The paper deals with the chronic health condition heart failure. This illness refers to condition where the pumping of blood by heart muscle decreases. Therefore, it cannot pump blood required by body and fails to accommodate systemic venous return. It results in accumulation of blood in liver, lungs or legs (Borlaug, 2014).). This illness is caused by damage to heart valves, heart defects, heart attack and arrhythmias. The paper discusses the pathophysiology of the illness and highlights the current research in this area. Based on the literature review public health applications are discussed.
Heart failure ensues when the network of adaptations becomes overwhelmed. It involves complex cascade of events from sub cellular level to interactions between organs. The adaptations include the Frank-Starling mechanism. This mechanism aids in sustaining cardiac performance. Other adaptation is modification in myocyte regeneration. Augmentation is the other method of adaptation. It includes augmentation of the contractile tissue by myocardial hypertrophy. It may or may not include cardiac chamber dilation. Another important adaptation is the stimulation of the neurohumoral systems (Borlaug, 2014).
Adrenergic cardiac nerves release norepinephrine which results in augmentation of the myocardial contractility. It activates the sympathetic nervous system, renin-angiotensin-aldosterone system or RAAS which is functional in maintaining arterial pressure. Activation of the RAAS system leads to causes of rention of salt and water which facilitate the rise in Angiotensin and aldosterone. The release of vasoactive substances endotelin-1, norepinephrine, epinephrine, vasopressin, leads to vasoconstriction. With higher level of cytosolic calcium entry into the myocytes impairs myocardial relaxation. Due to increase in the expenditure of the myocardial energy, myocardial cell death occurs. This contributes to heart failure and other adverse hemodynamic responses (McMurray et al., 2014).
The risk of heart failure increases if a person has high blood pressure, is overweight, suffering from diabetes, have sleep apnoea. Other risk factors includes smoking, cigarette, administration of the medications containing bisphosphonates (Ford et al., 2015).
This section deals with the current research on heart failure. It presents the information from the well researched articles and highlights information that can be considered as evidence based option by the care providers, patients and the physicians for management of illness.
The heart failure patients with iron deficiency can have sustainable improvement with ferric carboxymaltose over a period of one year (Ponikowski et al., 2015). Conducted with multi-centre, double-blind, placebo-controlled trial it was found effective in increasing functional capacity and quality of life. This is an evidence based option for reducing the risk of hospitalisation for deteriorating heart failure. The randomised control trial by Barth et al. (2015) has proved that psychosocial interventuions are effective for smoking cessation after heart attack. Patients were found to quit within six months which decreased the risk of artherosclerosis and acute thrombic events.
Baptiste et al. (2016) conducted a research on the heart failure education program that is led by a contemporary nurse. The aim of the education program is to educate patient on the management of heart failure. The researcher used longitudinal quasi-experimental design and presented the findings of the research which indicates high effectiveness of the program in promoting behaviour change in the patients with heart failure. The article is evidenced based option for other nurses engaged in caring for heart failure patients as it contains well researched information that is reliable on how nurses can sensitise patients. Similar findings were found in the paper of Cockayne et al. (2014). This randomised control trial showed that self management of the illness can be enhanced by the support of nurses. However, it particularly emphasise on the cognitive behavioural self-management technique. The findings showed no difference in admission or readmission to hospital of the patients who have implemented this method on their own and those who were cared by the specialised heart failure nurse. The positive impact of educational intervention on health care patients was studied by González et al. (2014). The findings of the research showed that with the increase in the education of the patient, self-care and self-management is enhanced. It means that the educational interventions provide appropriate training to the patients on how to engage in health promoting behaviour. This qualitative research finding is a credible source for the patients. It acts as evidenced based option when treating the patients of heart failure.
Some of the 10 essential public health services which should be implemented and integrated into public health policy are recommended below.
