Congestive heart failure (CHF) is a critical public health problem that is prevalent worldwide in terms of mortality and morbidity. Despite the progress in the study of its pathogenesis, diagnostics, and treatment, the outcomes of patients with CHF remain unfavorable (Ambrosy et al., 2014).
According to the results of the study conducted by the Centers for Disease Control and Prevention (CDC), approximately 5.7 million Americans have CHF, while every ninth death is caused or affected by this disease (“Heart failure fact sheet,” 2016). The mentioned organization also reports that patients diagnosed with CHF tend to die within the next five years, and the costs for treating them are estimated at $30.7 billion per year (“Heart failure fact sheet,” 2016). The risk factors include hypertension, overweight, obesity, coronary disease, diabetes, smoking, et cetera.
Causes, Role of Patients, and Economic Burden
Atrial fibrillation (AF) is the most frequent violation of the rhythm of the heart, which leads to CHF. Worldwide, more than 33 million people suffer from AF, and this type of arrhythmia develops in more than 5 million people annually (Suman-Horduna et al., 2013). CHF patients with AF have a low quality of life, which is caused by non-compliance with clinical recommendations and ineffective anticoagulant therapy, as reported by Suman-Horduna et al. (2013).
The development of one condition can provoke the occurrence of another. A reduction in cardiac output due to loss of the contribution of the systole of the atria and decrease in the time of diastolic filling of the left ventricle leads to the development of CHF (Suman-Horduna et al., 2013; Yancy et al., 2017). Given the fact that the number of patients with CHF and AF is steadily increasing every year, the questions of optimal anticoagulant therapy become extremely urgent.
The problem of measuring CHF cases and evaluating the prevalence of the disease is associated with recording patient data. Schultz, Rothwell, Chen, and Tu (2013) state that hospital and discharge records are critical to provide appropriate follow-up for patients and prevent further hospitalizations. Based on the analysis of nine algorithms, the authors discover that the integration of ambulatory care physician billings and hospital administrative data compose the best option for determining and controlling CHF prevalence.
Consistent with the above research, Yancy et al. (2017) claim that proper and timely updates of patient records as well as attention to detail may reduce many mortality cases. In addition, as recommended by the American College of Cardiology / American Heart Association, by focusing on the treatment of concomitant and contributing disease, care providers may achieve the recognition of early CHF signs.
Several studies indicate that in-patient education is a viable way to reduce the rate of readmissions and improve the overall condition of patients with CHF. Feltner et al. (2014) explore the role of transitional care interventions in 47 trials and conclude that home-visiting programs and clinic interventions were effective in decreasing readmissions and mortality levels. The authors note that telemonitoring proved to be unhelpful in reducing high SOE that is one of the key signs of CHF.
The study by White et al. (2013) reveals different results: a teach-back method used to educate patients and assess learning outcomes lead to no reduction in readmissions within one month after the intervention implementation. Therefore, it is necessary to examine the role of education in a long-term period.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J.,… Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: A systematic review and meta-analysis. Annals of Internal Medicine, 160(11), 774-784.
Heart failure fact sheet. (2016). Web.
Schultz, S. E., Rothwell, D. M., Chen, Z., & Tu, K. (2013). Identifying cases of congestive heart failure from administrative data: A validation study using primary care patient records. Chronic Diseases and Injuries in Canada, 33(3), 160-166.
Suman-Horduna, I., Roy, D., Frasure-Smith, N., Talajic, M., Lespérance, F., Blondeau, L.,… AF-CHF Trial Investigators. (2013). Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. Journal of the American College of Cardiology, 61(4), 455-460.
White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel, J. (2013). Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing, 28(2), 137-146.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M.,… Hollenberg, S. M. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart failure society of America. Journal of the American College of Cardiology, 70(6), 776-803.