NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary

NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary To Prepare: Reflect on the strategies presented in the Resources this Module’s Learning Resources in support of locating and analyzing research. Use the Walden Library to identify and read one peer-reviewed research article focused on a topic in your specialty field that interests you. Review the article you selected and reflect on the professional practice use of theories/concepts described by the article. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary The Assignment: Using the “Module 4 | Part 4” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following: Your topic of interest. A correctly formatted APA citation of the article you selected, along with link or search details. Identify a professional practice use of the theories/concepts presented in the article. Analysis of the article using the “Research Analysis Matrix” section of the template Write a 1-paragraph justification stating whether you would recommend this article to inform professional practice. Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following: Describe your approach to identifying and analyzing peer-reviewed research. Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research. Identify at least one resource you intend to use in the future to find peer-reviewed research. Please include intro/ conclusion. Topic of interest/ article is chosen (I will attach the article). APA format. rubric provided. Goldgrab, D., Balakumaran, K., Kim, M. J., & Tabtabai, S. R. (2019). Updates in heart failure 30-day readmission prevention. Heart Failure Reviews , 24 (2), 177–187. https://doi-org.ezp.waldenulibrary.org/10.1007/s10… rubric_detail_____blackboard_learn.pdf contentserver.asp.pdf Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6003_Module04_Week07_Assignment_Rubric Grid View EXIT List View Using the Week 4 Part 4 section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identi!ed. Be sure to include the following: · The topic of interest you have selected. · Correctly formatted APA citation of the article you selected, along with link or search details. Excellent Good Fair Poor 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response clearly identi!es the topic of interest selected. The response partially identi!es the topic of interest selected. The response vaguely identi!es the topic of interest selected. The response accurately and completely provides a citation of the article selected, including an accurate and complete link or thorough search details. The response provides a partial citation of the article selected, including a partial link or search details. The response vaguely or inaccurately provides a citation of the article selected, including vague or inaccurate search details. The response vaguely and inaccurately identi!es the topic of interest selected, or is missing. The response clearly identi!es and describes in detail a professional practice use of the theories/concepts presented in the article. The response partially identi!es and describes a professional practice use of the theories/concepts presented in the article. The response vaguely or inaccurately identi!es and describes a professional practice use of the theories/concepts presented in the article. The response vaguely and inaccurately provides a citation of the article selected, including vague and inaccurate search details, or is missing. The response vaguely and inaccurately identi!es and describes a professional practice use of the theories/concepts presented in the article, or is missing. · Identify a professional practice use of the theories/concepts presented in the article. Analysis of the article using the Research Analysis Matrix section of the template. · Write a one-paragraph justi!cation explaining whether or not you would recommend the use of this article to inform professional practice. Write a 2-3 paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following: · Describe your approach to identifying and analyzing peer-reviewed research. · Identify at least two strategies that you would use that you found to be e”ective in !nding peer-reviewed research. · Identify at least one resource you intend to use in the future to !nd peerreviewed research. Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, #ow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response clearly and accurately provides a detailed analysis of the article using the Research Analysis Matrix section of the template. The response provides a partial analysis of the article using the Research Analysis Matrix section of the template. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS The response provides a vague or inaccurate analysis of the article using the Research Analysis Matrix section of the template. The response provides a vague and inaccurate analysis of the article using the Research Analysis Matrix section of the template, or is missing. The response vaguely or inaccurately explains the justi!cation of whether or not to recommend the use of the article to inform professional practice. The response vaguely and inaccurately explains the justi!cation of whether or not to recommend the use of the article to inform professional practice, or is missing. The response clearly and accurately explains in detail the justi!cation of whether or not to recommend the use of the article to inform professional practice. The response partially explains the justi!cation of whether or not to recommend the use of the article to inform professional practice. 