Hospital discharge plan for patients with congestive heart failure

This integrative review investigates how nurses plan the hospital discharge of patients with Congestive Heart Failure (CHF) since an inadequate discharge plan and patients' subsequent non-adherence to instruction provided upon discharge are indicated as potential factors for re-hospitalization. A total of 24 papers were found in a search carried out in the LILACS and MEDLINE databases between 2004 and 2008, which given the inclusion criteria, were reduced to 14 papers. The papers were analyzed and categorized into "Health Education", and "Nursing Care". The synthesis of results indicates that the discharge plan devised by nurses is based on two categories. The actions of nurses to promote health education can enable patients with CHF to improve self-care.     

Selection of congestive heart failure patients for heart transplant

Heart failure is one of the most common causes of hospitalization in adult patients. With the recent technological advances and the use of new medications for controlling rejection, heart transplant has been established as a definite therapeutic measure for properly selected patients with advanced congestive heart failure. As there is an active transplant program in the Cardiovascular Center of Puerto Rico and the Caribbean, this review is intended to acquaint the practicing physician with the required work up and management of patients referred for cardiac transplant. Emphasis is given to indications, clinical and psychosocial evaluation, optimization of medical therapy and to the absolute and relative contraindications.     

Post-acute home care and hospital readmission of elderly patients with congestive heart failure

After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce hospital readmission during the post-acute period. Using proportional Cox regression analysis, the authors examined the independent and joint effects of post-acute informal and formal services on hospital readmission. No evidence of service impact was found. Rather, hospital readmission was associated with a longer length of CHF history and noncompliance with medication regimes. Research, policy, and practice implications are discussed.     

Adequacy of home care and hospital readmission for elderly congestive heart failure patients

Readmission to acute care facilities is a frequent and costly problem among older adults with congestive heart failure (CHF). The study reported in this article tested the hypothesis that adequate home care, operationalized as patient-perceived adequacy of formal and informal assistance, is associated with lower readmission to acute care facilities. The study followed 253 elderly (age 65 and older) Medicare patients discharged to their homes after hospitalization for CHF, through structured telephone interviews at two, six, 10, and 14 weeks postdischarge. Study findings point to the importance of home care in reducing the high risk of readmission among elderly patients. The findings raise implications for practice, policy, and research.     

Increasing self-knowledge: Utilizing tele-coaching for patients with congestive heart failure

The objective was to assess self-care knowledge changes with dually eligible Medicare and Medicaid patients diagnosed with congestive heart failure (CHF), who received a telecoaching protocol integrating symptom monitoring with face-to-face video chat with a social worker. We recruited 45 patients with CHF from a regional managed care organization. Sessions via a Health Insurance Portability and Accountability Act-compliant tablet-based platform focused on educational information designed to improve patient self-care. Social workers administered the 13-item Member Confidence Measure (MCM) at baseline and at a 30-day follow-up period. Scores were recorded to measure differences in patients’ understanding of CHF and related symptoms, their knowledge of the disease, and the behaviors necessary to prevent their symptoms from getting worse. Over the 30-day period, scores significantly (p < .01) increased on the total scale score and specific confidence measure subscales (symptom recognition, medication adherence, medical attention, healthy choices, and safety). Gender, race, and age were unrelated to these improvements. In addition, effect sizes for the sub-scales ranged from .54 to 1.08; the effect size of the intervention as expressed by the total scale score was 1.12. Overall, patients increased knowledge over a 30-day period. Tele-coaching by social workers holds promise as a feasible model for health education for high-risk populations.     

A congestive heart failure project with measured improvements in care.

This project was designed to improve the in-hospital management of Medicare beneficiaries with congestive heart failure (CHF). Eleven hospitals were studied using two indicators: (a) assessment of left ventricular (LV) function, and (b) use of angiotensin converting enzyme (ACE) inhibitors in patients with systolic dysfunction. Baseline performance rates were obtained for 990 cases with the Diagnosis Related Group (DRG) 127 for CHF discharged January 1994 to December 1994. Baseline data feedback presentations in 1995 spurred quality improvement plans with interventions such as physician education, critical care maps, and standing orders. Follow-up abstractions were performed on 612 discharges October 1995 through April 1997. The study demonstrated 12% improvement (53% to 65%, p < .01) in assessing LV function and 20% improvement (54% to 74%, p < .01) in appropriate ACE inhibitor use. Projects emphasizing Health Care Quality Improvement Program (HCQIP) principles can successfully affect health care management for the Medicare population.     

Relationship between hospital length of stay and quality of care in patients with congestive heart failure

Objective: To determine the relationship between hospital length of stay (LOS) and quality of care in patients admitted for congestive heart failure (CHF).

