Identification of risk factors, beginning early interventions can prevent heart failure progression

Heart failure can quickly develop or become worse during a hospital stay, even when it isn't the primary cause for admission. Hospitals and clinicians must be diligent to identify patients at risk for secondary heart failure as they aim to improve outcomes, contain costs and prevent readmissions, according to an article in Critical Care Nurse (CCN).

Heart failure is the leading cause of hospital admissions and readmissions in patients older than 65 years and is a leading cause of death among hospitalized patients. However, patients who are admitted for a different reason may develop secondary heart failure while they're in the hospital, complicating their recovery.

Due to healthcare reform efforts, hospitals are increasingly focused on ways to improve outcomes for patients with heart failure. Among other goals, these initiatives strive to increase the cost-effectiveness of care and reduce 30-day heart failure readmissions.

"Identification and Prevention of Secondary Heart Failure: A Case Study," published in the journal's August 2017 issue, explores possible strategies by which nurses and clinicians can identify secondary heart failure in hospitalized patients and implement early measures to prevent progression to acute decompensated heart failure.

Vlad Gheorghiu, MSN, NP, AGACNP-BC, PCCN-CMC, is a graduate student in the Adult-Gerontology Acute Care Nurse Practitioner Program at the School of Nursing at California State University (CSU), Los Angeles. He worked with program coordinator Thomas W. Barkley Jr., PhD, ACNP-BC, director of nurse practitioner programs at CSU, to write the article.

"Improving outcomes for patients with secondary heart failure should begin during admission and be reinforced along the continuum of care, including after discharge," Gheorghiu said. "Patients can quickly progress to acute decompensated heart failure if early signs and symptoms of heart failure are not identified in a timely manner."

The hypothetical case describes an acutely ill patient with complex disease who was not initially admitted for heart failure but who developed acute decompensated heart failure during his hospital stay.

The article follows his stay in the hospital from the emergency department to a progressive care surgical unit to a medical telemetry unit, to a respiratory intensive care unit and to a specialized heart failure unit. After he and his family receive education about managing his heart condition at home, the patient is discharged with instructions for follow-up medical appointments.

At each stage of the patient's stay, the article provides guidance about important aspects of heart failure management, including:

• Stratifying risk on the basis of factors such as age, heart rate, blood pressure, diabetes and existing cardiovascular conditions
• Recognizing early signs and symptoms
• Identifying differences between heart failure and conditions with similar symptoms
• Correlating assessment results with laboratory data

Among the implications for clinical practice, the authors recommend a patient's plan of care incorporate guideline-directed medical therapy, management of comorbid conditions and precipitating risk factors, and health promotion and self-care education.

At the organizational level, hospital-established protocols to identify and assess patients with potential and existing heart failure and comprehensive education programs for nurses and other clinicians may also improve outcomes for high-risk patients.

As the American Association of Critical-Care Nurses' bimonthly clinical practice journal for high-acuity, progressive and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.