NURS FPX 4025 Assessment 4

Name

Capella university

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Presenting Your PICO(T) Process Findings to Your Professional Peers

Acute heart failure (AHF) is described as the development of novel or deteriorating signs and indications of cardiac failure, and it is the most common reason for unplanned hospitalization in individuals over the age of 65. AHF remains linked with negative results, with 90-day hospitalizations and 1-year death ranging from 10.1 to 30.2% (Arrigo et al., 2020). Appropriate AHF care is critical for reducing hospital admissions and improving the health of patients. The assessment will focus on the role of an evidence-based fluid management approach in AHF treatment, including its impact on fluid retention and patient outcomes. It will address data based on recent research comparing fluid management treatment with diuretic therapy to improve patient outcomes.

Diagnosis: Prognosis, Potential Risks, and Associated Complications

AHF is a dangerous condition wherein the heart is unable to propel sufficient blood into the body to supply oxygen, leading to higher fluid levels. AHF is marked by indications of systemic blockage, including excess fluid build-up caused by elevated biventricular heart refill pressure (Arrigo et al., 2020). One of the most dreaded complications of AHF is a recurring readmission due to recuperation and excess fluids. AHF remains a crucial medical issue due to 90-day hospitalizations and 1-year death rates ranging from 10.1 to 30.2% (Arrigo et al., 2020). It places a major fiscal strain on medical settings; the total clinical expenses of yearly average readmission per patient are about $16,000 (Mauro et al., 2023). 

Comorbidities also cause implications for the AHF patients. For example, comorbidities include hypertension (70.1%), diabetes (~40.2%), and kidney failure (~20.1-30.3%), which raise the risk of AHF in older adults. The average age of individuals diagnosed with AHF varies from 70 to 73 years. Around fifty percent of the patients are male. Mostly (65.1-75.2%) had a prior history of cardiac failure (Mauro et al., 2023).  Risk factors, including ischemic heart disease, account for 30.5-40.2% of all AHF hospitalizations in South America. 

Psychosocial variables such as depression, stress, mental retardation, and social exclusion also impose an elevated risk of unexpected repeated hospitalization or mortality of patients with AHF (Arrigo et al., 2020). Chronic consequences are recurring heart failure episodes, deteriorating cardiac function, or thromboembolic events. For instance, an AHF patient could initially face acute shortness of breath due to a higher fluid level, but if not treated, they could suffer multi-organ dysfunction. Initial detection and fluid management are critical for raising survival or lowering impairment. Fluid management is recommended to reduce issues and improve patient outcomes (Wobbe et al., 2020). Evidence-based therapies against risk factors are critical in the care of AHF patients.

Formulating the Research Question 

For solving the issue related to AHF management, the following PICO(T) inquiry was created: In patients with acute heart failure (AHF) who experience diuretic resistance (P), how does the use of evidence-based fluid management interventions (I) compared to standard diuretic therapy (C) affect fluid retention and patient outcomes (O) over 12 weeks (T)? It focuses on improving patient care by investigating proven fluid control treatments to boost patients’ health. 

This question reflects each component of the PICO(T) procedure. Population (P) entails AHF patients as they encounter issues like diuretic resistance, rendering it tough to avoid decompensation and readmissions. Intervention (I) uses evidence-based fluid management strategies. It entails ultrafiltration (UF) therapy for maximum fluid removal (Wobbe et al., 2020).

This approach focuses on the patient’s clinical status rather than a one-size-fits-all diuretic regimen. Comparison (C) is the standard diuretic therapy, which entails loop diuretics for overcoming congestion and symptom relief. The Outcome (O) centres on lowering fluid retention and improving patient outcomes, crucial metrics for effective AHF care. The Time (T) is 12 weeks, which offers enough time to determine the impact of fluid management methods on patient results. This organized inquiry allows for a focused research into the efficacy of fluid management strategies in AHF care, resulting in scientifically supported care adjustments.

Summary of Evidence from Peer-Reviewed Sources

A comprehensive examination of research articles identified the necessary investigations into fluid management treatments for AHF patients. The literature research was done methodically using digital databases including PubMed, CINAHL, the Cochrane Library, and Google Scholar. Every resource has been critically examined by employing the CRAAP criteria: currency, relevance, authority, accuracy, and purpose to validate relevancy and legitimacy (Kalidas, 2021).

Four reliable sources were utilized to evaluate the aspects of fluid management in AHF care. Using a systematic review method, Rahman et al. (2020) discussed that mechanical circulation of fluid clearance with the ultrafiltration process and peritoneal dialysis can overcome diuretic resistance in AHF patients. It is a credible and helpful resource because it is based on extensive research published in the legitimate cardiology publication “Cardiology in Review,” delivering evidence for effective approaches to address the major challenges of fluid retention.

NURS FPX 4025 Assessment 4

Wobbe et al. (2020) offered strong evidence on the efficacy of the ultrafiltration (UF) approach compared to standard diuretic therapy among admitted AHF patients. UF improves fluid evacuation (1372.6 mL) and weight loss (mean difference: 1.593 kg) in AHF patients while decreasing readmissions (p=0.004), and the risk of deteriorating cardiac failure. This study, published in the highly acclaimed and peer-reviewed journal Heart Failure Reviews, adds depth by indicating that UF is an efficient and secure care choice for volume-overloaded AHF patients.