Methods: This observational study was conducted in the medical wards of the Geneva University Hospitals, Geneva, Switzerland. A random sample of 371 patients was drawn from the 1084 patients discharged alive with a principal diagnosis of CHF between January 1997 and December 1998. Explicit criteria grouped into three scores were used to assess the quality of processes of care: admission work-up (admission score); evaluation and treatment during the stay (treatment score); and readiness for discharge (discharge score). The association between LOS and quality of care was analysed using linear regression with adjustment for clinical characteristics.

Results: The mean proportion of criteria met were 80% for the admission score, 66% for the treatment score, and 76% for the discharge score. Mean (SD) LOS was 13.2 (8.8) days. The admission score was not associated with LOS, but the treatment score increased by 0.5% (95% CI 0.3 to 0.7; p<0.001) with each additional day in hospital and the discharge score increased by 2.5% (95% CI 1.6 to 3.3; p<0.001) per day from admission to day 10 but remained unchanged thereafter. Adjustment for potential confounders did not substantially modify these relationships.

Conclusions: In patients with CHF there is a significant association between LOS and the quality of the treatment provided, as well as with readiness for discharge. Appropriate reorganisation of processes of care should accompany attempts at reducing LOS to avoid detrimental effects on quality of care.

     

老年充血性心力衰竭患者心率变异性分析

目的了解老年充血性心力衰竭(CHF)患者心率变异性(HRV)变化,探讨其临床意义.方法采用NHE高频心电检测仪,对86例心脏病患者进行HRV分析.结果老年CHF组(30例)各项指标均低于心功能代偿组(56例),尤其SD、HRVI两组比较差异非常显著(P＜0.005).CHF组HRV减低程度与心功能级别呈负相关.SD、HRVI在心功能NYHA分级Ⅱ级与Ⅲ-Ⅳ级亚组间比较差异显著(P＜0.01和P＜0.05).结论HRV分析是判断老年CHF预后和猝死危险性的一项无创、敏感、可定量、可重复的指标.     

老年充血性心力衰竭患者心率变异性分析

目的了解老年充血性心力衰竭(CHF)患者心率变异性(HRV)变化,探讨其临床意义.方法采用NHE高频心电检测仪,对86例心脏病患者进行HRV分析.结果老年CHF组(30例)各项指标均低于心功能代偿组(56例),尤其SD、HRVI两组比较差异非常显著(P＜0.005).CHF组HRV减低程度与心功能级别呈负相关.SD、HRVI在心功能NYHA分级Ⅱ级与Ⅲ-Ⅳ级亚组间比较差异显著(P＜0.01和P＜0.05).结论HRV分析是判断老年CHF预后和猝死危险性的一项无创、敏感、可定量、可重复的指标.     

环磷腺苷葡胺对慢性充血性心力衰竭患者心功能和B型钠尿肽的影响

目的探讨注射用环磷腺苷葡胺对慢性心力衰竭患者心功能和B型钠尿肽的影响。方法60例慢性心力衰竭患者随机分为治疗组和对照组,治疗组应用环磷腺苷葡胺加常规治疗,对照组仅用常规治疗,疗程7d。治疗前后两组分别测定左心室射血分数和血浆B型钠尿肽水平;观察治疗前后两组心功能和血B型钠尿肽的变化和组间差异。结果治疗组对心力衰竭的临床疗效优于对照组（P〈0．05）;两组患者治疗后血B型钠尿肽水平较治疗前均明显下降（P〈0．05）,但两组问有显著性差异（P〈0．05）。结论慢性心力衰竭患者在常规治疗基础上加用环磷腺苷葡胺治疗可进一步改善心功能,降低血浆B型钠尿肽水平。     

卡维地洛治疗充血性心力衰竭合并快速型心房纤颤的疗效观察

目的　观察卡维地洛治疗充血性心力衰竭 (CHF)合并快速型心房纤颤 (Af)的临床疗效。方法　将CHF并快速型Af患者 5 6例 ,随机分为治疗组、对照组各 2 8例。治疗组在常规治疗的基础上加用卡维地洛。对照组给予强心利尿等常规治疗。疗程均为 16周。结果　治疗组在临床疗效 (92 .86 % )、心电图疗效 (85 .72 % )以及心泵功能各项指标均明显优于对照组 (P <0 .0 1)。结论　卡维地洛治疗CHF并快速型Af,既能有效控制心室率 ,又能显著改善心功能。     

Factors contributing to the hospitalization of patients with congestive heart failure.

OBJECTIVES: This study identifies acute precipitants of hospitalization and evaluates utilization of angiotension-converting enzyme inhibitors in patients admitted with congestive heart failure. METHODS: Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure. RESULTS: The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure > or = 180 mm Hg (15%), atrial arrhythmia with heart rate > or = 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions < or = 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital. CONCLUSIONS: Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.