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Designed for the Unique Needs
of Homecare Providers
This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.
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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978
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CHF
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Heart Failure
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| Heart failure is among the top five most prevalent diagnoses of home healthcare patients. It is the most expensive disease in the U.S. Medicare System because of multiple admissions. It is estimated that for people over 65 years old, the incidence of heart failure approaches 10 per 100. Heart failure represents 14% of Medicare beneficiaries but accounts for 43% of all Medicare spending. |
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Heart failure is the most common cause of hospital admission in the older adult. The most common cause for hospital re-admission in patients with heart failure is fluid overload. The evidenced-based literature indicates that patients delay seeking medical advice despite progressive symptoms on average 12 hours to 14 days. In addition, research has identified key indicators to predict those most at risk for re-admission due to fluid overload or dehydration. Both of these issues are amenable to early intervention programs with the appropriate surveillance systems in place.
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Heart Failure vs Congestive Heart Failure
In 2005 and 2009, the American College of Cardiology/American Heart Association
(ACC/AHA) Guidelines on the Evaluation and the Management of Chronic Heart Failure defined it as a preventable disease. The early stages of heart failure may be silent. We now use the term "congestive heart failure" to describe only those patients who are in the active state of fluid overload, i.e. those with physical signs and symptoms of fluid excess.
Research supports that transition of care, as in the combination of discharge planning and post discharge care for patients with heart failure, significantly reduces re-admission rates, improves outcomes such as survival, quality of life and cost. At the center of these successful programs is self-care management with multidisciplinary team support.
Self-care interventions to reduce co-morbidities affecting cardiac health are a part of a comprehensive management program. (2009) Home healthcare for heart failure patients therefore extends to therapeutic lifestyle change counseling in order to overcome obstacles to maintain or improve health.
Heart failure guidelines are specific concerning pharmacotherapy, diagnostics and mechanical interventions. They, however, provide only general self-care measures. It is the interpretation of these general guidelines into more specific, individualized, comprehensive interventions and surveillance that have demonstrated both improved outcomes and quality of life. The focus on effective patient self-care can promote independence and safety in illness management. It is evidenced-based nursing care that provides the additional framework for the specific interpretation of these guidelines provided in this Clearinghouse.
By developing and sharing Best Practice models for heart failure management, VNAA's goal is to have a broad national impact by empowering homecare agencies and clinicians to improve both patient outcomes and satisfaction.
Best Practice:
Each homecare patient with heart failure should have an individualized, comprehensive, self-care management plan to monitor for and to treat fluid overload or dehydration as well as minimize risk factors contributing to instability. In addition, the plan should include mutually agreed upon goals for heart failure care including lifestyle modifications. Families are an important component in the self-care management plan since their participation is key to long-term success. (See details under Monitoring)
WHAT THE HOMECARE CLINICIAN CAN INFLUENCE
The homecare clinicians' role in assisting patients and families in managing chronic illness is to ensure patient safety and to promote independence in illness management. This involves discovering what a patient or family knows about his or her illness, what they need to know about monitoring signs and symptoms, what their self-care action plan is if signs and symptoms occur, what changes they need to incorporate into daily life in order to reduce the incidence of these signs and symptoms, what life style changes are incorporated into daily life in order to maximize health.
Since guideline based goals for heart failure management include:
- Promoting clinical stability
- Reducing disease progression
The clinician's influence extends to assessing for risk factors for instability. Since exacerbations of other co-morbidities such as diabetes, hypertension, anemia and depression can affect fluid status these risk factors for instability require surveillance. |
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Levels of evidence
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Level 1
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Systematic reviews and repeated studies, thoroughly researched.
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Level 2
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Experimental (Single or Quasi experimental study) and non-experimental (Exploratory or qualitative study).
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Level 3
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Recommendations of respected, experienced homecare authorities.
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Level 4
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Not Recommended.
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