41 (41%) – 45 (45%) 36 (36%) – 40 (40%) 32 (32%) – 35 (35%) 0 (0%) – 31 (31%) The response clearly and accurately describes in detail the approach to identifying and analyzing peer-reviewed research. The response partially describes the approach to identifying and analyzing peerreviewed research. The response vaguely or inaccurately describes the approach to identifying and analyzing peer-reviewed research. The response vaguely and inaccurately describes the approach to identifying and analyzing peer-reviewed research, or is missing. The response vaguely or inaccurately identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research. The response vaguely and inaccurately identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research, or is missing. The response clearly identi!es and accurately describes in detail at least two strategies used to be e”ective in !nding peer-reviewed research. The response provides a complete, detailed, and speci!c synthesis of at least one outside resource that may be used in the future to !nd peer-reviewed research. The response fully integrates at least 1 outside resource and 2-3 course speci!c resources that fully supports the summary provided. The response partially identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research. The response provides an accurate synthesis of at least one outside resource that may be used in the future to !nd peer-reviewed research. The response integrates at least 1 outside resource and 2-3 course speci!c resources that support the summary provided. The response vaguely or inaccurately synthesizes at least one outside resource that may be used in the future to !nd peer-reviewed research. The response minimally integrates resources that may support the summary provided. The response fails to integrate any resources that may be used in the future to !nd peerreviewed research to support the summary provided, or is missing. 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for #ow, continuity, and clarity. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 80% of the time. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 60%- 79% of the time. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity < 60% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive. Purpose, introduction, and conclusion of the assignment is vague or o” topic. No purpose statement, introduction, or conclusion was provided. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%). NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary Uses correct grammar, spelling, and punctuation with no errors. Contains a few (1-2) grammar, spelling, and punctuation errors. Contains several (3-4) grammar, spelling, and punctuation errors. Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%) Uses correct APA format with no errors. Contains a few (1-2) APA format errors. Contains several (3-4) APA format errors. Contains many (? 5) APA format errors. Total Points: 100 Name: NURS_6003_Module04_Week07_Assignment_Rubric EXIT Heart Failure Reviews (2019) 24:177–187 https://doi.org/10.1007/s10741-018-9754-4 Updates in heart failure 30-day readmission prevention David Goldgrab 1 & Kathir Balakumaran 1 & Min Jung Kim 1 & Sara R. Tabtabai 1 Published online: 28 November 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Heart failure (HF) and HF 30-day readmission rates have been a major focus of efforts to reduce health care cost in the recent era. Since the implementation of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), concerted efforts have focused on reduction of 30-day HF readmissions and other admission diagnoses targeted by the HRRP. Hospitals and organizations have instituted wide-ranging programs to reduce short-term readmissions, but the data supporting these programs is often mixed. In this review, we will discuss the challenges associated with reducing HF readmissions and summarize the rationale and effect of specific programs on HF 30-day readmission rates, ranging from medical therapy and adherence to remote hemodynamic monitoring. Finally, we will review the effect that the focus on reducing 30-day HF readmissions has had on the care of the HF patient. Keywords Heart failure . 