Heart & Lung - The Journal of Critical Care

Information for Authors

2010-07-01

Review Application

2010-07-01

Reader Communication

2010-07-01

Do our patients understand?

Ashley Moore — 2010-07-01

Nurses serve as patient educators across the healthcare spectrum. We strive to provide the knowledge needed to promote health and improve outcomes and quality of life. Although we may assume that our patients comprehend the information being provided, as many as 90 million Americans, or half of our adult population, have difficulty understanding health information. These patients are unable to grasp simple health instructions that affect their ability to actively participate in their own care. Healthy People 2010 defined health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Testing the psychometric properties of the Chinese version of the Heart Failure Learning Needs Inventory

Mingming Yu, Sek Ying Chair, Carmen W.H. Chan, Meili Liu — 2009-11-23

Objective: To translate the Heart Failure Learning Needs Inventory into Chinese and to evaluate its psychometric properties in the Chinese population with heart failure (HF).Methods: The study used a cross-sectional design. Instrument performance was measured on a convenience sample of 247 patients with HF recruited from the cardiac departments of 3 university-affiliated hospitals and repeated on 34 patients to examine the test–retest reliability.Results: One item of advanced directives was deleted from the Chinese version of the instrument because of its poor culture relevance. The Chinese version demonstrated acceptable internal consistency with a Cronbach's α of .96 for the total scale and .77 to .89 for the subscales. The item-to-total correlation ranging from .54 to .85 provided further evidence of the instrument's internal consistency. The content validity index was .86, indicating satisfactory content validity. The test–retest reliability was satisfactory with an intraclass correlation coefficient of .96 for the total scale and .61 to .91 for the subscales. There were no significant differences in the total scale and subscale scores over 10 days (P > .05). This finding further supported the stability of the instrument. Moreover, principle component analysis revealed 9 factors, explaining 60.89% of the variance. Means of the subscales were relatively lower than that of the western countries. Furthermore, the means of 2 subscales, general HF information and lifestyle modification, were different among patients with New York Heart Association classifications I and IV.Conclusion: The Chinese version of the Heart Failure Learning Needs Inventory is a reliable and valid instrument to measure the learning needs of patients with HF in Mainland China.

Risk factors for late extubation after coronary artery bypass grafting

2009-12-11

Objective: To evaluate the independent risk factors for late extubation after coronary artery bypass grafting (CABG).Methods: Preoperative, intraoperative, and postoperative characteristics of patients undergoing isolated CABG between June 2005 and June 2008 at the Tongji Hospital were retrospectively analyzed. Elapsed time between CABG and extubation of more than 8hours was defined as late extubation.Results: The incidence of late extubation after CABG was 69.23% (288/416). Through univariate and logistic regression analysis, the independent risk factors for late extubation after CABG were older age (odds ratio [OR]=4.804), duration of cardiopulmonary bypass (OR=2.426), perioperative use of intra-aortic balloon pump (OR=1.451), preoperative arterial oxygen partial pressure (OR=.204), and postoperative hemoglobin level (OR=.793).Conclusion: Older age, prolonged cardiopulmonary bypass time, perioperative intra-aortic balloon pump requirement, low preoperative arterial oxygen partial pressure, and low postoperative hemoglobin level were identified as the 5 independent risk factors for late extubation after CABG.

Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes

Ju Young Shin, René Martin, Jerry Suls — 2010-05-14

Objective: The objectives of this meta-analytic review were to assess the magnitude and direction of associations among gender and acute coronary syndrome (ACS) symptom presentations, and to evaluate the potential role of the type of symptom-measurement strategy.Methods: A systematic review of articles and dissertations from between 1966 and 2007 was performed. Effect sizes were calculated and meta-analyzed, using random-effects models.Results: Gender differences of moderate or larger (ds=−.31 to −.68) magnitude were evident, and women were more likely than men to report back pain, palpitations, nausea/vomiting, and loss of appetite. For most symptoms, the magnitude of effects did not vary across different symptom-assessment strategies.Conclusions: Our conclusions challenge those of some previous reviews in demonstrating substantive effects in the magnitude of gender differences in ACS symptoms that were consistent, irrespective of measurement approach. These data have implications for clinical practice, and suggest that gender-specific public-health campaigns targeting ACS symptoms may be warranted.

Plasma circulatory markers in male and female patients with coronary artery disease

Hem C. Jha, Aabha Divya, Jagdish Prasad, Aruna Mittal — 2010-04-26

Objective: Inflammatory processes play a role in the pathogenesis of atherosclerosis, and plasma circulatory markers have been associated with cardiovascular risk. There is no single report in which adhesion molecule and circulatory cytokines have been evaluated in a single population set with coronary artery disease (CAD) on the basis of gender. Thus, we evaluated plasma circulatory markers in patients with CAD and in controls that were divided by gender (because functioning of circulatory markers and response toward conventional factors are not identical in men and women) and by conventional risk factors such as smoking and alcohol intake.Methods: A total of 192 patients with CAD (148 male and 44 female) and 192 controls with no symptoms of CAD (142 male and 50 female) were enrolled. Detection of concentration to high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, IL-13, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and adhesion molecules (intercellular adhesion molecule [ICAM]-1 and vascular adhesion molecule [VCAM]-1) was performed using enzyme-linked immunosorbent assay kits.Results: In male patients with CAD, levels of IL-4, IL-6, IL-8, IL-13, ICAM-1, VCAM-1, hsCRP (P < .001), and IFN-γ (P = .003) were significantly higher compared with controls; however, levels of IL-10 were significantly lower (P < .001). In female patients with CAD, levels of IL-4, hsCRP, VCAM-1 (P = .001), and IL-13 (P = .028) were significantly higher and IL-10 levels were significantly lower (P < .001) compared with controls. In addition, levels of circulatory markers were strongly associated with male smokers and imperceptibly associated with male alcoholics and female smokers and alcoholics.Conclusion: This study compared the plasma circulatory markers between patients with CAD and healthy controls, between patients with CAD who smoke and controls, and between alcoholic patients with CAD and controls divided by gender. Moreover, among circulatory markers studied, higher levels were found for IL-4, IL-13, hsCRP, and VCAM-1, and lower levels were found for IL-10 in male and female patients with CAD compared with healthy controls.

Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners

2009-11-23

Background: Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center. Idiopathic pulmonary fibrosis results in scarring of the lung and respiratory failure, and has a median survival of 3 to 5 years from the time of diagnosis. The purpose of this study was to determine whether patients with idiopathic pulmonary fibrosis and their care partners could be more optimally managed by a disease-management intervention entitled “Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management,” which nurses delivered using the format of a support group. We hypothesized that participation would improve perceptions of health-related quality of life (HRQoL) and decrease symptom burden.Methods: Subjects were 42 participants randomized to an experimental (10 patient/care partner dyads) or control (11 patient/care partner dyads) group. Experimental group participants attended the 6-week program, and controls received usual care. Before and after the program, all participants completed questionnaires designed to assess symptom burden and HRQoL. Patients and care partners in the intervention group were also interviewed in their home to elicit information on their experience after participating in the Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management.Results: After the intervention, experimental group patients rated their HRQoL less positively (P = .038) and tended to report more anxiety (P = .077) compared with controls. Care partners rated their stress at a lower level (P = .018) compared with controls. Course evaluations were uniformly positive. Post-study qualitative interviews with experimental group participants suggested benefits not exemplified by these scores. Patient participants felt less isolated, were able to put their disease into perspective, and valued participating in research and helping others.Conclusion: Further exploration of the impact of disease-management interventions in patients with advanced lung disease and their care partners is needed using both qualitative and quantitative methodology. Disease-management interventions have the potential to positively affect patients with advanced lung disease and their care partners.

Management of recurrent pleural effusions with a tunneled catheter

Elizabeth McConnell Baker, Sheila Melander — 2009-12-11

Recurrent pulmonary effusions are commonly seen in patients with end-stage diseases. Traditional treatment modalities have required several days of hospitalization or frequent invasive procedures. Drainage with a tunneled pulmonary catheter can provide symptom palliation and resolution of the effusion without activity restriction or hospitalization.

Investigating activity in hospitalized patients with chronic obstructive pulmonary disease: A pilot study

Chris Winkelman — 2010-04-09

Objective: This study examined therapeutic mobility activity, and investigated whether serum levels of inflammatory biomarkers interleukin (IL)-6 and IL-10 varied between periods of rest and activity.Methods: This observational, exploratory study took place in a medical intensive care unit and in stepdown units at an urban, academic medical center managed by intensivists. Our sample included 17 adults with exacerbations of chronic obstructive pulmonary disease (COPD).Results: Our results indicate that activity can occur for about 20 minutes, early during a hospitalization, among critically ill adults with COPD exacerbations, and activity can progress safely over 2 days in an intensive-care or stepdown setting. Physical activity was low in intensity, as measured by actigraphy.Conclusion: Although no significant differences were evident between serum inflammatory biomarkers at rest vs after activity in this small sample, trend-related data indicate that low-intensity activity has the potential to alter the inflammatory profile of hospitalized COPD adults.

Acute Streptococcus agalactiae endocarditis: Outcomes of early surgical treatment

2009-08-26

The incidence of Streptococcus agalactiae is widely recognized as increasing in nonpregnant adults. This report describes a retrospective case series of S. agalactiae endocarditis at the Heart Institute of Sao Paulo, Brazil, between 2000 and 2006. Early diagnosis and valve surgery seem to have contributed to improved patient outcomes.

Septic shock caused by Plesiomonas shigelloides in a patient with sickle beta-zero thalassemia

2009-09-14

Invasive infection and extraintestinal complications are rarely caused by Plesiomonas shigelloides, a waterborne bacterium belonging to the Vibrionaceae family. We report a case of a 16-year-old female patient with sickle beta-zero thalassemia who survived septic shock caused by P. shigelloides associated with secondary acute respiratory distress syndrome and disseminated intravascular coagulation. Treatment with a carbapenem was successful, and the patient recovered without any sequelae. The previous reports of P. shigelloides sepsis are cited, and possible pathogenic mechanisms are discussed.

