The investigations of congestive heart failure (CHF) at the beginning of the 2000s showed the increasing number of cases among adult patients with 300,000 deaths per 1,000,000 patients annually (Scott & Winters, 2015). The numbers are impressive, and many researchers continue investigating the field in order to find out new ways of treatment that can be offered to CHF patients or other ways which can help to reduce readmission rates. Wu et al. (2013) suggest a low literacy level as one of the possible reasons for increased risks of hospitalization and deaths among CHF patients.
Education and understanding of the nature of the health problems are integral aspects of a treatment process (Skaperdas et al., 2014). However, it is not enough to gather the information about the causes of the health problem. It is necessary to research the field and find out what people think about management of the diseases. Current literature is controversial in regards to the role of body mass index as one of the possible risk factors.
This literature review aims at improving the understanding of the concept of congestive heart failure and recognition of various types of treatments, including medical, surgical, and non-medical, in order to clarify what researchers know about the possibility to reduce readmission rates among CHF patients whose BMI is higher than necessary. Several medical databases and Google Scholar are used to gather the information about the disease, BMI, and treatment methods. Journal articles published during the last five years are summarized and synthesized in this review.
Congestive Heart Failure Patients
Patients who have congestive heart failure are usually the people aged 65 or more years (Scott & Winters, 2015). Their main complaints include fatigue, weakness, shortness of breath, irregular heartbeats, mental activities change, and weight gain (Rabbat et al., 2012). The causes of this disease may vary from heart attack or coronary artery disease to diabetes or high blood pressure (de Oliveira et al., 2017; DiNicolantonio, Chatterjee, & O’Keefe, 2015; Rabbat et al., 2012).
CHF is a chronic type of illness, and patients should understand that their awareness and the necessity to improve and control their health are two obligatory conditions that have to be followed. However, the evaluation of the statistical data proves that patients do not want to or unable to use all medical, surgical, and non-medical opportunities and learn their options. They continue addressing hospitals several times per year. For example, in 1979, 1,274,000 patients were reported, in 2004, 3,860,000 patients addressed for help, and, during the last two years, 5,800,000 cases were investigated (Rabbat et al., 2012; Wu et al., 2013). Approximately 5% of all CHF dies annually, and 37% have a low level of disease’s literacy at the baseline (Wu et al., 2013).
CHF patients are not the only people who should take responsibility for the improvement of their literacy levels. It is the task of health care providers to support patients, meet their needs and experiences, and educate them to any extent possible using various clinical approaches, engaging patients in various targeted and training programs (Skaperdas et al., 2014). Such aspects as pathophysiology, etymology, and management have to be frequently discussed with patients to avoid further misunderstandings or complications (Scott & Winters, 2015). Therefore, cooperation between patients and their caregivers have to be properly developed and investigated from different perspectives (Wu et al., 2013).
Readmission Rates in CHF Patients
In medical research, much attention is paid to CHF readmission rates (Bradley et al., 2013; Rabbat et al., 2012). It is a kind of national priority to reduce hospital readmission rates among CHF patients using various strategies and programs. Still, the knowledge for treatment is limited, and patients do not know what steps can be taken to stabilize their health.
Bradley et al. (2013) remark that many patients with Medicare insurances address hospitals due to their heart failures within 30 days and cause certain negative outcomes that cost the American society about $15 billion annually. Such decompensation makes researchers focus on various reasons for a new admission to a hospital. Interventions have to be based regarding such factors as the patient’s age, any prior hospital admission’s peculiarities, the length of the last stay in a hospital, the level of CHF severity, and other medical comorbidities that may change the development of CHF (Rabbat et al., 2012). The peculiar feature of any new readmission is the impossibility to control its development and use the same treatment methods.
Depending on the severity of the problem, CHF patients can be provided with different types of help, including medical or surgical interventions, counseling and education, and non-medical treatment (Skaperdas et al., 2014).
Medical and Surgical Interventions
CHF, as any heart failure, may be treated medically or surgically. Medications may vary considerably because of possible allergies or intolerance. As a rule, doctors offer their CHF patients such medications as beta blockers to slow heart rate, ACE inhibitors to low blood pressure, or angiotensin blockers in case a patient suffers from ACE intolerance, nitroglycerin, and various diuretics or inotropes (Scott & Winters, 2015; Wu et al., 2013). Though medical therapy is not usually effective alone, it is frequently offered to CHF patients due to the inability to find another effective method and avoid surgeries. Pharmacological therapy has its benefits for patients, including the possibility to be treated at home and continue taking regular activities (Rabbat et al., 2012; Wu et al., 2013).
