CONCLUSION
Heart failure is a global epidemic, particularly in countries with a rapidly aging population. In the United States, HF is the most common reason for hospital admission among those over 65 years of age. Half of patients diagnosed with HF die within five years, both nationally and internationally. There are known racial, ethnic, gender, socioeconomic, and age differences that produce varied responses to the disease and to treatments.
There are many different forms of heart failure. Each one represents a distinct set of symptoms leading to the diagnosis. The failure may occur on the right or the left side of the heart, resulting in fluid retention or respiratory symptoms, respectively. Over time, failure of one side of the heart or the other will result in both sides of the heart failing. The patient with HF will exhibit either a reduced (HFrEF) ejection fraction or a preserved (HFpEF) ejection fraction. Systolic HF will exhibit a low EF; diastolic HF will exhibit a normal EF.
Risk factors for heart failure include advanced age, female gender, tobacco use, obesity, excessive drinking, and genetic disposition. Some factors, such as smoking, drinking, and obesity, are modifiable, and lifestyle changes in these areas may prevent HF or slow the progression. Illness caused by the COVID-19 virus has emerged recently as a comorbidity of HF. Similar risk factors and mutual exacerbation of symptoms have also caused HF to be a determining survival factor in COVID-19.
The definitive test to confirm a diagnosis of heart failure is a blood test measuring the level of the neurohormone released in HF, B-type natriuretic peptide (BNP). Normal results are <100 pg/ml. The higher the level of the BNP, the more severe the degree of HF. Oher diagnostic tests are performed to determine cardiac and pulmonary function and the presence and degree of any comorbidities such as diabetes, liver or renal failure, COPD, hypertension, or any other heart diseases.
HF may be treated by medications, surgical procedures, or the implantation of devices designed to support the heart that is failing, occasionally as a bridge-to-transplant. HF patients are usually on cardiac monitors when they are in an acute care hospital, necessitating time in an intensive care, step-down critical care, or telemetry unit if they are ambulatory.
A great deal of research and clinical trials have been performed to reduce the readmission rate of HF patients to the hospital. Billions of dollars are spent in the United States each year for the treatment of HF, mostly on hospitalization. Patient and family teaching, cardiac rehabilitation, the promotion of self-care, and prevention of the worsening of the HF patient’s condition all serve as methods to prevent the recurrence of HF symptoms that could necessitate readmission to the hospital.
Caring for heart failure patients is a multidisciplinary approach. Physicians, nurses, respiratory therapists, physical therapists, occupational therapists, exercise physiologists, mental health workers, social workers, dietitians, discharge planners, technicians, and families all work together for the benefit of heart failure patients.
RESOURCES
American Association of Heart Failure Nurses
Heart failure (American Heart Association)
Heart failure (NIH/Medline Plus)
Heart failure (National Heart, Lung, and Blood Institute)
REFERENCES
NOTE: Complete URLs for references retrieved from online sources are provided in the PDF of this course.
Abramson M, Harvey J, Greenfield M, Lauman S, & Metzler D. (n.d.). Partners in therapy: a case study of OT intervention for a recipient of a left ventricular access device. Advance for Occupational Therapy Practitioners, 16–20.
American Heart Association (AHA). (2021). What is cardiac rehabilitation? Retrieved from https://www.heart.org
Amgen. (2019). What is Corlanor? Retrieved from https://www.corlanor.com
Andersen J, Gerds TA, Gislason G, Schou M, Torp-Pedersen C, Hlatky MA, Møller S, Madelaire C, & Strandberg-Larsen K. (2020). Socioeconomic position and one-year mortality risk among patients with heart failure: a nationwide register-based cohort study. European Journal of Preventive Cardiology, 27(1), 79–88. doi:10.1177/2047487319865946
Astellas Pharma. (2018). Lexiscan. Retrieved from https://www.astellas.us
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. (2020). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(10). Retrieved from https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659
Bennett A, Nxumalo K, Pike W, & Carroll O. (2020). Abstract P480: the distinct role of occupational therapy in addressing the self-care management needs of patients with heart failure. Circulation, 141. Retrieved from https://www.ahajournals.org/doi/abs/10.1161/circ.141.suppl_1.P480
Blum MR, Øien H, Carmichael HL, et al. (2020). Cost-effectiveness of transitional care services after hospitalization with heart failure. Annals of Internal Medicine, 172, 248–57. doi:10.7326/M19-1980
Boa Sorte Silva NC, Pulford RW, Lee DS, & Petrella RJ. (2020). Heart failure management insights from primary care physicians and allied health care providers in Southwestern Ontario. BMC Family Practice, 21(1), 1–9. doi:10.1186/s12875-020-1080-y
Byrd R, Smith P, Mohamedaly O, Snyder LD, & Pastva AM. (2019). A 1-month physical therapy–based outpatient program for adults awaiting lung transplantation: a retrospective analysis of exercise capacity, symptoms, and quality of life. Cardiopulmonary Physical Therapy Journal, 30(2), 61–9. doi:10.1097/CPT.0000000000000087
Byrne AL, Hegney D, Harvey C, Baldwin A, Willis E, Heard D, Judd J, Palmer J, Brown J, Heritage B, Thompson S, & Ferguson B. (2020). Exploring the nurse navigator role: a thematic analysis. Journal of Nursing Management, 4, 814. doi:10.1111/jonm.12997
Centers for Disease Control and Prevention (CDC). (2020a). Heart failure. Retrieved from https://www.cdc.gov
Centers for Disease Control and Prevention (CDC). (2020b). Perceived exertion: Borg perceived rating of exertion scale. Retrieved from https://www.cdc.gov
Chapel DB & Husain AN. (2018). Acute-onset heart failure secondary to long-standing abuse of alcohol, cocaine, and marijuana. Toxicology Research and Application, 2. doi:10.1177/2397847318770726
Cleveland Clinic. (2021). Heart disease: stem cell therapy. Retrieved from https://my.clevelandclinic.org
Cleveland Clinic. (2019). Heart failure and women. Retrieved from https://my.clevelandclinic.org
Clevenger R. (2019). The role of respiratory in the management of congestive heart failure. Retrieved from https://rtsleepworld.com
Docherty KF, Vaduganathan M, Solomon SD, & McMurray JJV. (2020). Sacubitril/valsartan: neprilysin inhibition 5 years after PARADIGM-HF. JACC Heart Failure, 8(10), 800–10. doi:10.1016/j.jchf.2020.06.020. Erratum in JACC Heart Failure,8(12), 1057. PMID:33004114.
