Examining the Effectiveness of Adjunctive Therapy with Medications and Lifestyle Changes in Improving Functional Cardiac Level
Research and Evidence-Based Nursing Practice (NSG 410)
July 16, 2022
Examining the Effectiveness of Adjunctive Therapy with Medications and Lifestyle Changes in Improving Functional Cardiac Levels
Introduction
Chronic heart failure refers to a situation whereby a patient’s heart fails to perform its central role of pumping blood sufficiently, leading to a build of fluids and blood within the chest cavity, initiating breathing issues (Choi et al., 2019). Patients experiencing this condition often display severe symptoms, including breathing challenges when sleeping or physically active. In addition, their lower extremities, particularly the feet, ankles, and legs, frequently become swollen (Koshy et al., 2020). The patients also have a lethargic feeling and have difficulty participating in physical undertakings (Real et al., 2018). According to Brennan (2018), the severe symptoms of chronic heart failure lower patients’ quality of life and decrease their capability to participate in daily activities effectively. Reports indicate that more than six million Americans aged between eighteen and forty-five experience heart failure, with more than three hundred thousand mortalities (Chaplin, 2019). Due to the high prevalence of chronic heart failure, this literature review examines effective interventions for managing the condition.
The researcher examined various databases, including the British Medical Journal (BMJ), MAG Online Library, Wiley Clinical Healthcare Hub, Wiley Online Library, and The Korean Journal of Internal Medicine (KJIM). The researcher utilized search words such as heart failure, heart failure diagnosis, management, and prognosis. In addition, the researcher used other search words such as chronic heart failure and adjunctive therapy.
Clinical Question
In adult patients aged eighteen and forty-five diagnosed with chronic heart failure who are admitted to Inova Fairfax Hospital, is adjunctive therapy with medications and lifestyle changes effective in improving cardiac functional level compared to medication only in a six-month period? Several studies indicate that medication alone is insufficient in improving patients’ condition and that mixing lifestyle changes and medications produces positive outcomes amongst patients with chronic heart failure. Therefore, this paper assesses various studies by evaluating sample size and type, instrument validity and reliability, methodology, data collection and procedures consistency, data analysis, results, and limitations.
Background
In the first article, according to Brennan (2018), heart failure is increasing in prevalence within the United Kingdom, with frequent hospital admissions and high mortality rates. Therefore, Brennan (2018) performed a study to improve patients’ outcomes via holistic, interventional, and assisted pharmacological care. His experiment established heart failure; The study sampled 4740 participants with chronic heart diseases. The researcher sought ethical consent for the study. The investigator guided individuals with stable chronic heart failure despite left ventricular ejection fraction (Brennan, 2018). Their study’s independent variable was an integrated nurse-led chronic heart failure care management (Brennan, 2018). With proper care and treatment systems in place, practitioners can enhance the experiences and outcomes of individuals suffering from heart failure. Management comprises holistic, interventional, and pharmacological care to guarantee optimal treatment. The dependent variable was chronic heart failure nursing care (Brennan, 2018). The study findings determined that training and experience in caring for people living with heart failure and managing their drugs are vital for practitioners caring for patients with the condition. Therefore, HFSNs are appropriately placed to up-titrate and initiate patient medicine (Brennan, 2018). The study concluded that nurse-led heart failure amenities enhanced patient outcomes via holistic, interventional, and aiding pharmacological care.
In the second article, Chaplin (2019) conducted a study to scrutinize the rate of chronic heart failure amongst adults. The researcher examined peer-reviewed articles for the investigation to acquire quantitative and qualitative data. The researcher utilized a stratified sampling technique for the various reports. The researcher considered five hundred adult patients for the study; however, they used a computation formula to get the sample size, settling for a sample size of 2615 respondents that was convenient and easy to work with (Chaplin, 2019). The study’s independent variables comprised pharmacological management, care planning, and managing heart failure. The researcher considered these factors the independent variables because they were most affected by heart failure among grownups. The dependent variable was heart failure amongst adults. (Chaplin, 2019). The study findings indicate that for the first heart failure-associated hospital admission, 149 per 1000 were at risk when offered a placebo, in contrast, participants offered beta-blockers as interventions were ten fewer per 1000. Additionally, the median quality of life within the control group (risk with advice for moderate sodium diet) was 72.4 IQR (63.8-86.3), on the other hand, the median quality of life within the intervention group (risk difference with advice for low sodium diet (95% CI)) was 7.8 lower (Chaplin, 2019). It is challenging to anticipate the trajectory of individuals with heart failure conditions, with intermissions of stability interrupted by severe deterioration in a steady general decline. This situation affects health care providers and patients, leading to a deficiency of effective advance care planning (Chaplin, 2019). Over the years, telemedicine has widely evolved, with modern equipment that can self-diagnose patients becoming common. These types of equipment have increasingly been relied on in detecting even patients with acute cardiac arrest symptoms. (Chaplin, 2019). However, despite their extensive presence, their complete reliability remains unproven worldwide by the international board of medicine, as stated by Chaplin (2019).