Fever of unknown origin (FUO) due to a solitary cavitary lung lesion: The deadly ferritin-laced doughnut

Burke A. Cunha, Francisco M. Pherez, Douglas S. Katz — 2009-10-16

Fever of unknown origin (FUO) is the clinical designation for patients who have fevers >101F that have persisted for >3 weeks that remain undiagnosed, after an intensive ambulatory/in-hospital workup. Fevers of unknown origin may be due to wide variety of infectious, neoplastic, or rheumatic/inflammatory disorders. The most common causes of FUOs in elderly patients are infectious and neoplastic diseases. With FUOs, the clinical presentation and routine laboratory tests are usually sufficient to narrow differential diagnostic possibilities. We present a case of an elderly Italian woman who presented with an FUO and a solitary, thick-walled cavitary lesion on chest x-ray (CXR). The infectious disease differential diagnosis of her FUO included lung abscess, M. tuberculosis (TB), systemic mycoses, and echinococcal-cyst (or hydatid-cyst) disease. The malignancy and neoplastic differential diagnosis included bronchogenic carcinoma, lymphoma, and metastatic carcinoma. Her nonspecific laboratory tests indicated a highly elevated erythrocyte sedimentation rate (ESR) >100 mm/hour, chronic thrombocytosis, relative lymphopenia, and highly elevated serum ferritin levels. Excluding highly elevated serum ferritin levels, the differential diagnosis of her FUO with a solitary, thick-walled cavitary lesion was lung abscess vs tuberculosis. However, her highly elevated serum ferritin levels proved to be the critical diagnostic clue in predicting the diagnosis of squamous-cell carcinoma. We conclude that serum ferritin levels are an important part of the laboratory workup. As with other nonspecific laboratory tests, the diagnostic significance of highly elevated ferritin levels depends associated clinical features in the clinical presentation.

Comment on “A randomized trial of massage therapy after heart surgery”

Brent A. Bauer, Susanne M. Cutshall, Deb Engen, Thoralf M. Sundt — 2010-04-19

To the Editor: We read with interest the article by Albert et al, “A Randomized Trial of Massage Therapy After Heart Surgery,” and were surprised to see the largely negative results. We conducted a similar study in a similar population and found markedly different outcomes. We evaluated the efficacy and feasibility of massage therapy delivered to 113 patients in the postoperative cardiovascular surgical setting. Patients were randomized to receive a massage or to have quiet relaxation time (control subjects). Patients receiving massage therapy exhibited significantly decreased pain, anxiety, and tension. The outcomes were felt to be so compelling that massage therapy has been incorporated into the routine postoperative management of cardiac surgery patients at Mayo Clinic.

Scoring system for diagnosis of swine flu

Viroj Wiwanitkit — 2010-05-31

I am responding to the recent article by Cunha et al on the new scoring system as a novel diagnostic tool for swine flu. Cunha et al reported, “During the ‘herald’ wave of the H1N1 pandemic, the diagnostic weighted point score system accurately identified probable H1N1 pneumonia and accurately differentiated H1N1 pneumonia from ILIs and other viral and bacterial community-acquired pneumonias.” I agree that this new diagnostic system is interesting and useful. However, there are some concerns about this scoring system. First, complete evaluation is needed of both its diagnostic properties (eg, sensitivity, specificity, accuracy, and predictive value) and its economic properties (eg, cost effectiveness and cost utility). Second, the question arises of whether this new system can replace the old classical rapid screening test which has a relatively high false-negative rate. Although the new system has a good diagnostic property, it requires many data for scoring, including clinical and laboratory approaches. For the management of a swine-flu pandemic, a diagnostic tool must not only be accurate but also user-friendly and fast. Whether these several checklists are practical for general users in real-life application, and whether this new approach can serve as a point of care testing to bring the fastest diagnostic results for early management of cases, are important queries that remain to be answered.

Rapid identification of heart failure in the emergency department

2010-07-01

Purpose: The purpose of this study is to describe common characteristics of patients with acute heart failure syndrome (AHFS) presenting to the emergency department (ED). Background: Rapid identification of patients with AHFS in a busy ED is challenging, yet vital for clinicians treating patients and researchers screening for study subjects. AHFS is difficult to recognize early as it often mirrors or accompanies other common ED presentations, such as acute coronary syndrome, and pulmonary and renal disease. In addition, patients have individualized symptoms and are often unclear of their disease process. By knowing common characteristics of patients with AHFS, clinicians and researchers are better placed to identify possible AHFS patients.

Health status and health-related quality of life in congestive heart failure

K.A. Landry — 2010-07-01

Purpose: The major purpose of this study was to examine the health status and health-related quality of life (HRQOL) of men and women with a diagnosis of CHF. Background: CHF is a serious chronic disease with high mortality. It affects 5 million Americans, and approximately 550,000 new cases will be diagnosed each year (AHA, 2006). According to the AHA (2004), 5 years after being diagnosed with CHF, the mortality rate is more than 50%. Under the age of 65, about 80% of men and 70% of women who have heart failure will die within 8 years (AHA, 2004). The problem is that there is very little information on gender differences and health outcomes as it relates to HRQOL and health status in CHF patients. Understanding the variables that impact the quality of life can help clinicians target interventions to support and maximize QOL among individuals with CHF.

Quality of Life, Hope, Social Support, and Self-Care in heart failure patients

K.A. McGurk — 2010-07-01

Purpose: The purpose of this study was twofold. First, it filled a gap in the heart failure and nursing literature by describing Quality of Life and the psychosocial variables of Hope, Social Support, and Self-Care in heart failurepatients. Second, it tested the conceptual relationships between Quality of Life, Hope, Social Support, and Self-Carein this population.

Heart failure medication use after mitral valve repair: Is there room for improvement?

N.M. Albert, C.M. Lewis, M.T. Karafa, S.M. Morrison — 2010-07-01

Purpose: This study examines use of core heart failure medications after mitral valve repair in patients with a baseline rejection fraction ≤ 40% and changes in ejection fraction (pre-to-postoperation at discharge and at 1 year) in groups based on heart failure drug use.

Do central adiposity measures predict lifestyle patterns and knowledge in obese patients with heart failure?

