Running Head: CONGESTIVE HEART FAILURE

Congestive Heart Failure: Evidence-Based Practice Jessi Chipman Ferris State University

CONGESTIVE HEART FAILURE Congestive Heart Failure-Evidence Based Paper The research unit that wrote, Evaluation of Treatment for Congestive Heart Failure in Patients

Aged 60 Years and Older Using Generic Measures of Health Status (SF-36 and COOP Charts), conducted a study in regards to the before and after effect of using angiotensin converting enzyme inhibitors (ACE) and impact of well-being with patients 60 years or older suffering from congestive heart failure (CHF). This qualitative and quantitative study evaluated this elderly populations perceived level of physical functioning and well-being before and after starting ACE treatment and their overall improvement of quality of life. This study was measured using the short form 36 health survey (SF-36) and Darmouth COOP charts, which are generic health status measures (Jenkinson, et al. 1997, p. 8). All 68 patients, ages 60-92 years of age, consented to being a part of this study with the intensions that their health care provider would not know their survey results and that their treatment would not be altered due to participation. Methods Each participant, ages 60-92, completed the SF-36 and COOP functional status charts before their ACE inhibitor treatment (6.25 mg of captopril) and then again at their follow-up appointment approximately one month later (Jenkinson, et al. 1997, p. 8). The SF-36 questionnaire covered 8 measures that consisted of; physical function, social function, role limitations due to physical problems, role limitations due to emotional problems, mental health, energy/validity, pain, and general health perception. The COOP is a shorter questionnaire than the SF-36 and consisted of eight questions evaluating physical fitness, feelings, daily activities, social activities, pain, overall health, social support, and quality of life (Jenkinson, et al. 1997, p. 8). The COOP chart used images that were linked to each category of question that matched the perceived physical state of health on a five to one scale. An additional measurement that was used was the oxygen cost diagram (OCD). This measured the breathlessness the client encountered at rest or during physical activity, such as walking uphill. Results

CONGESTIVE HEART FAILURE The results of this study indicated that there was little correlation between the use of ACE

inhibitors and improvement of well-being or quality of life in patients 60 years of age and older suffering from congestive heart failure. Although the treatment with the ACE inhibitor lengthens the amount of years lived with CHF, it was not linked to the improvement of quality of life. Not all 68 participants completed the study due to death and incomplete follow-up. The data collected was from 61 participants, eighteen males and 42 females, with a mean age 81 (Jenkinson et al. 1997, p. 9). The results from the COOP, SF-36, and OCD charts indicated very little improvement or change of health status before and after treatment. Discussion The SF-36 and COOP charts appeared to be an effective method of data collection and analysis but the results may be compromised due to age and comorbidities. The elderlys expectation of change may be altered due to low physical mobility and comorbidities which in return would make the results inconclusive. Ageism could affect the results by assuming that the elderly population will have lowered improvement of quality of life to start with because of their age. The younger population, who can be more active, may notice an improvement with therapy or treatment due to increased mobility where the elderly may not have that opportunity. It is not to say that this is true for all young and elderly populations but this may have an impact on the results. This is another limitation to the study conducted. The relatively small group of participants may represent a generalized area of population rather than a generalized age. Meaning, people adapt according to environment rather than age in several different ways. This could impact a persons perceived belief of well-being and in return, compromising the results. Another limitation is the male to female ratio in this study, weighing heavily more towards females. Gender differences could potentially compromise results because pain and health maintenance are perceived differently between males and females. Developing a plan of care for CHF patients is evidently crucial. According to Ladwig and Ackley 2011, congestive heart failure has several appropriate nursing diagnoses for better quality of care. Three of these consist of: fear related to disease process, ineffective self-health management related to perceived

CONGESTIVE HEART FAILURE barriers, and ineffective coping r/t gender differences in coping strategies. Ineffective self-health management related to perceived barriers was addressed within this study. One outcome criteria for this diagnosis is for the patient to verbalize ability to manage therapeutic regimens within one month of

starting therapy. In order to complete that outcome nursing interventions are important. It is important to be sure to provide support for self-management throughout the process of care and assess the influence of cultural beliefs, norms, and values on the individuals perceptions of the therapeutic regimen (Ladwig & Ackley, 2011, p. 407-409). Fear related to disease process should have an outcome measure of patient verbalizing fears within one week of diagnosis. Two nursing interventions for this are to assess source of fear with client and assess for a history of anxiety (Ladwig & Ackley, 2011, p. 367-369). Ineffective coping related to gender differences in coping strategies has an outcome criterion of using effective coping strategies one month after therapy begins. Nursing interventions include; be supportive of coping behaviors and encourage the patient to make choices and participate in planning care (Ladwig & Ackley, 2011, p. 301-303). Conclusion In order to provide the best plan of care for a patient, it is important to understand their lifestyle and how they got where they are. The best plan of care can only be the best plan of care to a willing participant. Improving quality of life and reducing stressors on a patient with a medical condition can be tough to standardize because there are so many things to take into consideration. Age, gender, cultural beliefs, and environment are just a few. Within this study conducted there were several factors that could lead to misrepresentation of the elderly population and the outcome ACE inhibitors have on the quality of life experienced with CHF. Comorbidities that exist related to age and not related to age are crucial factors in improving quality of life and therapeutic regimens. Treating an underlying cause may be an appropriate measure of the disease process but may be perceived unbeneficial because other complications related to comorbidities overrides the benefits of one medication. Do ACE inhibitors improve quality of life with CHF? That is not a factor that can be standardized. It always varies depending on the individual.

CONGESTIVE HEART FAILURE References Jenkinson, C., Jenkinson, D., Shepperd, S., Layte R., & Peresen S. (1997). Evaluation of treatment for congestive heart failure in patients aged 60 years and older using generic measures of health status (SF-36 and COOP charts). Age and Ageing, 26, 7-13. doi: 10.1093/ageing/26.1.7. Ladwig, G., &Ackley, B. (2011). Mosbys guide to nursing diagnosis. 3rd ed. Maryland Heights. Missouri: Mosbys Elsevier.