Discuss about the Report for Hospitalizations for Heart Failure Pashient.
The essay is on the topic of heart failure and its causes. Heart failure is a major public health issue worldwide, and its incidence is rising. The lifetime risk of developing heart failure cases is one in five people. It is a potential burden on the health care system with high rates of hospitalization and outpatient visit. The severity of the disease can be predicted by its risk factors such as ischemic heart disease, smoking, obesity, diabetes and hypertension. This essay will discuss the epidemiology of heart failure and the fatality of the disease. It will also focus on the incidence of heart failure in Malaysia and how it has affected people in Malaysia. The situation can be dealt with by new models of patient-centered care that can support heart failure patient and decreases hospitalization rate. It will describe the burden of the disease and what actions need to be taken to minimize the incidence of heart failure. The thesis statement would be ‘reducing the global burden of heart failure’.
Congestive heart failure is a clinical condition which occurs when the heart muscle weakens and cannot pump blood sufficiently to maintain normal blood flow in the body. The structural or functional cardiac disorder impairs ventricle’s ability to fill or eject blood. The condition develops over time when pumping action of heart weakens in the individual. Heart failure can affect the right ventricle or left ventricle or both sides of the heart. It may either systolic or diastolic and acute or chronic. Heart failure begins with the left ventricle of the heart as it is the main pumping chamber of the heart (Mann et al., (2014).
The symptoms associated with heart failure include shortness of breath, tiredness, and swelling. The breathing problems worsen during exercise, while lying down. Acute heart failure results due to acute pulmonary edema, cardiogenic shock characterized by hypotension and peripheral vasoconstriction. Heart failure may be ongoing (chronic) or occurring suddenly (Acute heart failure). It may cause irregular heartbeat, persistent cough with pink or white phlegm, increased the need to urinate at night, abdomen swelling, weight gain, lack of appetite and nausea, lack of appetite and chest pain (when heart failure occurs by heart attack) (Roger, 2012).
This section will discuss the cause of Left-sided heart failure. It occurs when the heart cannot pump adequate oxygen-rich blood to the rest of the body. During left-sided heart failure, it causes blood to congest into the lungs causing respiratory problem and fatigue due to insufficient supply of blood. Pulmonary edema is detected by crackles sounds. Severe pulmonary edema may cause cyanosis due to low blood oxygen. Other symptoms of left ventricular failure include gallop rhythm indicating increased blood flow and laterally displaced apex beat when the heart is enlarged. Heart murmurs may also indicate heart failure (Vachiéry et al., 2013).
Right-sided heart failure affects right ventricle when the heart cannot pump enough blood to the lungs to pick up oxygen. In this case, fluids accumulate in the abdomen, legs, and feet causing swelling. Right-sided heart failure is caused by left side heart failure. This is because when left ventricle does not pump blood efficiently, the pressure in the left side builds up and right side fails. When blood backups in the ventricles into the lungs and then the right ventricle also fails. This then extends to the liver and other organs. It is also caused by chronic lung disease, tricuspid stenosis (Narrowing the tricuspid valve), pulmonic stenosis ( narrowing the pulmonary valve), tricuspid regurgitation (improper closing of tricuspid valve), pericardial constriction (stiffening of pericardium) and left-to-right shunt (abnormal connection between left and right side of the heart) (Schwartzenberg et al., 2012).
Systolic heart failure occurs when the left side of the heart cannot pump blood out of the body normally. It is called systolic as ventricles cannot contract completely during systole, and so the test may show low ejection fraction. It may be caused by coronary artery disease, cardiomyopathy, high blood pressure, arrhythmia (irregular heart rhythm), mitral regurgitation and viral myocarditis (viral infection in heart muscle). Coronary artery disease or heart attack blocks the arteries thus limiting blood flow to heart muscle. It damages heart muscle and impairs heart muscle’s ability to pump blood. Cardiomyopathy weakens the heart muscle, and when the patient has high blood pressure, the heart has to work harder against increased pressure further damaging heart muscles. In the case of mitral regurgitation, mitral valve does not close properly leading to leakage on the left side of the heart (E Hogan & Cowger, 2014).