In the third article, Choi et al., (2019) explained that heart failure is a significant cardiovascular illness due to its rapidly growing health care costs, high mortality, substantial morbidity, and escalating prevalence. The number of heart failure patients is growing globally, including in Korea (Choi et al., 2019). There have significant advances in treatment, diagnostic modalities, and definition of heart failure over the years, and there are constant efforts to enhance heart failure risk stratification using genetic and imaging testing and biomarkers (Choi et al., 2019). Therefore, Choi et al., (2019) developed a study to examine future directions of heart failure and its management. The researchers utilized the observation technique to identify the number of individuals influenced by modernizations in managing heart failure issues. They examined various articles to acquire information on population sizes and utilized the international epidemiology of heart failure to get the actual number of patients (Choi et al., 2019). From a population of 39 heart failure patients, the researchers utilized a random sampling approach and settled on 10 participants for the study. Choi et al., (2019) state that heart failure prevalence varies between 1 and 2% in developed nations, depending on location and definition. Individuals above seventy display a prevalence rate more significant than 10%. HFpEF and HFrEF indicate unique etiological and epidemiological profiles. HFpEF patients are likely to develop hypertension and atrial fibrillation; more are females and are older (Choi et al., 2019). These patients also have decreased rate of myocardial infarction compared to HFrEF patients (Choi et al., 2019). The study’s independent variable included heart failure and future directions, while the dependent variables included genetic testing, new biomarkers, strain imaging, and CMR and CT. The study findings demonstrate that remote monitoring is vigorous in managing heart failure amongst patients. The result also established that hemodynamics is best for managing heart failure (Choi et al., 2019). The intervention displayed that the management rate trended positively. Examination of the HeartWare ventricular assist device (HVAD) indicated a mean support duration of 363 ± 280 days, showing success rates of 87% within six months, 85% within one year, and 73% within three years. (Choi et al., 2019). The study also proved that a more extensive group would have been significant in backing heart failure management and the issues directions combined with health education to heart failure patients (Choi et al., 2019).
In the fourth article, Koshy et al., (2020) conducted a study investigating the influences of managing heart failure on chronic heart failure treatment. The researchers appraised several peer-reviewed articles from the PubMed database to acquire data. They considered 36 studies to obtain sufficient information concerning heart failure. The researchers randomly chose individuals to offer more details on the research topic (Koshy et al., 2020). The researchers utilized a qualitative research technique since it was founded on deliberating the complaints of the patients within the study to examine their heart failure. Furthermore, information associated with dyspnea, low mood, and fatigue were considered to acquire the required data (Koshy et al., 2020). The study’s independent variable was heart failure, which was identified from the population size available in the sample. The dependent variables comprised low mood dyspnea, fatigue, and intolerance. More than 40% of the participants complained of coughing (Koshy et al., 2020). The study findings established that chronic heart failure leads to a wide range of symptoms amongst patients, several of which are under-recognized. Enhancements in patient contact can assist in recognizing fundamental problems and improve clinical management on a systemic stage. The reform of clinical amenities away from face-to-face appraisals with a higher emphasis on digital innovations offers challenges but one in which practitioners could actively participate in research activity and routine care. Within the clinical setting, the average completion time is 6.7 minutes with 91% of started evaluations finished fully. Additionally, an outpatient clinic environment could significantly benefit from enlisting a professional to monitor chronic heart failure patients’ progress during treatment and consultations (Koshy et al., 2020).
In the fifth article, Real et al., (2018) examine the influence of chronic heart failure amongst adults. Their study also investigated how to manage and treat chronic heart failure. The researchers used a simple random sampling procedure to identify the sum of individuals to include in the study to examine their heart failure issues. The respondents got a diagnosis or treatment of their problem from a selected care team (Real et al., 2018). They sampled 42 adults for the research to build a constructive report (Real et al., 2018). Other than the random sampling technique, the researchers utilized software to develop a sample size structure to guarantee unbiased results. The care team considered participants with critical conditions as exceptional cases. The researchers used the National Institute for Health and Care Excellence (NICE) guidance for managing and diagnosing respondents with heart failure issues (Real et al., 2018). The study’s independent variables were information provision to respondents, teamwork and diagnosis; interventions and rehabilitation; and treatment and monitoring. The dependent variable was the participants with the heart failure condition. The study results indicated that individuals with heart failure issues had prolonged oxygen therapy within their homes, though it was not recommended for the heart failure condition (Real et al., 2018). Additionally, there were numerous pieces of advice on treating heart failure victims using Angiotensin-Converting Enzyme (ACE) inhibitors, ivabradine, and sacubitril for individuals with chronic heart failure (Real et al., 2018). They indicate that when diagnosing heart failure one should gauge N-terminal pro-B-type natriuretic peptide (NT-proBNP) in individuals suspected of heart failure. In case NT-proBNP > 2000 ng/L the individual should be referred immediately to a specialist within 2 weeks. If NT-proBNP is between 400 and 2000 ng/L, the individual should be referred to a specialist within six weeks (Real et al., 2018). The research displayed a positive association between the literature offered and the results on chronic heart failure amongst adults and their management and treatment.
