Heart failure with preserved LV function: pathophysiology, clinical presentation, treatment, and nursing implications

Diastolic heart failure: state of the science on best treatment practices

PURPOSE

The purpose of this article is to increase awareness among nurse practitioners (NPs) of the current state of the science on diastolic heart failure (DHF), the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for DHF, and pathophysiology, diagnosis, and nonpharmacological and pharmacological management of DHF.

DATA SOURCES

The articles included in the review of the state of the science were retrieved by a search of PUBMED literature using the following key search terms: heart failure, diastolic heart failure, preserved systolic function, heart failure management, treatment of diastolic heart failure, treatment of diastolic dysfunction, and treatment of preserved systolic function. Current published guidelines from the ACC and AHA were reviewed to establish clinical recommendations for patients with DHF.

CONCLUSIONS

The state of the science and clinical recommendations for DHF are in the early stages compared to those for systolic heart failure (SHF). The need for more randomized clinical trials on nonpharmacological and pharmacological management and the development of standardized guidelines for DHF patients are clearly apparent.

IMPLICATIONS FOR PRACTICE

Both nonpharmacologic and pharmacologic management are effective and necessary to control the clinical signs and symptoms of DHF and improve overall quality of life. Successful tailoring of a treatment plan to suit each individual patient's needs and including the family are important for the NP to consider.

Heart Failure and Weight Gain Monitoring

Heart failure is one of the most common diagnoses of the elderly in the United States. The nursing literature has demonstrated that nursing interventions aimed at effective discharge planning and appropriate self-care activities can improve outcomes for patients hospitalized with heart failure. The purpose of this research was to identify, through retrospective medical record review, the discharge instruction related to self-weight monitoring provided to a sample of heart failure patients. The patients in the sample were 65 years and older with an ICD-9 diagnostic code of heart failure upon discharge from an acute care hospital in the Midwest. Results demonstrated the lack of nursing attentiveness to teaching self-monitoring weight gain to heart failure patients while hospitalized and the need for more comprehensive planning for appropriate discharge referrals. Suggestions are made for expanding documentation tools to improve nursing discharge planning and case management to ensure that the patient or caregiver is able to carry out self-care activities at home.

Heart failure from diastolic dysfunction related to hypertension: Guidelines for management

PURPOSE

To provide advanced practice nurses with a greater understanding of the pathophysiology, diagnostics, and management of diastolic dysfunction resulting from hypertension.

DATA SOURCES

Electronic database searches were performed using Medline and CINAHL. Data were obtained from medical textbooks and research and review articles.

CONCLUSIONS

As the number of older adults with heart failure (HF) continues to increase, so will the need for effective care and guidance. In addition to further testing of appropriate pharmacologic regimens, adherence factors such as medication costs and patients' functional abilities must be considered.

IMPLICATIONS FOR PRACTICE

HF resulting from diastolic dysfunction has emerged as a separate entity over the past 10-15 years. One of the most common causes of diastolic dysfunction is uncontrolled hypertension. Populations at greatest risk include elders, particularly women, and African Americans.