N.M. Albert, J.F. Bena, A.S. Tang, J. Forney, E. Slifcak — 2010-07-01

Purpose: To examine relationships between central adiposity measures (waist-to-hip ratio, waist circumference, and metabolic syndrome status) and patient characteristics, lifestyle patterns (diet adherence and functional status) and knowledge of diet, exercise and adiposity distribution to determine if central adiposity measures are better predictors than body mass index of factors that influence cardiovascular morbidity risk.

When do patients hospitalized for heart failure want to communicate?

J. Howie-Esquivel, K. Dracup — 2010-07-01

Purpose: The aims of this study were to 1) identify when heart failure (HF) patients want to communicate regarding disease management, prognosis and end of life wishes, and 2) to identify the relationship of communication with clinical variables and quality of life (QOL).

Health literacy and self-care of patients with heart failure

K.S. Yehle, A.M. Hess, K.S. Plake, M.M. Murawski, H.L. Mason — 2010-07-01

Purpose: The primary objective of this project was to examine the association between patient health literacy level and self-care. Background: Nearly 90 million Americans lack the necessary health literacy skills to adequately care for themselves in the face of a complex healthcare system and self-care regimens. Patients with heart failure are particularly challenged by meeting with multiple healthcare providers, who may emphasize different self-care strategies, which can be difficult for patients to interpret. Understanding how to effectively care for one's self is thought to improve heart failure symptoms and patient outcomes. Little is known about how health literacy influences self-care in patients with heart failure.

Sleep, anxiety, and depression among adults with left- ventricular assist devices

J.M. Casida, J.E. Davis — 2010-07-01

Purpose: The purposes of this pilot study were to: (1) identify the patterns of sleep efficiency (SE), sleep fragmentation (SF), sleep quality (SQ), anxiety, and depression; and (2) determine the change in the pattern of these variables before and up to 3 months after implantation of a left-ventricular assist device (LVAD).

Results of PFOS trial

D. Chapa, S.A. Thomas, E. Friedmann — 2010-07-01

Purpose: To compare the longitudinal changes in depression and anxiety of heart failure (HF) outpatients who received implantable cardioverter defibrillators (ICDs) and those who received medication. To evaluate the contributions of social support and severity of HF to changes in depression and anxiety in these patients.

Thirst and QOL in persons with heart failure

C.M. Reilly, K. Meadows, S. Dunbar, S. Culler, A. Smith — 2010-07-01

Purpose: The aim of this research is to identify relationships between fluid intake, thirst, and quality of life (QOL) in persons with heart failure (HF) using descriptive and correlation analysis.

Identifying factors of HF patients who return within thirty days

K. Dixon, M. Mansfield — 2010-07-01

Purpose: The purpose of this study was to identify and describe every HF patient who was admitted with a diagnosisrelated group of HF twice within 30 days. Background: Although heart failure (HF) is one of the highest admission diagnoses for medical floors, the diagnosis does not pay enough to cover the costs of a hospital stay. Patients who effectively self-manage their own care at home are less likely to be readmitted within 30 days. Although HF readmissions are attributable to diminished self care, other identifiable factors of patients who are readmitted within 30 days may prove useful in preventing further readmissions. Do the patients who return within 30 days have identifiable factors?

Examining the effects of exercise in left-sided heart failure

M. Gall, R. Nailon — 2010-07-01

Purpose: This study examined individuals with left-sided heart failure(LHF)and the relationship between cardiac rehab and: self-reported level of depression and quality of life (QOL)

Implementation of a specialized medical service to improve heart failure care and outcomes

JoAnn Z. Ioannou, Cheryl R. Dennison, J.Z. Ioannou, C.R. Dennison — 2010-07-01

Purpose: The purpose of this study is to describe the implementation and evaluation of a multidisciplinary heart failure service which was developed to improve heart failure discharge core measure performance,and reduce 30-day readmission rates.

Do heart failure clinics provide guideline-recommended treatment to older women with advanced heart failure and preserved systolic function?

B.L. Huiskes, K. Dracup — 2010-07-01

Purpose: The purpose of this study was to examine the pharmacologic management of older women with heart failure and preserved systolic function (HFPSF) in heart failure (HF) clinics for consistency with national guideline recommendations addressing blood pressure (BP) control, treatment with angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers, and diuretics.

Rx: Comfort - evolution of palliative content in major North American and European heart failure guidelines between 1994 and 2008

B.L. Huiskes, K. Dracup — 2010-07-01

Purpose: The purpose of this study was to trace the development of palliative content in major heart failure (HF) management guidelines during a period of remarkable progress in HF treatment outcomes.

The meaning of fatigue is more than what the patient can't do

C. McDermott, J. Jones, C. Nowels, D. Bekelman — 2010-07-01

Purpose: A better understanding of the patient's experience and beliefs about fatigue is needed to improve HF selfcare. The purpose of this study is to enhance understanding of the patient and caregiver's perception of fatigue as a distressing symptom of HF.

Predictors of uncertainty in adults with an acute exacerbation of heart failure

K.A. Sethares — 2010-07-01

Purpose: The purpose of this study is to explore the influence of age, educational level, length of time with heart failure and severity of symptoms on levels of uncertainty in a sample of HF patients.