Conclusion
The various reviewed articles in this paper possess diverse similarities and differences. One significant similarity is that the articles are primary studies. In addition, most articles used a small sample size to ensure accuracy and convenience during the survey. All the studies focused on the various means of managing chronic heart failures amongst patients. Additionally, the articles concluded that medication alone was insufficient in managing chronic heart failure; therefore, multiple therapies and lifestyle changes would significantly help manage the condition. One key difference between the articles is that the researchers utilized different intervention techniques to define, manage, and treat chronic heart failure.
The articles displayed various strengths. One significant strength is that they were primary studies. Primary research is a technique utilized by investigators to gather data directly instead of relying on pre-collected data from past studies. As a result, researchers can collect first-hand information concerning the research topic; therefore, their findings offer significant insights. Due to this factor, the research findings were reliable and valid. Another strength is that the researchers utilized random sampling techniques to acquire their participants. The random sampling approach guarantees that results from a sample approximate what would have been gotten when the whole population had been measured. In addition, random samples ensure that every unit within the population has the same opportunity to participate in the research.
Additionally, random sampling helps in eliminating any bias from the study. For instance, medication treatment in heart failure with decreased ejection fraction is significantly founded on a mixture of drugs incrementally titrated up to the maximum prescription until maximum benefit is accomplished. One significant weakness displayed in some of the articles is the usage of a small sample size. Smaller samples hinder the researcher from extrapolating the findings, while bigger sample sizes increase the identification of differences and stress statistical differences that are not clinically relevant. Also, smaller sample sizes influence a study’s reliability, resulting in higher variability that leads to bias.
The significant gap identified in the articles is that they focused on the older generation without significantly examining the younger generation. Despite the older generation being more predisposed to heart failure, individuals of all ages can have heart failure, including adolescents, children, and infants. Additionally, heart failure in the younger generation is frequently due to a congenital heart defect that the child is born with and is called congestive heart failure.
In conclusion, chronic heart failure is featured by severe exacerbations and insistently decreased exercise capability, leading to repeated hospital admissions. Studies approximate that over twenty-six million individuals have chronic heart failure globally, with Europe having a prevalence of between 1 and 2% (Koshy et al., 2020). The internationally aging population will escalate these statistics, amplifying resource and financial pressures in the health care system. Therefore, various studies have examined chronic heart failure amongst adults to offer empirical evidence on the multiple interventions that practitioners and patients can implement to ensure they effectively manage and treat chronic heart failure. Using primary data and randomized techniques ensures that the studies are highly reliable and valid. However, future studies should consider using sufficient sample sizes that are a representation of the entire population. Additionally, adequate sample sizes ensure accuracy, reliability, and confidence in the identified findings. The reviewed articles effectively answered the clinical question by proving that adjunctive therapy with medications and lifestyle changes effectively improves cardiac functional levels compared to medication only.
References
Brennan, E. J. (2018). Chronic heart failure nursing: Integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688. https://doi.org/10.12968/bjon.2018.27.12.681
Chaplin, S. (2019). Chronic heart failure in adults: Diagnosis and management. Prescriber, 30(1), 16-18. https://doi.org/10.1002/psb.1730
Choi, H. M., Park, M. S., & Youn, J. C. (2019). Update on heart failure management and future directions. The Korean Journal of Internal Medicine, 34(1), 11-43. https://doi.org/10.3904/kjim.2018.428
Koshy, A., Gallivan, E., McGinlay, M., Straw, S., Drozd, M., Toms, A., Gierula, J., Cubbon, R., Kearney, M., & Witte, K. (2020). Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Failure, 7(5), 2193-2207. https://doi.org/10.1002/ehf2.12875
Real, J., Cowles, E., & Wierzbicki, A. S. (2018). Chronic heart failure in adults: Summary of updated NICE guidance. BMJ, 362. https://doi.org/10.1136/bmj.k3646