30-day readmission reduction . Medication reconciliation and adherence . Telemonitoring . Remote hemodynamic monitoring . Early follow-up . HRRP . GDMT . Guideline-directed medical therapy Introduction Since the passage of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), there has been a concerted effort to reduce 30-day HF readmissions in addition to other admission diagnoses [1]. Under the HRRP, if a hospital’s readmission rate for a particular admission diagnosis is below the national average by a predetermined percentage, the hospital suffers reductions in re-imbursement by the Centers for Medicare and Medicaid Services (CMS). From 2008 through 2014, among the top three diagnoses targeted by the HRRP, including acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA), HF had the highest number of hospitalizations within the Medicare fee-for-service population over 65 years of age [2]. HF also had the highest rate of 30-day readmissions at 23.5% [2]. Efforts such as the Hospital to Home BSee you in 7^ program, [3] focusing on follow-up clinic visits within 7 days of discharge from an HF admission, have resulted in a reduction in 30-day readmissions from 21.5 to 17.8% nationally between 2007 and 2015 [4]. Despite this improvement in the short-term readmission rates, the impact of HF on the US healthcare system will continue to grow. The American Heart Association (AHA) projects that the prevalence of HF will increase by 46% from 2012 to 2030 and the cost is predicted to increase substantially from $307 billion annually to $697 billion by the year 2030 [5]. In 2014, HF was the underlying cause of death in 68,626 patients and listed as a contributing cause of death in 308,976 patients. To some degree, one in every eight deaths was attributed to HF [6]. The increasing prevalence and cost of HF, combined with efforts to avoid CMS and HRRP financial penalties, has led to a surge of research into the efficacy of programs intended to reduce 30-day HF readmissions.NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary In this paper, we present the various strategies previously published, including the rationale and data for or against their effectiveness. We have grouped the programs by the particular aspect of HF care they target, with the major categories being: medication use and adherence, hemodynamic monitoring, telemonitoring, early post-discharge follow-up, nurse-led education, and readmission risk assessment. * Sara R. Tabtabai [email protected] The challenge of the heart failure readmission 1 University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06032, USA HF is a complex syndrome encompassing both HF with reduced and preserved ejection fraction. It is the end-common 178 pathway of a diverse number of disease states, including congenital heart disease, ischemia, arrhythmia, and external factors. The end result of congestion and/or poor perfusion results in negative effects on multiple organ systems. Patients with HF are often medically complex, with multiple comorbidities, a long list of medications, and a wide range of symptoms that can be attributed to a number of etiologies. A few specific points highlight the challenge of reducing readmissions for HF. About half of patients hospitalized for HF have preserved ejection fraction (HFpEF), for which there is no targeted therapy [7]. As discussed in further detail in the next section, multiple medications have been well described to reduce readmissions and overall improve function in patients with HF with reduced ejection fraction (HFrEF). Despite multiple avenues of research, the same has yet to be established for HFpEF [7]. The natural history of HF also lends itself to the underlying problem of frequent readmissions. Unlike other HRRP-targeted admission diagnoses like AMI and PNA, which are most often isolated events that are treated and not expected to imminently recur, HF is a chronic illness which requires daily management to avoid decompensations. Additionally, as depicted in Fig. 1, the natural history of HF is characterized by a series of decompensations, after which the patient does not return to their prior baseline quality of life, and inherently requires a higher intensity of care. This continues in a downward trajectory until ultimate pump failure and death. When access to care, health literacy, and other socioeconomic factors are additionally considered, preventing and reducing HF readmissions seems a lofty goal. Fig. 1 Hospitalizations and quality of life during the course of heart failure disease progression Heart Fail Rev (2019) 24:177–187 Medical therapy: implementing the guidelines There is a multitude of data on the utility of specific medications to improve outcomes for HFrEF, not only by improving mortality, but also by reducing rehospitalization. Guideline Directed Medical Therapy (GDMT), the mainstay of prescription therapy for HFrEF, includes beta blockers (BB) [8–10], angiotensin converting enzyme inhibitors (ACE-I), [11–14] aldosterone antagonists (AA) [15, 16], and newer drugs including valsartan-sacubitril, and ivabradine, incorporated in the 2017 ACC/AHA/HFSA focused update of the guideline for the management of heart failure [17]. The data supporting reduction in HF hospitalizations is robust and derived from large, randomized controlled trials (RCT) on outcomes in HFrEF patients. PARADIGM-HF, an RCT comparing Entresto, a combination therapy of valsartan and sacubitril, to enalapril, resulted in significant decreases in mortality and HF readmissions [18]. HF readmissions at 30 days were decreased by 38% in patients randomized to receive Entresto compared to enalapril. A 26% lower allcause readmission rate was also observed in participants on Entresto compared to enalapril [19]. The SHIFT trial, an RCT of ivabradine, a selective sinus-node inhibitor, found reduced hospitalizations when given to patients on maximally tolerated beta blockers with persistent heart rates greater than 70 beats per minute [20]. In response to these robust findings, the HF guidelines were updated in 2017 to include transitioning patients from an ACE or ARB to Entresto for further reduction in morbidity and mortality, and ivabradine in specific patients for reduction in HF hospitalizations in HFrEF patients [17]. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary Heart Fail Rev (2019) 24:177–187 Although there are no targeted therapies identified for HFpEF, specific medications have been shown to decrease hospitalizations and thus should be prescribed where appropriate. The TOPCAT (treatment of preserved cardiac function heart failure with an aldosterone antagonist) trial showed efficacy in a post-hoc analysis of HFpEF patients in America of reduced HF hospitalizations in the treatment arm randomized to use of spironolactone [21]. Additionally, the use of ARBs remains in the guidelines with a specific aim to reduce HF hospitalization in this patient population. However, initiation of proven medical therapies alone is not sufficient. Subsequent attention should be turned to achieving the target doses studied in the seminal trials. A retrospective study of BIOSTAT-CHF, a European database of HF patients, evaluated the effect of GDMT dosing on HF outcomes [22]. The database included 2100 patients from 69 European countries. The investigators noted that only 22% of patients were prescribed the recommended target doses of ACE-I/ARB and only 12% received the target doses of BB. Accordingly, they noted that patients on < 50% target dose had increased rates of death and HF hospitalizations. Similar findings were reported in QUALIFY, an international, prospective study including 6669 outpatients with HFrEF [23]. They concluded that at 6-month follow-up, patients who achieved greater than 50% target dose had better clinical outcomes, including lower mortality, HF exacerbation, and hospitalization. As described, expansive data is available on the utility of medical therapy to improve HF clinical outcomes, including reducing HF hospitalizations. However, recent studies have shown that the uptake in prescription of the newer GDMT agents has been slow. In particular, Luo et al. recently reported that rates of Entresto prescription in appropriate HF patients remains low 5 years after the ground-braking PARADIGMHF results were published [24]. Implementing strategies that improve awareness of and adherence to HF management guidelines is thus a prime focus for reducing HF readmission rates and improving quality of care for HF patients. Pitfalls in medical therapy: medication intolerance and non-adherence Many barriers exist to implementing GDMT effectively. Medication intolerance including renal and hemodynamic effects, as well as electrolyte disturbances are the most common limitations of these groups of medications. Hemodynamic limitations are perhaps the most ominous and necessary to recognize. The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT) included both acute and chronic HF patients from 21 European countries [25]. In this population, rates of use of ACE-I/ARB, beta blocker, and ivabradine differed significantly between chronic ambulatory HF patients and patients hospitalized with acute 179 decompensated HF (ADHF). Patients admitted with ADHF had lower rates of GDMT use compared to their ambulatory cohorts, highlighting the challenge of understanding the root of medication use limitations. Rather than concluding that patients admitted with ADHF are Bunder-treated^ and thus more likely to be admitted, one must recognize that inability to initiate or up-titrate GDMT due to side effects or intolerance often reflects overall low reserve, more comorbidities, and higher mortality. This is especially true when use of these agents is limited by low blood pressure or poor renal function. HF patients that do not tolerate use or up-titration of GDMT should be considered for evaluation for advanced heart failure therapies. Hyperkalemia is another potential limiting factor, particularly for ACE-I/ARB and the newer agent Entresto. A rise in serum potassium does not necessitate discontinuation of a medication with proven mortality benefits. A reduction of the dose, institution of a low potassium diet, or strategic use of loop or thiazide type diuretics can stabilize serum potassium and allow for continued use of t … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary To Prepare: Reflect on the strategies presented in the Resources this Module’s Learning Resources in support of locating and analyzing research. Use the Walden Library to identify and read one peer-reviewed research article focused on a topic in your specialty field that interests you. Review the article you selected and reflect on the professional practice use of theories/concepts described by the article. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary The Assignment: Using the “Module 4 | Part 4” section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identified. Be sure to include the following: Your topic of interest. A correctly formatted APA citation of the article you selected, along with link or search details. Identify a professional practice use of the theories/concepts presented in the article. Analysis of the article using the “Research Analysis Matrix” section of the template Write a 1-paragraph justification stating whether you would recommend this article to inform professional practice. Write a 2- to 3-paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following: Describe your approach to identifying and analyzing peer-reviewed research. Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research. Identify at least one resource you intend to use in the future to find peer-reviewed research. Please include intro/ conclusion. Topic of interest/ article is chosen (I will attach the article). APA format. rubric provided. Goldgrab, D., Balakumaran, K., Kim, M. J., & Tabtabai, S. R. (2019). Updates in heart failure 30-day readmission prevention. Heart Failure Reviews , 24 (2), 177–187. https://doi-org.ezp.waldenulibrary.org/10.1007/s10… rubric_detail_____blackboard_learn.pdf contentserver.asp.pdf Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6003_Module04_Week07_Assignment_Rubric Grid View EXIT List View Using the Week 4 Part 4 section of your Academic Success and Professional Development Plan Template presented in the Resources, conduct an analysis of the elements of the research article you identi!ed. Be sure to include the following: · The topic of interest you have selected. · Correctly formatted APA citation of the article you selected, along with link or search details. Excellent Good Fair Poor 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response clearly identi!es the topic of interest selected. The response partially identi!es the topic of interest selected. The response vaguely identi!es the topic of interest selected. The response accurately and completely provides a citation of the article selected, including an accurate and complete link or thorough search details. The response provides a partial citation of the article selected, including a partial link or search details. The response vaguely or inaccurately provides a citation of the article selected, including vague or inaccurate search details. The response vaguely and inaccurately identi!es the topic of interest selected, or is missing. The response clearly identi!es and describes in detail a professional practice use of the theories/concepts presented in the article. The response partially identi!es and describes a professional practice use of the theories/concepts presented in the article. The response vaguely or inaccurately identi!es and describes a professional practice use of the theories/concepts presented in the article. The response vaguely and inaccurately provides a citation of the article selected, including vague and inaccurate search details, or is missing. The response vaguely and inaccurately identi!es and describes a professional practice use of the theories/concepts presented in the article, or is missing. · Identify a professional practice use of the theories/concepts presented in the article. Analysis of the article using the Research Analysis Matrix section of the template. · Write a one-paragraph justi!cation explaining whether or not you would recommend the use of this article to inform professional practice. Write a 2-3 paragraph summary that you will add to your Academic Success and Professional Development Plan that includes the following: · Describe your approach to identifying and analyzing peer-reviewed research. · Identify at least two strategies that you would use that you found to be e”ective in !nding peer-reviewed research. · Identify at least one resource you intend to use in the future to !nd peerreviewed research. Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, #ow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. 18 (18%) – 20 (20%) 16 (16%) – 17 (17%) 14 (14%) – 15 (15%) 0 (0%) – 13 (13%) The response clearly and accurately provides a detailed analysis of the article using the Research Analysis Matrix section of the template. The response provides a partial analysis of the article using the Research Analysis Matrix section of the template. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS The response provides a vague or inaccurate analysis of the article using the Research Analysis Matrix section of the template. The response provides a vague and inaccurate analysis of the article using the Research Analysis Matrix section of the template, or is missing. The response vaguely or inaccurately explains the justi!cation of whether or not to recommend the use of the article to inform professional practice. The response vaguely and inaccurately explains the justi!cation of whether or not to recommend the use of the article to inform professional practice, or is missing. The response clearly and accurately explains in detail the justi!cation of whether or not to recommend the use of the article to inform professional practice. The response partially explains the justi!cation of whether or not to recommend the use of the article to inform professional practice. 