Nurses' attitude toward the Electronic Health Record still uncertain after 6 months

A.S. Laramee, M.S. Bosek, H. Shaner-McRae, T. Powers-Phaneuf — 2010-07-01

Purpose: Compare nurses' perception/attitudes pre/post implementation of a comprehensive electronic health record (EHR) at a rural, academic medical center. Background: The American Hospital Association's 2008 survey of 3049 acute care hospitals found that <2% of hospitals had a comprehensive EHR, 9% have a basic EHR system, & 17% have computerized physician order entry. Since few hospitals have an EHR, many nurses will be involved in future EHR implementations. Knowledge of nurses' feelings about EHRs can guide implementation teams in optimization of communication, addressing misconceptions and offer valued insight. Given the organizational investment and commitment to successfully implement an EHR, understanding baseline nurse attitudes and expectations is pivotal. Willingness of nurses to adopt EHRs is a major determinant of implementation success, as nurses are the largest workforce. Little is known about the nurses' perception of EHR implementation process or the impact of an EHR on the nurse's ability to provide quality patient care.

Depression in heart failure- the value of nurse assessment: Preliminary findings

C. Russell, K. Bowden, U. Piamjariyakul, K. Reeder, C. Smith, N. Thompson — 2010-07-01

Purpose: To identify contributing factors of depression in heart failure (HF) reported by patients and mental health nurses. Background: Depression is more common in patients with HF than in the general population. HF patients, who have clinical depression, have an increased risk of morbidity and mortality. The Chronic Care Model was used to guide the assessment of depressive symptom experiences, using patient-directed problem solving facilitated by advanced practice mental health nurse specialists.

Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients

2010-07-01

Purpose: The purpose of this comparative study was to examine 1) prevalence of inadequate health literacy and 2) differences by health literacy level in HF knowledge, HF self-care, and 30-day readmission rates among patients hospitalized with HF.

Factors associated with delayed care-seeking in hospitalized heart failure patients

N.F. Altice — 2010-07-01

Purpose: The purpose of this study was to identify factors associated with delayed care-seeking among patients with recurrent symptoms of heart failure (HF). Background: Delay in care-seeking among patients with heart failure leads to longer length of stay and increased cost, morbidity, and mortality. Care seeking may be impacted by a variety of factors including difficulty with symptom recognition and interpretation as well as various social variables.

Identifying barriers to CPAP use in the sleep apnea patient

D. Sarginson, M.A. Prasun — 2010-07-01

Purpose: The purpose of this integrative review was to identify perceived barriers to CPAP treatment of sleep disorder breathing. Background: Over 15 million Americans are diagnosed with sleep disordered breathing and 82% of this population has heart failure.(1) Although continuous positive airway pressure (CPAP) is an effective form of treatment, many patients fail to adhere. By identifying perceived barriers to CPAP treatment, nurses may facilitate early recognition and solutions.

Incorporating new technology improves outcomes for heart failure patients

K. Robinson, D.T. Harris, C. Brenton, S. Thomason, S. Harrell, C. Fortier — 2010-07-01

Background: Appropriate care measure compliance and proper patient identification prevent heart failure readmissions. Methods: Proper identification of heart failure patients is needed to perform concurrent chart review and patient education. Electronic Medical Record implementation and use of pivot tables creates a workable list for the Heart Failure Inpatient Teaching Team. The list prioritizes patients based on the following criteria; heart failure diagnosis, BNP level, diuretics, and physician. Identification of patients provides opportunities to review charts and educate patients in real time. Weekly meetings, physician accountability, and sharing of appropriate care measure results led to the team's success.

Implementing a multidisciplinary team approach for the management of heart failure patients in home healthcare

C. Griffith, S. Guthrie, B. Papasifakis, S. Vanderveen — 2010-07-01

Background: Exercise has been shown to have favorable effects in patients with heart failure (HF). Even modest exercise can reduce blood pressure and blood glucose levels, reduce stress and depression, improve muscle mass, improve cardiovascular endurance, improve aerobic capacity, and even assist with remaining independent in the living environment. Despite all of this evidence, HF patients are frequently underserved by physical and occupational therapy in the home healthcare setting. This is in large part due to lack of confidence in delivering care to HF patients.

The best of both worlds: Combining heart failure and palliative care in interdisciplinary rounds

S. Thompson, J. Gentry — 2010-07-01

Background: Each year, over 500,000 Americans are diagnosed with heart failure. Despite aggressive medicalsurgical treatments, symptom burden remains intolerable for many patients. Notably, advanced heart failure patients have been shown to have more symptoms than those with stage IV cancer.1 Unlike cancer patients, those with heart failure may remain on aggressive, disease modifying therapy until the end of life and have a less predictable disease trajectory. Heart failure patients may experience repeated hospital admissions, unrelieved symptoms and often benefit from the addition of palliative care. The aim of palliative care for heart failure patients is to improve quality of life and reduce suffering for patients and families, regardless of the stage of disease and need for other therapies.

Promoting cardiac rehabilitation for patients with heart failure

C.R. Pearson, S. Gharabaghli, D. Seidensticker — 2010-07-01

Background: 5 million patients and their families are affected by Heart Failure (HF) with over 550,000 patients diagnosed each year, according to the Center for Disease Control (CDC). HF is a multisystem syndrome which affects the cardiovascular, humoral, neuroendocrine, renal, and musculoskeletal systems. Evidence-based healthcare research has shown that a cardiac rehabilitation program for patients with HF increases exercise capacity, quality of life, and improves oxygen consumption resulting in reduced hospitalizations and improved quality of life. As a result, the American College of Cardiology strongly recommends exercise training for patients with heart failure (Class 1 recommendation). Despite the research, cardiac rehabilitation is a very underutilized tool for our patients with heart failure.

