Heart & Lung: The Journal of Acute and Critical Care
Volume 38, Issue 5 , Page 363, September 2009

Guidelines for the Care of Heart Failure Patients

Sue Wingate RN, PhD, CRNP Sue is a nurse practitioner in the Heart Failure Treatment Program with Kaiser Permanente Mid-Atlantic States. She is an Associate Editor for The Journal of Cardiac Failure and is active in the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology

Article Outline

 

A recent graduate student I was precepting asked me about existing guidelines and algorithms for caring for the patient with heart failure. I dutifully pulled out the ACCF/AHA guidelines, the Heart Failure Society of America (HFSA) guidelines, and the European Society of Cardiology (ESC) guidelines, along with their websites and pocket guides (and slide sets and PDA downloads….). We looked through them together and then he asked, “Well, where is the guideline information on the nursing care for these patients?”

Does anybody have a good answer for him?? I sure didn't. There is certainly some very important information in all of these guidelines about interventions we as nurses do for patients with heart failure, for example:

•Diuretics and salt restriction are indicated in patients with current or prior symptoms of heart failure and reduced ejection fraction1

•Nonpharmacologic techniques for stress reduction may be considered as a useful adjunct for reducing anxiety in patients with heart failure2

•Patients should weigh themselves on a regular basis to monitor weight change, preferably as part of a regular daily routine3

But all of these topics, and almost all other non-pharmacologic-non-device interventions reviewed in these guidelines are labeled as “Level of evidence C”, which means that the evidence comes from very limited populations and includes data from consensus opinion of experts, case studies, or standards of care, not from more rigorous randomized or non-randomized trials or meta-analyses.

This issue was further exemplified in the results of a survey of non-pharmacologic care by heart failure experts.4 Significant variability in practice was noted in the following areas: sodium-restricted diets, alcohol use, sexual activity, increased weight including use of a diuretic regimen, and palliative care. Providers also varied in their treatment of risk factors and comorbid illness, and in their beliefs about patient education and health literacy.

Thus we have limited evidence about many of the interventions we as nurses routinely do for patients, and the actual use of these interventions varies widely among even those providers who identify themselves as experts in the care of heart failure patients.

We owe our patients better than this. AAHFN recognizes the gaps in practice knowledge and will soon be surveying our membership about this and acting on it. Stay tuned.

Sue Wingate RN, PhD, CRNP

President, AAHFN

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References 

  1. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;53:e1–e90
  2. Adams KF, Lindenfeld J, Arnold JMO, Baker DW, Barnard DH, Baughman KL, et al. Executive summary: HFSA 2006 comprehensive heart failure practice guideline. 2006 J Card Fail. 2006;12:10–38
  3. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European J Heart Fail. 2008;10:933–989
  4. Riegel B, Moser DK, Powell M, Rector TS, Havranek EP. Nonpharmacologic care by heart failure experts. J Card Fail. 2006;12:149–153

 The Official Journal of the American Association of Heart Failure Nurses

PII: S0147-9563(09)00187-3

doi:10.1016/j.hrtlng.2009.07.009

Heart & Lung: The Journal of Acute and Critical Care
Volume 38, Issue 5 , Page 363, September 2009

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