Diastolic heart failure occurs due to declining in the performance of one or both sides of the ventricle during diastole. Diastole is the event in cardiac cycle during which heart relaxes, and it is filled with blood coming from the body through the inferior and superior vena cavae to the right atrium and from lungs to left atrium. Diastolic dysfunction is detected by Doppler echocardiography. Left ventricular stiffening may be caused due to prolonged hypertension, aortic stenosis, diabetes, restrictive cardiomyopathy and old age people (Jackson, 2013).
The general cause of heart failure is previous myocardial infarction, high blood pressure, atrial fibrillation, excess consumption of alcohol and cardiomyopathy. All these symptoms either changes the function or the structure of the heart. Since heart failure is caused by myocardial infarction, this section will analyze what events lead to heart attack in the individual. A heart attack occurs when blood flow to the heart is disrupted causing damage to heart muscles. The heart is deprived of oxygen due to blockage of a coronary artery. The coronary artery is involved in supplying the heart muscle with oxygenated blood. In the absence of oxygen, muscle cells begin to die or infarct. The symptoms of heart attack are chest pain which may travel to back, arm, shoulder or jaw. The heart attack is also associated with nausea, the faint sensation, cold sweat and tiredness. Those persons who have diabetes, high blood pressure, high cholesterol, obesity and those who has poor diet intake, consumes lot of alcohol and does not exercise are at more risk of myocardial infarction. It is diagnosed by the test like an electrocardiogram, blood tests like troponin and creatinine kinase and coronary angiography (McMurray et al., 2012).
This section gives insight into diagnosis of heart failure. Heart failure is a costly and fatal condition. It is diagnosed by analyzing the history of symptoms and confirmed by echocardiography. Physicians determine the underlying cause of heart failure by blood test and chest radiography. The severity and cause of the disease may vary in individuals, so treatment will also depend on these factors. If any patient is suffering from mild heart failure, then they have advised lifestyle modification such as quitting smoking, increasing physical exercise, and changes in diet and medications. For patients with left-ventricular heart failure, angiotensin receptor blockers are given during treatment. Severe heart failure patients are treated by receptors blockers and beta blockers. In several cases, implantable cardiac defibrillator or pacemaker is also implanted in patients. In severe cases, cardiac resynchronization therapy is performed. If all form of treatment option fails, then ventricular assistive device or heart transplant is recommended (Roger, 2013).
This section discusses the epidemiological transition of cardiovascular disease with time. The health status and illness profile of people in the society depends on the extent of economic development and social organization in any place. When countries were in the earliest stage of development, rheumatic heart disease was prevalent due to nutritional deficiency disorder. This region included south-Asia, Sub-Saharan Africa, and South America. During the second stage of development, hemorrhagic stroke, and hypertensive heart disease became common. An example of this regions includes China and other Asian countries. With further development in society, life-expectancy improved but high-calorie diet, cigarette smoking, and sedentary lifestyle became common. This led to the prevalence of atherosclerotic cardiovascular disease and ischemic heart disease. This disease is prevalent in India, Latin America, and other countries. During the last stage of development, efforts to prevent and diagnose disease delay the disease to later ages. Regions in this stage include Western Europe, North America, Australia and New Zealand (Sakata & Shimokawa, 2013).