Tools for meeting core measures for heart failure best practice

N.J. Singer, J. Willman, D. Penzkowski — 2010-07-01

Background: Several quality and regulatory agencies have put forth a series of heart failure (HF) best practice recommendations or measures to ensure quality HF care. There are many recommendations for various different diagnoses and it can be challenging to remember, document and follow all best practice guidelines for patients with multiple issues. At our facility, nearly 200 different physicians can admit HF patients to as many as 12 different inpatient units. It is a challenge to keep caregivers up to date with the latest guidelines and use them with every patient. We wanted to provide easy to use, concise resources for caregivers. We also wanted to evaluate the use of resources and provide feedback to caregivers.

Nurse practitioners improving the transition from hospital to home and reducing acute care readmission rates in heart failure patients

J.M. Ballard-Hernandez — 2010-07-01

Background: Heart failure (HF) is a common, progressive, complex clinical syndrome, that affects approximately 5.7 million adults in the United States and the statistics are only expected to rise as the population ages. HF is the most common inpatient admitting diagnosis for patients over the age of 65. Despite a variety of pharmacologic and nonpharmacolgic therapies that have been shown to improve outcomes, acute care readmissions in this population remain high. Nearly one in four patients with HF are readmitted within 30 days of hospitalization. January 2009 to March 2009 Hoag Hospital experienced readmission rates for heart failure of 25.9% within 30 days of hospital discharge. Nurse Practitioners (NPs) knowledge of health assessment, advanced pathophysiology, pharmacology, clinical decision-making , and diagnostic reasoning make them an ideal candidate to manage this complex patient population and contribute to decreasing hospital readmissions.

Getting serious about transition: A medication reconciliation model of care in the management of heart failure

2010-07-01

Background: Gaps in transition after discharge from the hospital lead to re-hospitalization and thus higher costs in health care. Adverse drug events and medication errors have been shown to occur in 50% of patients during transitions in care. For this reason, the Cleveland Veterans Administration developed a medication reconciliation model of care targeting heart failure (HF) patients recently discharged from the hospital.

A novel heat failure disease management strategy reduces heart failure readmissions in veterans with heart failure

2010-07-01

Background: Introduction: Heart failure (HF) hospitalizations represent a major cause of morbidity and mortality among patients enrolled for care in the Veterans Administration health care system (VA), as well as a high cost to the system. However little is known about methods, which may reduce HF hospitalizations in this high-risk patient population. We hypothesized that a novel HF disease management program would reduce 30-day readmission rates for veterans with an admission for acute decompensated HF (ADHF).

Sociodemographic barriers to implementation of heart failure disease management within a Veterans Administration Medical Center

2010-07-01

Background: Heart failure (HF) represents a frequent cause for morbidity and mortality within the Veterans Administration (VA) health care system, and is associated with a high cost to the system. Heart failure disease management programs (HFDMP) have been proposed as one strategy by which to reduce HF hospitalizations and improve HF quality of care. However barriers to implementation of the programs within the VA are poorly understood.

Opportunity for improvement: Heart failure readmissions 30 days

C. Call, M. Hartwig, S. Pope, M. Hedrick, S. Bacher, S. Jennison — 2010-07-01

Background: Our Nurse Without Borders program started in January, 2006 to see all heart failure patients in the hospital for education, verifying CHF core measures, screening for depression and sleep apnea. We have used the Cardiocom scale for telehealth management of frequent CHF readmissions for the past 10 years. A nurse phones patients at home within 30 days of discharge. Our hospital has the lowest CHF readmission 21.2% for the state vs 24.9% for the nation. We utilize a multidisciplinary outpatient heart failure clinic however we still needed to improve. Using H2H (Hospital to Home) initiative started by American College of Cardiology, we want to be even more aggressive in decreasing our CHF readmissions.

Translation of evidence to practice: What are we prescribing and are patients taking it?

N. Ansani, L. Gordon — 2010-07-01

Background: Cardiovascular (CV) guidelines promote evidence-based disease management. Yet, variability in clinician adherence to guidelines and patient adherence to medications presents challenges to optimally treating disease. Therefore, our goal was (1) to analyze current prescribing and medication taking behaviors; then (2) to implement targeted and corrective quality improvement (QI) initiatives.

Educational bulletin board AIDS heart failure patients in complying to approved diet

D.M. Foti, H.J. Johnston, K.C. McBroom — 2010-07-01

Background: Evidence supports a diet low in sodium and cholesterol for heart failure (HF) patients. Frequent rehospitalizations of HF patients often occur due to fluid volume excess (FVE) which can be direcly linked to dietary sodium and/or fluid intake. Discharge at a dry weight along with educational resources about diet and recipes should decrease the readmission rate and improve quality of life

Early implementation and evaluation of a nutritional protocol in an Intensive Care Unit for patients receiving a Ventricular Assist Device

M.E. Nellett, D. Kadich, M. Gregory — 2010-07-01

Background: Patients receiving a Ventricular Assist Device (VAD) are at increased risk of altered nutritional status pre and postoperatively due to worsening symptoms of heart failure and cardiac cachexia. This profound state of malnutrition is characterized by loss of fat and muscle mass. This multifactorial metabolic and inflammatory response also can lead to reduced immune function and prolonged hospitalization. Post-operatively, these patients may continue to have poor intake or poor tolerance to oral feedings due to anorexia, delayed gastric emptying, and reduced motility. Inadequate nutrition contributes to a host of post-operative problems such as infection; poor wound healing, and limited functional capacity, yet, limited research exists on assessment and enhancement of nutritional status of VAD patients. Furthermore, a nutritional protocol had been lacking. A nurse led multidisciplinary team developed an approach to minimize malnutrition by implementing and evaluating a nutritional protocol in the ICU.

