Systematic review of disease management on heart failure patients

In the study of Stromberg et al., (2003), it conducted a study on improvement of survival enjoined with behavior care for inpatients diagnosis with heart condition.. the study used 106 respondents with assistance from the experienced nurses who did the follow-ups. The study used protocol led form. A prospective randomized study design was used in this case with a 12 months follow ups of patients at home. Ethical concept note was obtained from University of Linköping ethics board. The findings of the study were that there was decreased mortality rates associated with heart failure when compared with reference group or admissions. The approach used was  associated 55% decrease and had high self care scores compared  to reference group. Conclusion of the study implies that tracing back patients after discharge from hospital can improve the self care behavior for heart failure patients, with reduction in admissions and deaths. There were outlined limitations of the study included.

Systematic review of disease management on heart failure patients was conducted by Janardhana et al.,(2014). The study used randomized controlled trials with control group and intervention in place. Organized follow-ups were followed on the patients though phones call monitoring. Tele management approach has the ability to cover a huge coverage of patients at a time. The study utilized a study of 11 Meta analyses of non invasive studies. There was a lower reduction case mortality and heart failure patient admissions in hospitals. Overview of indentified randomized study trials of hospital readmissions reduction program was conducted. The findings of the study were that the efficacy of hospital readmission program was not consistent with the results expected. The review approach take is not viewed that health programs targeting heart  disease management are not effective, but rather one broad approach should not be utilized to generalize all, as it may produce huge impact erroneously on readmissions and clinical outcomes. It further suggests that that heart failure diseases management should be flexible to therapeutically offer support as each patient has its unique status and approach.

Finally, the study conducted by Gerard et al., (2012) with the objective of improving drugs medication adherence to patients with heart disease, suggest that prognosis on management of chronic heart failure is still at low levels. The study provides an analysis of studies that have assessed medical practice heart related condition patients. The objective of this review study was to identify and summarize how effective the strategies are in adherence to medical care among heart patients. The study used randomized study design with an intervention group and control group in play. The population targeted was above 18 years old. Intervention strategy was both serving primary and secondary aims. The findings of the study found out that 8 out of 16 studies using randomized control trials provided sufficient evidence that medications can be used to enhance medi care for chronic heart failure patients. There was limited high quality evidence to support patient enhanced interventions among persistent heart disease patients. The study limitation was that, there data meta analysis could not be performed.. Also there was limited number of studies that focused on interventions for heart failure patients. There was limited number of interventions that provided detail framework of approached used, this made difficult to establish whether the interventions were effective in enhancing adherence are delivered.

Gerard et al.’s study on improving drug medication adherence for heart disease patients

The three articles chosen best summarizes the case study issue under consideration. Patient Charlie has several medical conditions and bearing in mind her age, he is in critical conditions. The patient needed a close follow up intervention led by a nurse as per the study by Stromberg et al., (2003). The nurse led follow ups could should have been initiated prior long way upon his diagnosis of chronic heart failure disease. An experienced nurse should have the needed protocol follow up for patient Charlie. Report from this study suggest that a nurse led hospital discharge follow up should have been initiated to monitor his progress, the condition he is in now could have been managed long ago. The articles chosen have strong evidence of research with reviews across several years which provide a summarized care based on trial and studies conducted long ago. Review studies are helpful; as strengths and weakness of already tested protocols can be used and rolled out to new patients.

The quality of these research articles are of high quality s they are basing on reviews from previous primary studies conducted. Review studies provide a more precise approach and intervention that is effective. The cares that are being recommended have been proven to have an effect on patient care. In this case patient Charlie should have been given the medical follow up since the discovery of his medical conditions. Hospital disease management plan should have been the guide in managing his condition, but from the case history there was none which was adhered to. The recommendations of these studies have an impact on care and management of his condition. The study by Gerard et al., (2012, has outlined studied interventions which if effectively used can be able to manage the medical condition of patient Charlie. It shows also how the different players in care provision can be used effectively to manage myocardial infarction disease management. Articles review chosen followed the relevance of information while undertaking the studies and the overall management of heart failure disease management.

The article selected contributes rich information on care and management heart victims. It provides reviews of studies of studies that have utilized evaluative medicine adherence and interventions bearing in mind that chronic heart failure is symptomatic hence critical care is paramount. The article has summarized the following interventions which have been proven from previous studies that enhance adherence to accurate medication protocol. Medical approaches that were compatible with tachycardia were followed, this initiatives included offering knowledge empowerment to the patient, increasing care of the patient and adopting behvaiour health models with flexible pharmacological regime.