This section discusses the global burden of cardiovascular diseases. The severity of cardiovascular disease is dependent on lifestyle determinants of diet, physical activity, and tobacco consumption. Heart disease is now the leading cause of death worldwide leading to about 17.5 million deaths per year. It is estimated that the incidence heart disease is going to rise by more than 23 million by 2030. In 2008, cardiovascular disease was the cause of 30% death worldwide with most of them occurring in low and middle-income countries. It takes more lives than all forms of cancer put together. The direct and indirect burden of the disease is high. It has led to increased health expenditure and loss of productivity. It is also a leading cause of death in U.S with about 1 in 7 cases of death reported. In Europe and America, 1-2% of total health expenditure is incurred in heart failure treatment. More than 74% of cardiac patients suffer from at least one comorbidity to worsen the overall health status of the individual (Cook et al., 2014). In Malaysia, 6.7 % of the population is diagnosed with cardiovascular disease. The burden of the disease is determined by hospitalization rate, the cost of drugs, primary treatment and other treatment in countries. It is a challenge for the health care system to effectively manage the disease. The incidence of heart disease is more prevalent in women than in men (Sakata & Shimokawa, 2013).
This section is about incidence of heart failure in Malaysia. Global burden of disease is estimated by measuring the disability-adjusted-life-year (DALY) in selected population. One DALY is equal to one lost year of healthy life. It is calculated by sum of Years of Life Lost (YLL) and Years Lost due to Disability (YLD). In Malaysia, life expectancy for male is 71.7 years and 78 years for females. In Malaysia, ischemic heart disease, road injuries and cerebrovascular disease is the leading cause of death in terms of years of life lost (YLL). The major risk factor in Malaysia includes risk due to diet, high systolic pressure and high body mass index. Highest mortality rate was found in males within the age of 45-49 years. Ischemic heart disease continues to be the number one cause of death in Malaysia. It was in the first ranking both in the year 1990 and year 2013. According to latest published data of WHO in 2014, deaths due to coronary heart disease in Malaysia have reached 23.10%. Malaysia ranks 33rd in the world according to age-adjusted death rate, and it were 150.1 per 1 lakh population (Khatibzadeh et al.,,2013)..
The major risk factor for disease burden in Malaysia includes dietary risk, high blood pressure, and cigarette smoking. Adults between 15-49 years had dietary risk and children under five years had risk because of being underweight. It is a public health concern for Malaysia as the mortality due to coronary artery disease has increased three-fold in the last forty years (Yusuf et al., 2014). Malaysian population mainly consists of Indians, Chinese, and Malays. Although Indians comprise only 10% of the population, 56 % of patients having the heart attack before 40 years were Indians (Callender,2014). This is because Indians have the major prevalence of risk factors like diabetes, high blood pressure, and cholesterol. For patients with heart coronary surgery, common risk factors include dyslipidemia, hypertension, and diabetes. In the case of patients with heart attack, Indians had 4 % higher rate of diabetes than Malays. Other risk factors include obesity, low physical activity. So if there is a health drive to control the disease, the burden of the disease can be reduced. Heart failure has lead to high hospitalization rates and dismal survival rate compared to other cancers. It is also found that Asians suffer from heart failure ten years earlier than Western population (Dokainish et al., 2015).
This section is a detail on pharmacological management of heart disease. Malaysia can also reduce the burden of the disease if health care takes a role in adopting strategies to reduce heart disease incidence. Physician indicates diuretics to those heart disease patient who has symptoms of fluid retention. Angiotensin-converting-enzyme inhibitors are first line of drug for treatment of heart failure and left ventricular systolic dysfunction. This medication improves survival rate and quality of life in all kinds of heart failure. Digoxin is also a drug for heart failure and atrial fibrillation. Beta blockers are recommended to reduce the risk of exacerbation and clinical deterioration due to heart failure. Anticoagulation therapy with warfarin is indicated for patients with atrial fibrillation and past history of thromboembolic episodes. There are also surgical procedures to reduce the disease. This includes revascularization therapy for ischaemic heart failure patients and balloon valvoplasty for valvular heart disease. For a patient with low heart rate, pacemakers are beneficial. In severe cases, implantable cardioverter defibrillators are given for complications like resuscitated sudden cardiac death. When conventional surgical treatment fails, heart transplantation is the standard mode of treatment in such case. It increases quality of life and survival rate (Ambrosy et al., 2014).
