Evidence-Based Guidelines For Charlie

Annotated Bibliographies

The paper deals with the study of Charlie a 75-year old overweight man. The patient has history of heart failure as a result of ischaemic cardiomyopathy and hypertension. His present condition is not well. While working in general practice clinic it was noticed that Charlie is breathless, has visible peripheral oedema, and tachycardia. Heart failure is a chronic health condition characterized by weakened heart muscle due to which it cannot pump adequate blood and meet the oxygen demands of the body (Berger et al., 2016). Since the patient is hypertensive and is experiencing shortness of breath he is at higher risk of heart failure. Further, overweight can increase the blood cholesterol level, blood pressure and type 2 diabetes. Therefore, there is a need of managing the illness considering multiple aspects. In this paper, three scholarly articles are used that best summarises the evidence for the management of Charlie’s condition. The justification for the chosen per reviewed article will be provided with other supporting evidences from literature.

Rees, K., Dyakova, M., Ward, K., Thorogood, M., & Brunner, E. (2013). Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev, 3.

In the study executed by Rees et al. (2013) Dietary advice is found to be effective for reducing the cardiovascular risk factors. It may be beneficial for approximately 12 months. The study was conducted due to uncertain effect of dietary advice. The researcher intended to assess if providing dietary advice ensures sustained changes in eating behavior. Thus, the author provided an international review based on the Randomized studies with no more than 20% loss to follow-up. The author carefully excluded the articles and other trials based on children, those related to reducing weight or supplementation. The data was extracted by carefully assessing the trial quality.

Selecting this article as evidence based option for management of Charlie’s condition is justified as diet is an important determinant of heart disease risk according to Rees et al. (2013). Based on the findings it was concluded that dietary changes were found to modestly improve the blood pressure and LDL-cholesterol levels. It is essential for Charlie to implement dietary changes as he is overweight. He has already experienced heart failure two years ago and currently he is again at risk as evident from his symptoms. These beneficial changes due low fat intake were found to reduce the incidence of heart stroke or attack.  Therefore, guidelines related to dietary changes are essential for Charlie for secondary prevention.  It is evident from the case study that Charlie has edema. Therefore, retention of fluid can an also be the cause of his weight gain. It has potential risk of heart failure as excess fluid increases the work load on heart. In order to eliminate excess fluid heart has to pump harder. Therefore, the physician or nurse could implement these guidelines on fluid restriction as suggested by Johansson et al. (2016).  Further, selecting the study of Rees et al. (2013) is justified as similar study executed by Hooper et al. (2016) emphasized on dietary changes for patients of cardiovascular disease. It implies on reduced intake of saturated fat and intake of whole-grains diet as protective factor for heart disease.  Implementing balanced diet for Charlie will reduce the risk of obesity and diabetes. It is also found to be effective for patients with hypertension and in controlling blood pressure (Mozaffarian, 2016).

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Justification And Recommendations

Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F., & Brater, D. C. (2009). Factorsassociated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651-658. https://dx.doi.org/10.1038/clpt.2009.7

In this article, Murray et al. (2009) investigated the factors that contributed to the exacerbation of heart failure. For the purpose of the study the author has conducted a cohort study nested with the randomised trial with the sample size of 192. The results findings of the study includes sodium or hemocrit level, left ventricular ejection fraction, ability to read the prescription label, refill adherence. According to study conducted the rate of hospitalisation of the patient with heart failure increases due to low refill adherence. The incidence of heart failure was found to be low in patients having skills to read prescription. Further, it was found that the risk of hospitalisation is reduced if a patient has health literacy. In short the results concluded that the risk of heart failure increases if patients do not adhere to the treatment regime, or fail to read the prescription or have low health related information.

These results were found significant at 95% confident interval. Hence, the study findings can be used by the physicians, pharmacists and the nurses to provide careful instructions to the patients. Therefore, it was justified to choose the above article for annotated bibliography.  In this case Charlie’s condition can be improved if he is informed by the nurses about taking medications on time. Emphasising on this factor may help Charlie to avoid negligence and take more precautions. He might feel more motivated if explained that taking medications could be beneficial. Non-adherence to treatment can result in poor outcomes such as mortality and morbidity as observed by Moser et al. (2015) in case of rural patients with heart failure. The outcome was mainly associated to poor health literacy. Similarly, increasing health literacy will help Charlie to better understand the activities that will promote his health. He will be aware of the consequences of not refilling the medicines. Nurses can take initiative to increase his prescription reading skills so as to prevent missing on any important guidelines.

Choosing this study for the annotated bibliography is justified because similar study by McNaughton et al. (2014) showed that that low health literacy in heart failure patients results in uncontrolled blood pressures, increase in hospitalisation, and mortality. Charlie is already hypertensive and overweight which makes health literacy a protective factor for him. Therefore, he may be more cautious after learning more about his illness and its consequences. Therefore, he can better read and comprehend the medication labels, appointments and refill instructions. According to Matsuoka et al. (2016) health literacy is independently related to the self care behaviour in patients with heart failure. Higher health literacy is related to change in patient’s health beliefs and self efficacy.

Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J., Dalal, H. M., Lough, F., … & Taylor, R. S. (2015). Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart, 2(1), e000163.

The research paper by Sagar et al., (2015) suggests exercise-based cardiac rehabilitation for heart failure. The paper conducted systematic review and meta-analysis of the randomized control trials to assess the effectiveness of the exercise-based cardiac rehabilitation program in the improvement of health related quality of life and hospitalization. Lack of exercise capacity adversely impacts the activities of daily life according to the researcher. Older patients of heart failure have poor prognosis and rate of survival. These patients have been projected to have increased admissions in hospital due to heart failure. The author thus reviewed various per reviewed articles recommending the exercise-based cardiac rehabilitation. In various randomized control trials patients were either given exercise training either alone or as a apart of cardiac rehabilitation programs which also includes psychological intervention, health education, in addition to exercises. The result findings showed that majority of studies reported a validated health related quality of life measure as well as hospitalization. Therefore, the author of this article suggested that advocating such program for heart failure patients may reduce mortality in the longer term.

Selecting this article as evidenced based management option for Charlie is justified because he has already experienced heart failure two years ago. Considering his present symptoms, it can be interpreted that he is highly vulnerable to future heart failure. Therefore, secondary prevention is important in this case. The health care professionals can use this article as evidence based option for management of Charlie’s condition. Since cardiac rehabilitation involves other programs as well it may give Charlie an additive effect. For instance, psychological interventions may help Charlie overcome anxiety and depression related to his vulnerable condition.  If not cardiac rehabilitation Charlie can be advocated to uptake exercise based program in home setting. According to Bäck et al. (2017) there is an equivalent preference for centre based and home based exercise programs among heart failure patients. However, the study found that in either case the patients had similar health benefits.  The evidence of justification can also be given from the randomized clinical trial of Kitzman et al. (2016). This trial was conducted for patients with heart failure who are overweight and obese. The trial showed that aerobic exercise and calorie restriction increased the peak oxygen consumption.  Höllriegel et al. (2016) investigated the effect of long term exercise training in patients with heart failure and in advanced chronic state. The results showed that training over a period of 12 months resulted in improved exercise capacity. It was beneficial in reversing of left ventricular remodeling. Therefore, these beneficial adaptations for Charlie may improve his current condition.

Conclusion

It can be concluded from the literature review that heart failure is a delicate condition and involve potential risks and comorbidities. The best way to manage heart failure patients is to increase their health literacy, physical activity and advice dietary changes. This recommendations based on the evidence generated from the annotated bibliography. It will improve self care behavior such as medication adherence, participation in health promoting activities in Charlie. Eventually, it may reduce the risk of future cardiovascular events. Implementing this evidence based options is found to improve the quality of life measure and hospitalizations in various studies. Therefore, it may delay the risk of death in case of Charlie.

References

Bäck, M., Öberg, B., & Krevers, B. (2017). Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation–facilitators, barriers and physiotherapist’s role: a qualitative study. BMC Cardiovascular Disorders, 17(1), 77.

Berger, J. S., Peterson, E., Laliberté, F., Germain, G., Lejeune, D., Schein, J., … & Weir, M. (2016). Risk of Ischemic Stroke in Newly Diagnosed Heart Failure Patients.

Höllriegel, R., Winzer, E. B., Linke, A., Adams, V., Mangner, N., Sandri, M., … & Erbs, S. (2016). Long-term exercise training in patients with advanced chronic heart failure: sustained benefits on left ventricular performance and exercise capacity. Journal of cardiopulmonary rehabilitation and prevention, 36(2), 117-124.

Hooper, L., Summerbell, C. D., Thompson, R., Sills, D., Roberts, F. G., Moore, H. J., & Smith, G. D. (2016). Reduced or modified dietary fat for preventing cardiovascular disease. Sao Paulo Medical Journal, 134(2), 182-183.

Johansson, P., van der Wal, M. H., Strömberg, A., Waldréus, N., & Jaarsma, T. (2016). Fluid restriction in patients with heart failure: how should we think?. European Journal of Cardiovascular Nursing, 15(5), 301-304.

Kitzman, D. W., Brubaker, P., Morgan, T., Haykowsky, M., Hundley, G., Kraus, W. E., … & Nicklas, B. J. (2016). Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. Jama, 315(1), 36-46.

Matsuoka, S., Tsuchihashi-Makaya, M., Kayane, T., Yamada, M., Wakabayashi, R., Kato, N. P., & Yazawa, M. (2016). Health literacy is independently associated with self-care behavior in patients with heart failure. Patient education and counseling, 99(6), 1026-1032.

McNaughton, C. D., Jacobson, T. A., & Kripalani, S. (2014). Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease. Patient education and counseling, 96(2), 165-170.

Moser, D. K., Robinson, S., Biddle, M. J., Pelter, M. M., Nesbitt, T. S., Southard, J., … & Dracup, K. (2015). Health literacy predicts morbidity and mortality in rural patients with heart failure. Journal of cardiac failure, 21(8), 612-618.

Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation, 133(2), 187-225.

Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F., & Brater, D. C. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651-658.  Management Of Heart Failure Example Paper