The patients with iron deficiency can take alternate iron supplements in addition to the iron therapy as it is proved effective for symptomatic heart failure. Other dietary supplements include magnesium, vitamin B1 (Chowdhury et al., 2014). More number of education programs should be developed for the patients who have experienced heart failure and those at risk. This method is proved to be effective in increasing self care. More number of specialist nurses in heart failure should be assigned to the patients for cognitive behavioural approach.
There should be more number of public health program promoting the healthy lifestyle choices that have multiple benefits other than eliminating the risk of heart failure. The government policies must ensure that such programs easy to access and cost effective. The patients must make healthy lifestyle choices such as cessation of smoking and alcohol. Increase in fruit and vegetable consumption and low sodium intake decreases the risk of heart failure as low risk diet has been found to be effective in reducing myocardial infarctions (Åkesson et al., 2014). However, it may be supplemented with other lifestyle choices such as exercises and mild physical activity. According to a prospective cohort study the healthy activities if properly implemented may increase life expectancy. Decrease in excess weight by involving in aerobic exercises is important to implement as it have been found to have prognostic and symptomatic benefits. Thus stringent guidelines can be integrated in rehabilitation to incorporate the evidence based options Gielen et al., 2015).
Conclusion
It is evident that heart failure is a chronic condition and decreases life expectancy. Integrating the evidence based practice can help treat the underlying cause of the disorder. In addition to the care providers the patients must have high self esteem to actively participate in the self management of heart failure.
References
Åkesson, A., Larsson, S. C., Discacciati, A., & Wolk, A. (2014). Low-risk diet and lifestyle habits in the primary prevention of myocardial infarction in men: a population-based prospective cohort study. Journal of the American college of cardiology, 64(13), 1299-1306.
Baptiste, D. L., Davidson, P., Groff Paris, L., Becker, K., Magloire, T., & Taylor, L. A. (2016). Feasibility study of a nurse-led heart failure education program. Contemporary Nurse, 52(4), 499-510.
Barth, J., Jacob, T., Daha, I., & Critchley, J. A. (2015). Psychosocial interventions for smoking cessation in patients with coronary heart disease. The Cochrane Library.
Borlaug, B. A. (2014). The pathophysiology of heart failure with preserved ejection fraction. Nature Reviews Cardiology, 11(9), 507-515.
Chowdhury, R., Warnakula, S., Kunutsor, S., Crowe, F., Ward, H. A., Johnson, L., … & Khaw, K. T. (2014). Association of dietary, circulating, and supplement fatty acids with coronary riska systematic review and meta-analysis. Annals of internal medicine, 160(6), 398-406.
Cockayne, S., Pattenden, J., Worthy, G., Richardson, G., & Lewin, R. (2014). Nurse facilitated Self-management support for people with heart failure and their family carers (SEMAPHFOR): a randomised controlled trial. International journal of nursing studies, 51(9), 1207-1213.
Ford, I., Robertson, M., Komajda, M., Böhm, M., Borer, J. S., Tavazzi, L., … & SHIFT Investigators. (2015). Top ten risk factors for morbidity and mortality in patients with chronic systolic heart failure and elevated heart rate: the SHIFT Risk Model. International journal of cardiology, 184, 163-169.
Gielen, S., Laughlin, M. H., O’Conner, C., & Duncker, D. J. (2015). Exercise training in patients with heart disease: review of beneficial effects and clinical recommendations. Progress in cardiovascular diseases, 57(4), 347-355.
González, B., Lupón, J., Domingo, M. D. M., Cano, L., Cabanes, R., de Antonio, M., … & Bayes-Genis, A. (2014). Educational level and self-care behaviour in patients with heart failure before and after nurse educational intervention. European Journal of Cardiovascular Nursing, 13(5), 459-465.
McMurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., … & Zile, M. R. (2014). Angiotensin–neprilysin inhibition versus enalapril in heart failure. New England Journal of Medicine, 371(11), 993-1004.
Ponikowski, P., Van Veldhuisen, D. J., Comin-Colet, J., Ertl, G., Komajda, M., Mareev, V., … & Mori, C. (2015). Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European heart journal, 36(11), 657-668.
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