Outpatient surgery is another intervention that can be offered to CHF patients (de Oliveira et al., 2017). Patients can be offered such surgeries as coronary bypass or heart valve replacement (de Oliveira et al., 2017). Mechanical assistance in the form of intraaortic balloon pumps is recommended for patients in case severe outcomes of cardiogenic shock are observed (Scott & Winters, 2015). However, nowadays, researchers want to prove the possibility of non-medical treatment as one of the most effective solutions.
Non-Medical Treatment for CHF Patients
Non-medical treatment is closely connected with the investigation of BMI and clarification if obesity is the cause of CHF development and readmission, and if a specific diet can be offered as the main solution to patients (Bradley et al., 2013; de Oliveira et al., 2017; DiNicolantonio et al., 2015). Weight is one of the symptoms CHF patients may have (Skaperdas et al., 2014). Therefore, changes in BMI may be defined as a separate cause of the health problem or a signal of the development of other health problems, such as hypertension or obesity that may provoke CHF.
No clear conclusions have been given to explain the connection between congestive heart failure and body mass index changes. Researchers find it necessary to focus on such non-medical forms of treatment as patient education, the development of STELR programs, and the improvement of communication between patients and their caregivers (Bradley et al., 2014; Rabbat et al., 2012; Wu et al., 2013). For example, there is RED project, meaning Re-Engineered Discharge (Rabbat et al., 2012). Its goal is to provide nurses with clear instructions and guidelines on how to help patients comprehend all their after-hospital care instructions, take medications, and follow appointments.
DiNicolantonio et al. (2015) offer a specific diet under which salt restriction is promoted. Salt is the cause of hypertension development among the American population. If such diet is accepted by people, they can easily reduce the presence of risk factors in their lives and protect their health. However, the authors do not give a direct answer to the question if salt restriction diet can promote the reduction of readmission rates among CHF patients (DiNicolantonio et al., 2015). Patients have to continue educating and learning what types of diets can be used to reduce their risks of being readmitted (Rabbat et al., 2012).
In general, the review of the literature shows that numerous interventions and investigations have been already developed to improve the understanding of congestive heart failure, its symptoms, complications, and treatment. Patients may use medications to be treated. Surgeries may be recommended to find a practical solution to the health problem.
The field of non-medical interventions remains to be open. Researchers offer their ideas and show that a specific diet may be a solution. Though the salt reduction is a possible treatment, it is not the only solution. This literature review creates a solid basis for the development of new ideas on how to combine such concepts as congestive heart failure, increased body mass index, and dietary treatment.
Bradley, E.H., Curry, L., Horwitz, L.I., Sipsma, H., Wang, Y., Walsh, M.N., … Krumholz, H.M. (2013). Hospital strategies associated with 30-day readmission rates for patients with heart failure. Circulation: Cardiovascular Quality and Outcomes, 6(4), 444-450.
de Oliveira, G. S., McCarthy, R. J., Davignon, K., Chen, H., Panaro, H., & Cioffi, W. G. (2017). Predictors of 30-day pulmonary complications after outpatient surgery: Relative importance of body mass index weight classifications in risk assessment. Journal of the American College of Surgeons, S1072-7515(17). doi: 10.1016/j.jamcollsurg.2017.04.013
DiNicolantonio, J.J., Chatterjee, S., & O’Keefe, J.H. (2015). Dietary salt restriction in heart failure: Where is the evidence? Progress in Cardiovascular Diseases, 58(4), 401-406.
Rabbat, J., Bashari, D.R., Khillan, R., Rai, M., Villamil, J., Pearson, J.M, & Saxena, A. (2012). Implementation of a heart failure readmission reduction program: A role for medical residents. Journal of Community Hospital Internal Medicine Perspectives, 2(1). doi: 10.3402/jchimp.v2i1.10674
Scott, M.C., & Winters, M.E. (2015). Congestive heart failure. Emergency Clinics of North America, 33(3), 553-562.
Skaperdas, E., Tuepker, A., Nicolaidis, C., Robb, J. K., Kansagara, D., & Hickam, D. H. (2014). Congestive heart failure self-management among US veterans: The role of personal and professional advocates. Patient Education and Counseling, 95(3), 371-377.
Wu, J.R., Holmes, G.M., DeWalt, D.A., Macabasco-O’Connell, A., Bibbins-Domingo, K., Ruo, B., … Pignone, M. (2013). Low literacy is associated with increased risk of hospitalization and death among individuals with heart failure. Journal of General Internal Medicine, 28(9), 1174-1180.