- Congestive Heart Failure
Reduce the risk of readmissions related to congestive heart failure (CHF)
Managed CHF conditions
With no identified cure for CHF, evidence-based practice must be used to manage the condition.
To help reduce readmissions for
congestive heart failure:
- Ensure appropriate discharge planning
- Create an individualized, patient-centered care plan
- Properly reconcile patient medication
- Provide adequate patient and caregiver education
- Promote strong clinical competency regarding disease management
- Schedule physician follow-up appointments or ancillary referrals
Post-acute care providers should also focus on symptom relief to reduce rehospitalization for heart failure, and thus help improve overall patient outcomes.
CHF: By the Numbers
More than 870,000 new cases of CHF are diagnosed each year. Although CHF affects people of all ages, it is the leading cause of readmissions in adults over the age of 65. Sixty-one percent of heart failure readmissions occur within the first 15 days, and in the long-term care setting, 27-43% of readmission rates are caused by heart failure alone.
6M
adults in the U.S. have CHF
50%
of people will die within 5 years of diagnosis
75%
of those affected have at least one comorbidity
$30B
cost of CHF annually
24.5%
of every 100 Medicare patients admitted to a hospital within a 30-day period due to CHF
Preventative action can help keep your patients better protected from CHF
- Discharge: Utilize discharge planning tools such as facility readiness assessments, hospital to post-acute transfer forms, post-acute care capabilities checklists and medication reconciliation worksheets.
- Clinical Competency: Ensure clinical competency with a patient-centered care plan, by performing a complete physical assessment to establish baselines and identify early signs and symptoms of CHF, monitoring for indicators and increase your understanding of clinical guidelines for managing CHF.
- Patient Screening: You can prevent CHF by screening symptomatic patients with common co-morbidities and performing diagnostic testing, including a complete physical assessment, medication review and labs.
- Nutrition: Ensure patients adhere to fluid restriction (1.4-2L), promote calorically dense products that will not negatively impact other disease states, specifically for patients taking nutritional supplements and recommend nutritional options with extra sodium or glucose that replenish electrolytes.
- Education: Educate patients and caregivers on indication, dosage, schedule and side effects of medications, communicate patient dietary needs and restrictions, routinely monitor patient weight, stress importance of good oral hygiene and recommend therapeutic exercise.
- OTC Medicine: Prescribe multi-vitamins and supplements, recommend smoking cessation and manage CHF side effects.
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Diagnosing CHF
Diagnosing a CHF exacerbation is generally focused on fluid retention. It is widely believed that the symptoms of fluid overload are evident as much as a week before hospitalization. However, some patients do not admit to symptoms to avoid a return to the hospital – often making their situation worse.
Signs and symptoms of CHF are:
- Symptoms of fluid overload
- Confusion/anxiety
- Chest pain
- Palpitations – stimulation of SNS response
- Anorexia, early satiety – resulting from decreased GI perfusion
- Unstable vital signs
When diagnosing CHF you will need to complete a full assessment, review patient history, confirm medication compliance, administration and profile, notify doctor of all abnormal assessment results and any deficiencies or non-compliance and inform and educate patient, family or caregiver. Further diagnostic testing may be requested to include labs (BNP, CMP, CBC, INR and blood glucose) and a portable chest x-ray or an EKG.
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Treating CHF
CHF can be treated in place according to physician orders. An automated external defibrillator (AED) should also be available on site.
To treat CHF, you will need to:
- Monitor patient vital signs and input/output every 4 to 8 hours
- Monitor electrolytes and renal function
- Provide supplemental oxygen, if necessary
- Update advance care plan and directives
Consider:
- Increase dosage of diuretics
- Increase other cardiac medications to optimize use and efficacy
- Use a portable chest x-ray
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National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/heart-failure/causes
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