Heart failure management is recognized as a significant healthcare challenge
Introduction
Heart failure management is recognized as a significant healthcare challenge within the healthcare industry. Advancing age and increased incidence of HF increases the financial costs that both individuals and third-party payers have to share. More than one million emergency visits happen in the US every year, with 80% of them requiring hospital admission. Close to six million adult American patients diagnosed with HF whose incidence stands at ten individuals for every 1000 past the age of 65 years. Healthcare experts acknowledge that the rates HF readmissions (counted for any reason in the first month irrespective of whether the patient was admitted in a different acute care clinical organization or within the same hospital) can be reduced through increasing knowledge as well as HF patient self-care activities. Suffice to say that decreasing readmissions would improve outcomes and the subsequent financial costs. Studies indicate that HF readmission reasons include but are not limited to symptom recognition delay, inadequate knowledge, and self- care skills, together with the failure to comply with the prescribed medications and recommended diet for HF patients. Consequently, this essay purposes synthesize research resulting from PICOT question framework which states ‘Amongst adults aged over 45 years diagnosed with heart failure (Population-P), would post-discharge HF education program hereafter abbreviated as (PHFEP) (Intervention- I) compared to conventional heart disease education (Comparison-C) decrease the rate of one-month hospital readmissions and improved quality of life for the patient (Outcome- O) within 90 days (Time –T)?’
Methods of the Articles Selection
After the formulation of the PICOT question, a comprehensive literature search ensued with the purpose of identifying, analyzing, and synthesizing before critically appraising the literature whose content addresses an EBP intervention seeking to decrease HF readmissions within the first-month post-discharge. The search engines utilized include Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PubMed. The key terms and phrases used were like heart failure, self-care, readmission, and education. Applying heart failure, readmission, and knowledge to Proquest resulted in 279 articles. Pub Med had 33 sources using word limiters like heart failure education and readmission with a publication year falling between 2014 and 2020. Including self-care added 20 more sources while readmission yielded 32. A total of 29 sources resulted in the Medline database when education, heart failure, and readmissions were applied. Lastly, the CINAHL search produced 43 sources for knowledge on HF, 21 for self- care, and 15 for readmissions. For an article to pass the inclusion criteria, it had to have been published between 2010 and 2020, be published in a peer-reviewed journal and was either research or evidence-based. Only articles whose content addressed HF readmission prevention, HF education, and self-care were included. Studies that were not published in English had a publication before 2010, and its subjects were minors below 18 were excluded from the articles to be reviewed. A total of 48 were recognized as potential sources, which were then narrowed to a final list of 7 articles as the definitive sources relevant for the proposed EBP intervention. The final list excluded articles that were not peer-reviewed, had evidence of low quality, and focused on children as the subjects of HF. In apprising the articles, Melnyk & Fineout –Ovenhault rating system was applied to rate the hierarchy of evidence. The articles reviewed comprised of level I evidence (systematic reviews and meta-analysis of relevant RCTs, level II evidence from RCTs level V evidence from a systematic review of qualitative and descriptive studies. Level VI evidence comes from a single qualitative or descriptive analysis. The studies were then summarized, describing the sample, setting as well as design. Additionally, the interventions, findings, and level of evidence were also included
Synthesize the Literature Identified
Analysis of identified literature demonstrated that a comprehensive post-discharge plan in support of HF patients decreases hospital readmissions as indicated in Diez et al. (2019) study whose objective was to establish the efficacy of a self- care program in preventing hospital readmissions due to
- Additionally, other articles deemed relevant to the Post Discharge HF Education Program(PHFEP) and therefore reviewed were Toukhsati et al. (2019) Sousa et al. (2019), Sevilla- Cazes et al. (2018), Linn, Azollin & de Souza (2016) and Qaddoura et al. (2015).