Establishing feasibility of a telemanagement system to facilitate self care among African American heart failure patients

M.L. McEntee, B.J. Johnson, C.R. Dennison, J. Finkelstein — 2010-07-01

Background: Common reasons for heart failure (HF) rehospitalization include delays in symptom recognition, medication and dietary non-adherence, and lack of knowledge and skills for self management. Existing telemonitoring systems provide limited support for self care and implementing personalized treatment plans. We developed a HF Home Automated Telemanagement (HF HAT) system to provide support with individualized treatment plans; monitoring symptoms, weight, and health status; and providing HF education. The system consists of a refurbished laptop and electronic scale placed in the patient's home, communicating patient data to a secured central server implementing real-time clinical decision support (CDS). The HF HAT system is designed to be simple, requiring only three keys to operate, making it usable by patients with no prior computer experience. Using the system daily, patients complete self-testing to report symptom experience, weight, and adherence to HF treatment recommendations; they receive instant feedback in the form of a 3-zone color-coded HF action plan. Patients complete a brief daily educational session with knowledge attainment and retention assessed the next day. The HAT unit also features progress charts which graphically display symptoms, weight, and zone-based action plans. A webbased care management portal is used by the care management team to customize clinical alerts and zone-based action plans based on patient-reported symptom experience and adherence.

How much of what you taught did your patients understand

M.P. Carroll, E. Brinker — 2010-07-01

Background: The Institute of Healthcare Improvement (IHI) estimates the bedside nurse spends an average of eight minutes educating patients prior to discharge from the hospital. The American Medical Association and the IHI have promoted the Teach Back (TB) method of patient education and health literacy to identify the gaps in patient knowledge and allow for review of critical information until the patient and/or caregivers can verify understanding. For the patient with heart failure to successfully manage this chronic disease and prevent unnecessary readmissions to the hospital it is critical that the patient, family members and caregivers understand the key concepts and interventions required to respond appropriately. Teach back provides verification of understanding and identifies gaps in learning.

Maximizing limited resources in reducing readmission rates in a heart failure transitional model

M. Osevala — 2010-07-01

Background: Reducing heart failure 30 day readmissions can be daunting in current economic conditions, however can initiating an advance practice nurse consult system for vulnerable patients impact readmission rates?

A specialty heart failure unit:Impacting quality care for hospitalized heart failure patients

L.B. Kuchler, N.F. Altice — 2010-07-01

Background: The hospitalized heart failure patient presents a complex array of health and learning needs. Management of these patients requires sophisticated, focused nursing intervention. Improving quality care for the heart failure (HF) population had long been a goal in our facility. In our large regional referral center for cardiology, we admit over 750 patients annually into 23 nursing units . These patients are managed by diverse multidisciplinary teams. As we focused on quality outcomes for this population, we knew a nursing unit, with a specific focus on HF patients was an essential component for success.

Lost in translation: Engaging nurses in research at the point of care

M.T. Bowers, L. Cox, K. McBroom — 2010-07-01

Background: Translating research into practice at the point of care is a challenge for nurse clinicians, students and researchers. Nurses in direct patient care roles often have little time to fully glean pertinent information necessary for their patients' involvement in research that is in progress in their clinical areas. Questions arise regarding terms used in the study and the actual process for patient enrollment. In order to engage staff in research at the point of care we created a mechanism for providing standardization of educational content and dissemination of material that is essential in maintaining the integrity of collected data. Our progressive care heart failure unit needed more information about patients participating in an ongoing heart failure study involving daily weight monitoring and early symptom recognition. Enrollment criteria, education for study patients, and information required for completion of case report forms and questionnaires all needed to be clearly articulated to the staff. Guiding staff to understand what is involved in the research process and providing an opportunity to ask questions about participants' specific care needs is an ongoing learning need that can not be met by a one time in-service.

The heart success pocket calendar: A corporate collaborative

C.T. Williams, H. Heilmann — 2010-07-01

Background: Self care and regimen adherence are critical elements in heart failure (HF) management. Tools, such as daily reminders, are frequently used in outpatient care to provide continued support. Unfortunately, accessibility of these educational materials can be problematic for some patients. A complex disease process such as HF coupled with a growing elderly population make it necessary for providers to develop effective tools that help promote self-care and regimen adherence. Santa Rosa Memorial Hospital wanted to create a convenient pocket size calendar that focused on the daily monitoring needs of HF patients - a simple educational tool that reflected evidence-based practice.

Pulmonary arterial hypertension (PAH) patient education strategy

T. Stewart — 2010-07-01

Background: When evaluating chronic care models, patients reported when working with healthcare providers there was minimal time spent setting personal goals, tailoring specific individual interventions, and arranging follow-up and coordination. PAH care coordination and patient education must be tailored to individual needs. Performing patient education for long sessions when patients are admitted or during initial PAH clinic evaluation is suboptimal. Knowledge retention during admission has been demonstrated to be minimal. Patients presenting for PAH evaluation are often new to the institution and have long clinic appointments combined with diagnostic testing. This stress combined with baseline fatigue makes concentration difficult.