Another resource is the European Society of Cardiology, which demonstrates that sodium and fluid management is effective in chronic or AHF management (ESC, 2021). It recommends classes 1 and 2a (using a sodium-glucose co-transporter-2 (SGLT-2) inhibitor). The ESC guidelines are useful and credible in healthcare as a guide for treating cardiac issues. Stachteas et al.’s (2024) systematic review of controlled trials and observational investigations found that SGLT-2 inhibitors have potential for decreasing diuretic tolerance in acute HF. Recognizing the resource’s evidence and study design provided solid evidence for improved AHF results.

Evidence-Based Response to the PICO(T) Question

The research continually supports the PICO(T) question by demonstrating that fluid management is associated with better results in AHF patients than standard diuretic therapy. Fluid build-up contributes to the deterioration of AHF patients’ conditions, resulting in increased hospital readmission rates and poorer medical results. Effective fluid management strategies like ultrafiltration and peritoneal dialysis can boost AHF patient outcomes by resolving diuretic resistance (Rahman et al., 2020). Further, Wobbe et al. (2020) confirmed that fluid management through UF improves fluid evacuation and weight loss in AHF patients.

It is associated with decreasing patient readmissions, deaths, and the risk of deteriorating cardiac failure. The conclusion is founded on multiple underlying assumptions, including that HF patients are more likely to comply with therapies, that medical providers can effectively assess and adjust fluid requirements, and that evidence-based therapy leads to better patient outcomes. However, socioeconomic standing, accessibility to healthcare, and psychological issues can affect results. Future studies should look into personalized methods to address the discrepancies.

Essential Care Steps Guided by Evidence-Based Recommendations

Research-based suggestions are crucial to enhance the outcomes of AHF patients by adopting effective measures of fluid regulation. The therapy begins with rapid clinical assessment to assess volume status and hemodynamic stability, which then dictates subsequent therapy. It is appropriate as Early hemodynamic analysis also identifies patients for advanced therapy such as UF and lowers the likelihood of multi-organ failure, which is a primary cause of death in AHF. Thus, this phase is critical because it guarantees that future therapies such as fluid management through UF, peritoneal dialysis, and SGLT2 inhibitors are customized to the patient’s particular pathophysiology, increasing safety and efficacy.

The second step is adopting efficient fluid management therapies like UF and peritoneal dialysis, along with SGLT-2, to overcome diuretic tolerance, reducing fluid retention among AHF patients (Rahman et al., 2020; Stachteas et al., 2024). These are suitable as these therapies reduce readmissions and mortality thoroughly than diuretics alone, and provide a personalized approach in high-risk patients, with recurrent decompensation. The last step is patient guidance, which helps to ensure that patients remain conscious of their fluid balance to maintain correct hydration and are informed about fluid management therapy. Patient awareness empowers patients to be more knowledgeable and participate in their therapy plan. These care steps are appropriate for improving the AHF patients’ outcomes as they help reduce mortality and re-hospitalization by managing fluid levels.

Conclusion

AHF is a severe clinical concern, worsened by high fluid levels and deteriorating patient condition. Compared to standard diuretic therapy, effective fluid management therapy improves patient results by lowering fluid retention. It leads to lower readmission and mortality rates.  Advanced therapies like UF support to improve AHF patient condition, reducing kidney impairment and the risk of deteriorating cardiac failure. Constant fluid assessment is crucial for adopting tailored therapies and improving patient health.

References

Arrigo, M., Jessup, M., Mullens, W., Reza, N., Shah, A. M., Sliwa, K., & Mebazaa, A. (2020). Acute heart failure. Nature Reviews Disease Primers, 6(1). https://doi.org/10.1038/s41572-020-0151-7

ESC. (2021, August 25). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Escardio.org. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure

NURS FPX 4025 Assessment 4

Kalidas, E. A. J. (2021). The effectiveness of CRAAP test in evaluating credibility of sources. International Journal of TESOL & Education, 1(2), 1-14. https://www.i-jte.org/index.php/journal/article/view/25

Mauro, C., Chianese, S., Cocchia, R., Arcopinto, M., Auciello, S., Capone, V., Carafa, M., Carbone, A., Galzerano, D., Maffei, V., & Marra, A. M. (2023). Acute heart failure: Diagnostic–therapeutic pathways and preventive strategies—a real-world clinician’s guide. Journal of Clinical Medicine, 12(3), 846. https://doi.org/10.3390/jcm12030846

Rahman, R., Paz, P., Elmassry, M., Mantilla, B., Dobbe, L., Shurmur, S., & Nugent, K. (2020). Diuretic resistance in heart failure. Cardiology in Review, 29(2), 73–81. https://doi.org/10.1097/crd.0000000000000310

Stachteas, Nasoufidou, Patoulias, Karakasis, Karagiannidis, Mourtzos, & Samaras, A. (2024). The role of sodium-glucose co-transporter-2 inhibitors on diuretic resistance in heart failure. International Journal of Molecular Sciences, 25(6), 3122–3122. https://doi.org/10.3390/ijms25063122

NURS FPX 4025 Assessment 4

Wobbe, B., Wagner, J., Szabó, Rostás, Farkas, N., Garami, Balaskó, Hartmann, P., Solymár, M., Tenk, Ottóffy, Nagy, A., Habon, T., Hegyi, P., & Czopf. (2020). Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: A meta-analysis. Heart Failure Reviews, 26(3), 577–585. https://doi.org/10.1007/s10741-020-10057-7

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