On the heart failure disease management programs, several programs were evaluated. Programs implemented were home based nursing care, medical friendly strategies implemented at the clinic level,  frequent communication support systems coupled with  tele monitoring. It was found out that the efficacy was associated with inconsistent results, however they are not ineffective, but they should incorporate different spectrum that produce impact on readmission process and improved clinical outcome for myocardial infarction patients. The medical team should enhance  disease management regime to be more effective and provide high quality care.

Justification for the choice of sources

A nurse led follow ups for patient with chronic heart failure is helpful , it improves self care and behavior change is initiated that is geared towards care provision and management of the disease, which overally reduces the number of events,  multiple admissions and inpatient duration at the hospital. The study especially by Stromberg et al., (2003) suggest that many nurse head congestive heart failure clinics with required knowledge and skills developed a comprehensive protocol targeting cardiac infarction  patients . Likewise in the clinical field, there is need to put the right people to do the right task in order to ensure you achieve the desired results for health disease management.

The use of the approach utilized by nurses in improving the health status of heart disease patients has been effective over the years. In Europe Sweden has been the country that has effectively utilized the nurse led approach in managing heart failure patients ( Jaarsma, 2013). Cleine et al (Cline et al, 2012).conducted studies on nurse led interventions and showed that it prolonged readmission and hospital stay. Across Sweden the health care field has adopted this approach of nurse le clinic to provide the needed effective care, (Strömberg, 2011). Follow up process has been proven to be effective in improvement of quality of care, (ESC, 2011). Comprehensive disease management on effective discharge plan has been shown to be effective in reducing readmission frequency and improved care for heart failure patients, (Gheorghiade, 2013). Face to face programs and follow ups reduces hospitalization rates among the heart failure patients, (Blue et al, 2011). Further face to face has been observed to be cheap and takes shorter duration  amongst patients who are recovering from  heart related conditions, (Stewart et al, 2012). Telephone support significantly reduces heart failure patient’s hospitalization, (Inglis et al, 2010). Improvement of self care has been key to decrease morbidity among patients, (Jaarsma et al, 2011). Self care on has been termed to mean basic activities such as weight monitoring activities and dietary management were critically improved, (Stromberg et al, 2013).  On drug adherences to medication, there is need to focus more studies as opposed to common approach of dispensing drugs with an aim of improving self care in heart failure patients, (Van & Jaarsma, 2008).  Hence providing care to heart failure patients is critical component in diseases management.

References

Blue L, Lang E, McMurray JJ, Davie AP, McDonagh TA, Murdoch DR, Petrie MC, et al.,(2011). Randomised controlled trial of specialist nurse intervention in heart failure. BMJ. 2011;323(7315):715-718.

Cline C, Israelsson B, Willenheimer R et al.,(2012). Cost effective management programme for heart failure reduces hospitalisation. Heart . 2012;80:442–446.

Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO, (2013). Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61(4):391-403.

Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, Stewart S, et al., (2010). Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev. 2010;(8):CD007228.

Jaarsma T , Strömberg A. Heart failure clinics in Europe, (2013). Prog Cardiovasc Nurs .;15:67 –68 72.

Jaarsma T, Halfens R, Abu-Saad HH et al. (2013) Effect of education and support on self-care and resource utilization. Eur Heart J . 2013;20:673–682.

Molloy, G. J., O’Carroll, R. E., Witham, M. D., & McMurdo, M. E. (2012). Interventions to enhance adherence to medications in patients with heart failure. Circulation: Heart Failure, 5(1), 126-133.

Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: long-term implications on readmission and survival, (2002). Circulation. 2002;105(24):2861-2866.

Strömberg A, Mårtensson J, Fridlund B et al., (2013). Nurse-led heart failure clinics in Sweden. Eur J Heart Fail. 2013;3:139–144.

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. https://dx.doi.org/10.1016/S0195-668X(03)00112-X

The Task Force of the Working Group on Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure, (2011).  Eur Heart J. 2011;22: 1527–1560.

Van der Wal MH Jaarsma T.(2008) Adherence in heart failure in the elderly: problem and possible solutions. Int J Cardiol. 2008;125:203–208.