Part A: Discussion of the Main Components of the Seven Articles
Diez et al. (2019) sought to determine the efficacy of a multidisciplinary intervention at the community level targeting to prevent and promote the health of active HF patients. The researchers used a randomized clinical study involving 32 patients where upon discharge, 14 patients were attended to by a multidisciplinary team. At the same time, 18 received standard care according to either congenital heart failure or chronic obstruction pulmonary disease. The study findings indicated that the likelihood of hospital readmission in the AUTOCUID group was 0.33 compared to the control group (95%). This led the researchers to conclude that CHF and COPD patients attended by a multidisciplinary team did not differ compared to those who received usual care but acknowledged the study’s limitation. A fundamental flaw was that the survey targeted to study 144 subjects, but only 32 participated. The research conducted by Linn, Azzolin & de Souza (2016) had a total of 82 patients with decompensated HF in a heart clinic in Southern Brazil. They used the retrospective longitudinal study. After approval by the Research Ethics Committee of the instruction, the outcome of the number of hospital readmissions for DHF in the preceding year was located in medical records, data collection at the second stage, and after approaching the patient. The results of this study indicated that the lower than self- care score of the patient, the higher the number of hospitalizations. This made the researcher conclude that there was a direct positive impact on the self- care and the number of hospital admissions the DCF patient encountered. Similar conclusions were determined by Toukhsati et al. (2019) in their metanalysis on articles that support the use of self- care interventions whose objective was to improve patient self- care and decrease HF readmissions. The meta- analysis of RCTs of self- care interventions led the researchers to conclude that Patient self-care interventions had the capacity to enhance clinical outcomes, including reducing hospital readmissions. A systematic review and subsequent meta-analysis conducted by Qaddoura et al. (2015) had articles reviewed. These were retrieved from databases like Embase, Medline, and CINAHL with a publication year falling between 190 and 2014). The study findings assisted the researchers to conclude that Hospital at Home for HDF patients not only reduced one-month readmission rates but also reduced index costs besides improving the patients’ quality of life. Souza et al. (2019) sought to establish whether HF patients can identify early signs of the disease using a systematic review method of HF patient education. Their findings determined that as HF patients struggle to balance their self-care on a daily basis, failure to teach them makes them remain at home and thus increase hospital readmissions. The sixth and last of the articles to be synthesized in this literature review is Sevilla- Cazes et al. (2018). This is a qualitative study with participants being HF patients recruited from two hospitals. These researchers sought to understand the challenges encountered by both patients and caregivers in HF homer management. The method used observational qualitative study using open-ended, semi-structured interviews. After interviewing 31 patients, they identified uncertainty regarding recommendations. This uncertainty emanates from unclear instructions as well as temporal incongruence between the onset of symptoms and patient behavior. Safe for one study conducted by Diez et al. (2019), which determined that that was a difference between HF patients receiving multidisciplinary care and those under standard practice, all the other five articles indicate that HF patient education and knowledge on self-care has a positive impact in reducing hospital readmission. As such, each of them contributes to PHFEP in that they have evidence supporting the efficacy of patient education in decreasing the rates of hospital readmission due to HF.
Part B: Comparison and contrast the articles
The majority of the articles compare in that they also sought to establish the efficacy of HF patient education. Linn, Azzolin & de Souza (2016) differ from the rest in its use of retrospective longitudinal study. Sevilla-Cazes et al. (2019) methodology of qualitative research is similar to Glogowska et al. (2015). Besides addressing HF patient education form different perspectives adopted by given researchers Sousa et al. (2019), Qaddoura et al. (2015) and Toukhsati et al. (2019) are compared in that the used either systematic review and or meta-analysis as their research methodology. Toukhsati et al. (2019) acknowledge the diversity of the multidisciplinary team in addition to limited reporting of the intervention as the main challenge in identifying change agents. On the other hand, Diaz et al. (2019) stated but the participation of only 32 out of the targeted 144 participations as the studies major limitation. Likewise, Qaddoura et al. (2015)pointed out the scarcity of modest quality studies addressing hospital as a critical challenge which limited their study.
Areas of Further Study
In conclusion, this essay acknowledges the need for further studies to obtain adequate evidence. There is a need to integrate emerging healthcare technologies like tel- support to enable HF patients to access follow up visits. Finally, the author of this paper reiterates that sufficient health literacy is directly linked to increased HF knowledge and self-care confidence amongst HF patients.