF, making it the top 5th reason for admission to the hospital (AARP, 2012, para 3). CHF is al the most common readmission to the hospital (Medscape, 2010, para. 2). This is a topic that has been evaluated many times and is currently one of our Core Measures. Our institution has a very specific protocol for this kind of admission and discharge. Even with this stringent protocol set up for doctors and nurses to adhere too it is still left with the patient to comply after discharge. in my experience, noncompliance has been a

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

CHF is the most frequent diagnosis at initial discharge that results in readmission. In 2009, Medicare began publicly reporting hospitals risk-standardized, all 30 day readmission rates among fee-for-service beneficiaries discharged after heart failure hospitalization from all United States acute care hospitals. That same year the average 30 day readmission rate for Medicare patients diagnosed with CHF was 21.2 %. Readmission rates six months post discharge are estimated around 44 %. Noncompliance with medication contributes to 65 % of patients admitted with exacerbation of CHF. It has been estimated that one quarter to one third of exacerbation of CHF admissions are preventable. A prior analysis of MedPac reported that 76 % of readmissions were preventable (Jencks, Williams, & Coleman, 2009). Variations in estimates of this proportion may reflect variances in the quality of care; it is also a result of subjective criteria used to demonstrate an avoidable readmission. The association between

Congestive Heart Failure (CHF) patients and their consistent trending of hospital re-admissions continue to threaten quality care and patient quality of life. Considered a chronic condition, CHF is diagnosed in approximately 13% of patients 85 or older (Clarke, Shah & Sharma, 2011). Re-admissions have become so prevalent among the CHF populations, that Centers for Medicare has initiated a quality campaign and offers incentives when hospitals implement telemedicine programs and show reduction in CHF hospital admissions. In relation to CHF, Conway, Inglis, and Clark (2014) states that, “Telemedicine involves transmission of physiological data, such as weight, … from the measuring device to a central server via telephonic, satellite,

Congestive Heart Failure (CHF) and Heart Failure (HF) are serious problems in regards to hospital re-admissions especially regarding the sixty-five year old population. Data demonstrates approximately over 670,000 individuals each year are diagnosed with CHF, along with that there are 6 (six) million Americans affected with CHF. Hersh, Masoudi, and Allen (2013) described readmissions of patients with CHF is increasing by 25% within thirty days of discharge from the hospital. This creates a huge impact on the taxpayers and patients due to the increasing percentages being re-admitted into the hospitals (Post discharge Environment Following Heart Failure Hospitalization: Expanding the View of Hospital Re-admission, 2013). The problem is to identify a plan to decrease the CHF/HF hospital re-admissions into the especially regarding the 65 (sixty-five) year olds and older, in spite of efforts from the hospital staff providing guidelines and nursing education regarding CHF/HF signs and symptoms.

Transitional care management includes services provided to patients whose medical problems require moderate or high complexity medical decision making during their transition from inpatient care to an outpatient setting. Transitional care for heart failure includes a collaborative effort by all health providers to ensure that the patient outcomes are improved. Key components of a transitional care plan for a heart failure patient includes identifying and assessing caregivers to determine their needs for education and support, integrating caregivers into the patient’s healthcare team, and bridging communications between patients, caregivers, and providers. Implementation of transitional care in a hospital setting should include comprehensive discharge planning, home visits, structured telephone support, scheduled follow up visits, and additional printed and online education and disease management information. In a meta-analysis of transitional care interventions to assess the efficacy, comparative effectiveness of transitional care interventions that reduce readmission and mortality rates for adults hospitalized with HF, concluded that home-visiting, multidisciplinary heart failure clinic interventions, and structured telephone support reduced heart failure specific readmission and mortality, and that these interventions should receive the greatest consideration by

Congestive heart failure (CHF) is a situation where the heart is not able to pump adequate blood to the other organs of the body. Causes of CHF are coronary artery disease, past myocardial infarction, hypertension, heart valve disease, cardiomyopathy, congenital heart defects, endocarditis and myocarditis (American heart association, 2013) .In the case scenario of Mr. P 76 year old man comes with the history of cardiomyopathy and CHF and in the past repeatedly admitted for the management of CHF symptoms. This essay discusses about approach to care, treatment plan, patient and family education and teaching plan that is given to Mr.P.

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

The heart is an organ that pumps oxygenated blood to the body and deoxygenated blood to the lungs. Heart failure is when the heart can’t pump blood very well. If the heart fails to work properly, a major system called the circulatory system won’t work properly and therefore the whole human body will fail to work properly because the cells won’t be able get oxygenated blood and use the oxygen to undergo cellular respiration and make energy.

Individuals with end stage decompensated congestive heart failure (CHF) will often be admitted to the hospital when complications arise. This is often the case because treatments (such as intravenous medications) needed to deal with the various complications of CHF require interventions that need to be administered by a team of medical staff with close monitoring of the patient. According to the CDC website report Hospitalizations for Congestive Heart Failure: United States 2000 -2010, 5.8 million people suffer from CHF in the United States, and hospitalization rates for individuals under the age of 65 with CHF increased significantly from 23% to 29% with rates for men higher compared to women. Fluid retention that is unresponsive to oral diuretic treatments is one of the most common situations that lead to a hospital admission (Austin, Hockey, Williams, & Hutchison, 2013). Detecting early signs of decompensated heart failure could help reduce the need for a hospital admission and improve the quality of life for those with end stage CHF by allowing treatment to occur in the home setting that might normally be provided in the hospital

One of the most important aspects of treating a patient with heart failure is providing an ample amount of education and counseling to both the patient and their family. It is essential that the patient understands the importance of participating in their treatment regimen and that it is a lifelong commitment that they must actively be involved with in managing their care (Hinkle & Cheever, 2014, p.800).

Heart failure (HF) is one of the leading causes of hospital admissions and readmissions in the United States (Desai & Stevenson, 2012; Gheorghiade, Vaduganathan, Fonarow, & Bonow, 2013). It is a condition that accounts for a very high morbidity and mortality (Bakal, McAlister, Liu, & Ezekowitz, 2014). Every hospital admission for heart failure patients results in disease progression and poor prognosis. For chronic HF patients, a hospitalization is one of the strongest prognostic predictors for increased mortality (Gheorghiade et al., 2013). Factoring in re-hospitalizations, especially at 30-day to 90-day mark, it is increasingly detrimental to patient prognosis.

One of the most common treatments for heart failure is ACE inhibitors. ACE inhibitors have shown to slow down the course of heart failure and decrease cardiovascular mortality (1). Overall, they work by suppressing the activity of angiotensin II. ACE inhibitors prevent the conversion of angiotensin I to angiotensin II by competitively inhibiting the activity of the angiotensin converting enzyme. Since angiotensin II is a vasoconstrictor, the lack of the protein allows blood vessels to remain dilated which decreases blood pressure. In addition, the lack of angiotensin II decreases aldosterone release which further lowers the blood pressure and puts less strain on the heart. Angiotensin II has been shown to be involved in the myocardial

6. What laboratory tests should be ordered for M.G. related to the order for furosemide (Lasix)? (Select all that apply)