41 (41%) – 45 (45%) 36 (36%) – 40 (40%) 32 (32%) – 35 (35%) 0 (0%) – 31 (31%) The response clearly and accurately describes in detail the approach to identifying and analyzing peer-reviewed research. The response partially describes the approach to identifying and analyzing peerreviewed research. The response vaguely or inaccurately describes the approach to identifying and analyzing peer-reviewed research. The response vaguely and inaccurately describes the approach to identifying and analyzing peer-reviewed research, or is missing. The response vaguely or inaccurately identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research. The response vaguely and inaccurately identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research, or is missing. The response clearly identi!es and accurately describes in detail at least two strategies used to be e”ective in !nding peer-reviewed research. The response provides a complete, detailed, and speci!c synthesis of at least one outside resource that may be used in the future to !nd peer-reviewed research. The response fully integrates at least 1 outside resource and 2-3 course speci!c resources that fully supports the summary provided. The response partially identi!es and describes at least two strategies used to be e”ective in !nding peer-reviewed research. The response provides an accurate synthesis of at least one outside resource that may be used in the future to !nd peer-reviewed research. The response integrates at least 1 outside resource and 2-3 course speci!c resources that support the summary provided. The response vaguely or inaccurately synthesizes at least one outside resource that may be used in the future to !nd peer-reviewed research. The response minimally integrates resources that may support the summary provided. The response fails to integrate any resources that may be used in the future to !nd peerreviewed research to support the summary provided, or is missing. 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for #ow, continuity, and clarity. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 80% of the time. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 60%- 79% of the time. Paragraphs and sentences follow writing standards for #ow, continuity, and clarity < 60% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive. Purpose, introduction, and conclusion of the assignment is vague or o” topic. No purpose statement, introduction, or conclusion was provided. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%). NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary Uses correct grammar, spelling, and punctuation with no errors. Contains a few (1-2) grammar, spelling, and punctuation errors. Contains several (3-4) grammar, spelling, and punctuation errors. Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%) 4 (4%) – 4 (4%) 3.5 (3.5%) – 3.5 (3.5%) 0 (0%) – 3 (3%) Uses correct APA format with no errors. Contains a few (1-2) APA format errors. Contains several (3-4) APA format errors. Contains many (? 5) APA format errors. Total Points: 100 Name: NURS_6003_Module04_Week07_Assignment_Rubric EXIT Heart Failure Reviews (2019) 24:177–187 https://doi.org/10.1007/s10741-018-9754-4 Updates in heart failure 30-day readmission prevention David Goldgrab 1 & Kathir Balakumaran 1 & Min Jung Kim 1 & Sara R. Tabtabai 1 Published online: 28 November 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Heart failure (HF) and HF 30-day readmission rates have been a major focus of efforts to reduce health care cost in the recent era. Since the implementation of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), concerted efforts have focused on reduction of 30-day HF readmissions and other admission diagnoses targeted by the HRRP. Hospitals and organizations have instituted wide-ranging programs to reduce short-term readmissions, but the data supporting these programs is often mixed. In this review, we will discuss the challenges associated with reducing HF readmissions and summarize the rationale and effect of specific programs on HF 30-day readmission rates, ranging from medical therapy and adherence to remote hemodynamic monitoring. Finally, we will review the effect that the focus on reducing 30-day HF readmissions has had on the care of the HF patient. Keywords Heart failure . 