This section is about prevention strategy for heart failure. Due to the significant morbidity and mortality associated with the disease worldwide and in Malaysia. Prevention strategy is necessary to reduce the incidences of heart disease. Prevention is crucial not just because of high morbidity and mortality, but also due to the high cost of medical treatment and time lost due to absence from work. It is necessary to analyze risk factor both at the individual level and by geographical location. Promoting lifestyle changes like quitting smoking, lipid reduction, dietary changes, improving the socio-economic condition and different therapy is the most important factor for preventing the heart disease (Mohamed et al., 2014)..
This section is about the role of healthcare department in making appropriate health policies. Healthcare department has a significant role in implementing policies and programs to reduce the burden of heart disease globally. They need to promote ways of prevention of heart failure by public awareness programs. They need to optimize care regimen, improve end-of-life care and provide equity of attention to all class of people in all countries. Health care organizations need to appoint specialist of heart failure in all discipline who manage the patient in an emergency. The health care models need to be redeveloped to implement better methods of quality care. Many people are not aware of the risk factors for heart disease and so giving support and education to the public in this regard is essential. There might be some shortcomings in the treatment process, so more research should be done to discover new therapy (Callender et al., 2014).
Prevention of heart failure should be a priority for policymakers, particularly for the high-risk population. Certain illness is also the risk factors for heart failure. Such patients should be encouraged to introduce lifestyle changes that minimize the possibility of heart disease. There should be more support for the implementation of public awareness programs that educated the public on heart failure, its cause, symptoms and prevention strategies. Health care professional should also be given the responsibility to identify patients with those illnesses that increase the risk of heart failure (Chiang et al., 2014). Such patients any given preventive medications. It is also important to raise awareness among healthcare professionals, and the purpose should be to improve diagnosis and treatment procedure and provide proper clinical practice guidelines to medical staff. Patients should be empowered to take adequate health care before developing the disease. Further research in heart failure is also an important factor for reducing the incidence of heart failure. The government and other health care department should provide a fund to encourage collaborative research. It will improve understanding of the pattern and effect of cardiovascular disease and will lead to prevention across the globe. Patients receiving long-term preventive therapy should regularly be assessed. Large scale screening program should also be arranged for the patient at risk of developing heart failure. It will lead to cost-effectiveness and increase life expectancy in people (Klement et al., 2015).
From the overall essay, it can be summarized that heart failure is the leading cause of disease worldwide, and adequate steps need to be taken to combat the effect of mortality and morbidity associated with the disease. The essay described the epidemiology of heart failure giving details on all types of heart failure. It explained the cause of heart failure and its symptoms. It reported the prevalence of heart disease globally and the burden of disease. About Malaysian context, it gave the detailed regarding the impact of heart disease in the region and what risk factors has made it the place with the highest incidence of the disease. It gave detail it different available treatment option for the disease. The final part of the essay gave a recommendation regarding policies that needs to be made to prevent heart disease. It gave details regarding improvement in heath care system awareness programs to enable people to make appropriate lifestyle changes.
From the pie chart, one can infer that National Library is a source for borrowing both academic and non-academic books. Books are available in different subjects in the library like history, science, biography, fiction and self-help subject books. After analyzing the percentage of books that were borrowed from the library, it is seen that people are mainly interested in books related to fiction. This is evident from the pie chart as it shows that 43 % people borrowed books on fiction. This might be because the National Library is not just for the use of student and college goers, but other class of people also comes to the library. The majority of book lovers have an interest in reading fiction books. So they may be visiting the library in their leisure time to read and enjoy such books. It is a good way of spending time on our own. People get engrossed in such fictional stories. The percentage of individuals taking biography book was 19%. It may indicate that many people are interested in knowing about the life of influential and inspiring characters in history. The percentage of science and history book borrowed were 14 %. This could be because of students coming to the library for help in their coursework. Self-help books have the least number of borrowers which was 10%. It is because very few people rely on self-help books. People may prefer searching the internet to find information instead of relying on such books.
Reference
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