Prevalence of central sleep apnea in heart failure patients in the era of beta-blockers

N. Johnson, S. Petersen-Stejskal, R.E. Germany — 2010-07-01

Background: Central sleep apnea (CSA) has been shown to improve with beta-blocker use in heart failure patients. It is unknown if the overall prevalence of CSA has decreased since the introduction of beta-blockers. Recent publications have reported that the addition of beta-blockers to the medical regimen of a patient with CSA has been shown to decrease the severity of CSA (Tamura 2009). Therefore, it is possible that CSA and SDB has decreased in overall prevalence with the use of beta-blockers.

Translating evidenced based practice in heart failure

T.G. Sawyer, B.B. Granger, K.G. McBroom — 2010-07-01

Background: Evidence-based practice guidelines represent the research that supports safe, high quality patient care. Currently, much data exists to suggest that clinicians are not compliant with existing research-based guidelines.(1- 3)(note – insert results of IMPROVE_HF) Although academic medical centers are more likely to be aware of existing evidence for practice, the application of this information in practice has not been well-integrated. In addition, nurses report difficulty accessing, and implementing evidence in daily patient care routines.(4) In nursing, little research has been done to evaluate the extent of the research-practice gap in clinical inpatient units. In addition to these needs, interventions to improve use of existing evidence in practice have not been widely evaluated. The opportunity to improve patient care and clinical outcomes by more effectively communicating research-based clinical guidelines is clear.

2010-07-01

Board of Directors

2010-07-01

Information for Readers

2010-07-01

Heart & Lung - The Journal of Critical Care

Information for Authors

Review Application

Reader Communication

Do our patients understand?

Testing the psychometric properties of the Chinese version of the Heart Failure Learning Needs Inventory

Risk factors for late extubation after coronary artery bypass grafting

Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes

Plasma circulatory markers in male and female patients with coronary artery disease

Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners

Management of recurrent pleural effusions with a tunneled catheter

Investigating activity in hospitalized patients with chronic obstructive pulmonary disease: A pilot study

Acute Streptococcus agalactiae endocarditis: Outcomes of early surgical treatment

Septic shock caused by Plesiomonas shigelloides in a patient with sickle beta-zero thalassemia

Fever of unknown origin (FUO) due to a solitary cavitary lung lesion: The deadly ferritin-laced doughnut

Comment on “A randomized trial of massage therapy after heart surgery”

Scoring system for diagnosis of swine flu

Rapid identification of heart failure in the emergency department

Health status and health-related quality of life in congestive heart failure

Quality of Life, Hope, Social Support, and Self-Care in heart failure patients

Heart failure medication use after mitral valve repair: Is there room for improvement?

Do central adiposity measures predict lifestyle patterns and knowledge in obese patients with heart failure?

When do patients hospitalized for heart failure want to communicate?

Health literacy and self-care of patients with heart failure

Sleep, anxiety, and depression among adults with left- ventricular assist devices

Results of PFOS trial

Thirst and QOL in persons with heart failure

Identifying factors of HF patients who return within thirty days

Examining the effects of exercise in left-sided heart failure

Implementation of a specialized medical service to improve heart failure care and outcomes

Do heart failure clinics provide guideline-recommended treatment to older women with advanced heart failure and preserved systolic function?

Rx: Comfort - evolution of palliative content in major North American and European heart failure guidelines between 1994 and 2008

The meaning of fatigue is more than what the patient can't do

Predictors of uncertainty in adults with an acute exacerbation of heart failure

Nurses' attitude toward the Electronic Health Record still uncertain after 6 months

Depression in heart failure- the value of nurse assessment: Preliminary findings

Adequate health literacy is associated with higher heart failure knowledge and self-care confidence in hospitalized patients

Factors associated with delayed care-seeking in hospitalized heart failure patients

Identifying barriers to CPAP use in the sleep apnea patient

Incorporating new technology improves outcomes for heart failure patients

Implementing a multidisciplinary team approach for the management of heart failure patients in home healthcare

The best of both worlds: Combining heart failure and palliative care in interdisciplinary rounds

Promoting cardiac rehabilitation for patients with heart failure

Tools for meeting core measures for heart failure best practice

Nurse practitioners improving the transition from hospital to home and reducing acute care readmission rates in heart failure patients

Getting serious about transition: A medication reconciliation model of care in the management of heart failure

A novel heat failure disease management strategy reduces heart failure readmissions in veterans with heart failure

Sociodemographic barriers to implementation of heart failure disease management within a Veterans Administration Medical Center

Opportunity for improvement: Heart failure readmissions 30 days

Translation of evidence to practice: What are we prescribing and are patients taking it?

Educational bulletin board AIDS heart failure patients in complying to approved diet

Early implementation and evaluation of a nutritional protocol in an Intensive Care Unit for patients receiving a Ventricular Assist Device

Establishing feasibility of a telemanagement system to facilitate self care among African American heart failure patients

How much of what you taught did your patients understand

Maximizing limited resources in reducing readmission rates in a heart failure transitional model

A specialty heart failure unit:Impacting quality care for hospitalized heart failure patients

Lost in translation: Engaging nurses in research at the point of care

The heart success pocket calendar: A corporate collaborative

Pulmonary arterial hypertension (PAH) patient education strategy

Prevalence of central sleep apnea in heart failure patients in the era of beta-blockers

Translating evidenced based practice in heart failure

Table of Contents

Board of Directors

Information for Readers