Heart failure: An update for nurses.

ABSTRACT: Heart failure (HF) is a chronic syndrome that requires patients to manage signs and symptoms and adhere to a complex medication regimen. This article discusses updates in HF care related to a universal definition and new therapies, focusing on the four pillars of therapy for HF with reduced ejection fraction.

Integrating Palliative Care Into Heart Failure Management.

BACKGROUND: The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families through the prevention and relief of suffering by assessment and treatment of physical, psychosocial, and spiritual problems. Any patient with chronic debilitating disease, including heart failure, is a candidate for interdisciplinary palliative care to manage their complex physical and psychosocial needs. CLINICAL RELEVANCE: The philosophy of palliative care has evolved to include a vision of holistic care extended to all individuals with serious illness and their families or caregivers that should be integrated throughout the continuum of care, including the acute phase. The critical care nurse will likely encounter patients with heart failure who are receiving or are eligible to receive palliative care at various time points during their illness. Critical care nurses therefore play a pivotal role in symptom palliation affecting the heart failure patient's quality of life. PURPOSE: To review the models of palliative care and the role that the critical care nurse plays in symptom palliation and preparation of the patient and their family for transition to other levels and settings of care. CONTENT COVERED: This review addresses the principles and models of palliative care along with how to integrate these principles into all phases of the heart failure disease continuum. Also included are recommendations for palliation of symptoms specific to heart failure patients as well as a discussion of the role of the critical care nurse and the importance of shared decision-making.

Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse.

High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient's ability to recognize heart failure symptoms and the critical care nurse's role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.

The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate.

Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.