Fukuoka S, Dohi K, Takeuchi T, Moriwaki K, Ishiyama M, Omori T, & Fujimoto N. (2020). Mechanisms and prediction of short-term natriuretic effect of sodium-glucose cotransporter 2 inhibitor in heart failure patients coexisting type 2 diabetes mellitus. Heart and Vessels, 9, 1218. doi:10.1007/s00380-020-01597-x
Fagih AA, Mariam AO, Saleh AB, Fahmi A-K, Khalid D, & Yahya AH. (2020). Remotely monitored inactivity due to COVID-19 lockdowns: potential hazard for heart failure patients. Saudi Medical Journal, 41(11), 1211ff.
Halabi A, Sen J, Huynh Q, & Marwick TH. (2020). Metformin treatment in heart failure with preserved ejection fraction: a systematic review and meta-regression analysis. Cardiovasc Diabetol, 19(1), 124. doi:10.1186/s12933-020-01100-w
Harding MM, Kwong J, Roberts D, Hagler D, & Reinisch C. (2020). Lewis medical-surgical nursing assessment and management of clinical problems (11th ed.). St. Louis: Elsevier.
Hartupee J & Mann DL. (2017). Neurohormonal activation in heart failure with reduced ejection fraction. Nature reviews. Cardiology, 14(1), 30–8. doi:10.1038/nrcardio.2016.163
Intermountain Health Care. (2021). Self-management: MAWDS for heart failure. Retrieved from https://intermountainhealthcare.org
Khan E. (2021). Heart failure and COVID-19: synergism of two inflammatory conditions? British Journal of Community Nursing, 26(1), 18–25.
Kaunda RE. (2019). Atrial and brain natriuretic peptides. Cardiovascular physiology concepts. Retrieved from https://www.cvphysiology.com
Klajda MD, Scott CG, Rodeheffer RJ, & Chen HH. (2020). Diabetes mellitus is an independent predictor for the development of heart failure: a population study. Mayo Clinic Proceedings, 95(1). doi:10.1016/j.mayocp.2019.07.008
Kruik-Kollöffel WJ, van der Palen J, Doggen CJM, van Maaren MC, Kruik HJ, Heintjes EM, Movig KLL, & Linssen GCM. (2020). Heart failure medication after a first hospital admission and risk of heart failure readmission, focus on beta-blockers and renin-angiotensin-aldosterone system medication: a retrospective cohort study in linked databases. PLoS ONE, 15(12), 1–18. doi:10.1371/journal.pone.0244231
Mayo Clinic. (2021). Cardiac rehabilitation. Retrieved from https://www.mayoclinic.org
McCuistion LE, Vuljoin DiMaggio K, Winton MB, & Yeager JJ. (2019). Pharmacology: a patient-centered nursing process approach (10th ed.). St. Louis: Elsevier.
Merck & Co. (2021). Heart failure (HF) (congestive heart failure). Merck Manual, Consumer Version. Retrieved from https://www.merckmanuals.com
Merck & Co. (2020). Heart failure. Merck Manual, Professional Version. Retrieved from https://www.merckmanuals.com
Morgan K. (2021). Personal communication.
National Heart, Lung, & Blood Institute (NHLBI). (2021a). Heart valve disease. Retrieved from https://www.nhlbi.nih.gov
National Heart, Lung, & Blood Institute (NHLBI). (2021b). Defibrillators. Retrieved from https://www.nhlbi.nih.gov
National Heart, Lung, & Blood Institute (NHLBI). (2021c). The survival benefit of an implantable defibrillator for heart failure lasts at least 10 years. Retrieved from https://www.nhlbi.nih.gov
National Heart, Lung, & Blood Institute (NHLBI). (2020d). Heart failure. Retrieved from https://www.nhlbi.nih.gov
National Institutes of Health (NIH). (2020). Heart health tests. Medline Plus. Retrieved from https://medlineplus.gov
Nationwide Children’s. (2017). Transtelephonic monitor (TTM) 30-day looping event monitor. Retrieved from https://www.nationwidechildrens.org
Physiopedia. (2021). Physical activity and cardiovascular disease. Retrieved from https://physio-pedia.com
Popa-Fotea N-M, Michu MM, & Dorobantu M. (2020). Metabolic syndrome, nutritional deficits and heart failure. Journal of Hypertension Research, 6(1), 10ff. Retrieved from http://link.gale.com/apps/doc/A625500000/AONE?u=uphoenix&sid=AONE&xid=3ecdcf87
Roberts P, Robinson M, Furniss J, & Metzler C. (2020). Occupational therapy’s value in provision of quality care to prevent readmissions. American Journal of Occupational Therapy, 74, 7403090010. doi:10.5014/ajot.2020.743002. Retrieved from https://ajot.aota.org
Roe M. (2021). Personal communication.
Roe M. (2020). Fall prevention: interventions for balance problems and risks. Retrieved from https://wildirismedicaleducation.com
Roshanghalb A, Mazzali C, & Lettieri E. (2020). Composite outcomes of mortality and readmission in patients with heart failure: Retrospective review of administrative datasets. Journal of Multidisciplinary Healthcare, 539. doi:10.2147/JMDH.S255206
Salahodinkolah MK, Ganji J, Moghadam SH, Shafipour V, Jafari H, & Salari S. (2020). Educational intervention for improving self-care behaviors in patients with heart failure: a narrative review. Journal of Nursing & Midwifery Sciences, 7(1), 60–68. doi:10.4103/JNMS.JNMS_19_19
Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, AlHabib KF, Al-Zakwani I, & Asaad N. (2020). Precipitating factors for hospitalization with heart failure: prevalence and clinical impact observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry). Medical Principles and Practice, 3, 270. doi:10.1159/000503334
Sana F, Isselbacher EM, Singh JP, Heist EK, Pathik B, & Armoundas AA. (2020). Wearable devices for ambulatory cardiac monitoring: JACC state-of-the-art review. J Am Coll Cardiol, 75(13), 1582–92. doi:10.1016/j.jacc.2020.01.046
Sears B. (2020). What is a timed up and go (TUG) test? Retrieved from https://www.verywellhealth.com
Sears B. (2019). The four phases of cardiac rehabilitation. Retrieved from https://www.verywellhealth.com
Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, & Collins SM. (2020). Physical therapist clinical practice guideline for the management of individuals with heart failure. Physical Therapy, 100(1), 14–43.
Singhvi A & Trachtenberg B. (2019). Left ventricular assist devices 101: shared care for general cardiologists and primary care. Journal of Clinical Medicine, 8, 1720. doi:10.3390/jcm8101720
Sole ML, Klein D, & Moseley M. (2020). Introduction to critical care nursing (8th ed.). St. Louis: Elsevier Saunders.
Taniguchi C, Okada A, Seto N, & Shimizu Y. (2020). How visiting nurses detect symptoms of disease progression in patients with chronic heart failure. International Journal of Qualitative Studies on Health & Well-Being, 15(1), 1–11. doi:10.1080/17482631.2020.1735768
Urbich M, Globe G, Pantiri K, et al. (2020). A systematic review of medical costs associated with heart failure in the USA (2014–2020). PharmacoEconomics, 38, 1219–36. doi:10.1007/s40273-020-00952-0
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9). Retrieved from https://pubmed.ncbi.nlm.nih.gov
Wang N, Farrell M, Hales S, Hanvey K, Robertson G, Sharp P, & Tofler G. (2020). Prevalence and seasonal variation of precipitants of heart failure hospitalization and risk of readmission. International Journal of Cardiology, 316, 152–60. doi:10.1016/j.ijcard.2020.04.084
Wolfe NK, Mitchell JD, & Brown DL. (2020). The independent reduction in mortality associated with guideline-directed medical therapy in patients with coronary artery disease and heart failure with reduced ejection fraction, European Heart Journal—Quality of Care and Clinical Outcomes. Retrieved from https://academic.oup.com
Yamada S, Arrell DK, Rosenow CS, Bartunek J, Behfar A, & Terzic A. (2020). Ventricular remodeling in ischemic heart failure stratifies responders to stem cell therapy. Stem Cells Translational Medicine, 9(1), 74–9.
Yamamoto S, Yamaga T, Nishie K, Nagata C, & Mori R. (2020). Positive airway pressure therapy for the treatment of central sleep apnoea associated with heart failure. Cochrane Database System Review, 12(12), CD012803. doi:10.1002/14651858.CD012803.pub2
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, et al. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. doi:10.1161/CIR.0000000000000509
Zahoransky MA & Lape JE. (2020). Telehealth and home health occupational therapy: clients’ perceived satisfaction with and perception of occupational performance. International Journal of Telerehabilitation, 12(2), 105–24. doi:10.5195/ijt.2020.6327