30-day readmission reduction . Medication reconciliation and adherence . Telemonitoring . Remote hemodynamic monitoring . Early follow-up . HRRP . GDMT . Guideline-directed medical therapy Introduction Since the passage of the Affordable Care Act (ACA) in 2012 and the Hospital Readmission Reduction Program (HRRP), there has been a concerted effort to reduce 30-day HF readmissions in addition to other admission diagnoses [1]. Under the HRRP, if a hospital’s readmission rate for a particular admission diagnosis is below the national average by a predetermined percentage, the hospital suffers reductions in re-imbursement by the Centers for Medicare and Medicaid Services (CMS). From 2008 through 2014, among the top three diagnoses targeted by the HRRP, including acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA), HF had the highest number of hospitalizations within the Medicare fee-for-service population over 65 years of age [2]. HF also had the highest rate of 30-day readmissions at 23.5% [2]. Efforts such as the Hospital to Home BSee you in 7^ program, [3] focusing on follow-up clinic visits within 7 days of discharge from an HF admission, have resulted in a reduction in 30-day readmissions from 21.5 to 17.8% nationally between 2007 and 2015 [4]. Despite this improvement in the short-term readmission rates, the impact of HF on the US healthcare system will continue to grow. The American Heart Association (AHA) projects that the prevalence of HF will increase by 46% from 2012 to 2030 and the cost is predicted to increase substantially from $307 billion annually to $697 billion by the year 2030 [5]. In 2014, HF was the underlying cause of death in 68,626 patients and listed as a contributing cause of death in 308,976 patients. To some degree, one in every eight deaths was attributed to HF [6]. The increasing prevalence and cost of HF, combined with efforts to avoid CMS and HRRP financial penalties, has led to a surge of research into the efficacy of programs intended to reduce 30-day HF readmissions.NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary In this paper, we present the various strategies previously published, including the rationale and data for or against their effectiveness. We have grouped the programs by the particular aspect of HF care they target, with the major categories being: medication use and adherence, hemodynamic monitoring, telemonitoring, early post-discharge follow-up, nurse-led education, and readmission risk assessment. * Sara R. Tabtabai [email protected] The challenge of the heart failure readmission 1 University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06032, USA HF is a complex syndrome encompassing both HF with reduced and preserved ejection fraction. It is the end-common 178 pathway of a diverse number of disease states, including congenital heart disease, ischemia, arrhythmia, and external factors. The end result of congestion and/or poor perfusion results in negative effects on multiple organ systems. Patients with HF are often medically complex, with multiple comorbidities, a long list of medications, and a wide range of symptoms that can be attributed to a number of etiologies. A few specific points highlight the challenge of reducing readmissions for HF. About half of patients hospitalized for HF have preserved ejection fraction (HFpEF), for which there is no targeted therapy [7]. As discussed in further detail in the next section, multiple medications have been well described to reduce readmissions and overall improve function in patients with HF with reduced ejection fraction (HFrEF). Despite multiple avenues of research, the same has yet to be established for HFpEF [7]. The natural history of HF also lends itself to the underlying problem of frequent readmissions. Unlike other HRRP-targeted admission diagnoses like AMI and PNA, which are most often isolated events that are treated and not expected to imminently recur, HF is a chronic illness which requires daily management to avoid decompensations. Additionally, as depicted in Fig. 1, the natural history of HF is characterized by a series of decompensations, after which the patient does not return to their prior baseline quality of life, and inherently requires a higher intensity of care. This continues in a downward trajectory until ultimate pump failure and death. When access to care, health literacy, and other socioeconomic factors are additionally considered, preventing and reducing HF readmissions seems a lofty goal. Fig. 1 Hospitalizations and quality of life during the course of heart failure disease progression Heart Fail Rev (2019) 24:177–187 Medical therapy: implementing the guidelines There is a multitude of data on the utility of specific medications to improve outcomes for HFrEF, not only by improving mortality, but also by reducing rehospitalization. Guideline Directed Medical Therapy (GDMT), the mainstay of prescription therapy for HFrEF, includes beta blockers (BB) [8–10], angiotensin converting enzyme inhibitors (ACE-I), [11–14] aldosterone antagonists (AA) [15, 16], and newer drugs including valsartan-sacubitril, and ivabradine, incorporated in the 2017 ACC/AHA/HFSA focused update of the guideline for the management of heart failure [17]. The data supporting reduction in HF hospitalizations is robust and derived from large, randomized controlled trials (RCT) on outcomes in HFrEF patients. PARADIGM-HF, an RCT comparing Entresto, a combination therapy of valsartan and sacubitril, to enalapril, resulted in significant decreases in mortality and HF readmissions [18]. HF readmissions at 30 days were decreased by 38% in patients randomized to receive Entresto compared to enalapril. A 26% lower allcause readmission rate was also observed in participants on Entresto compared to enalapril [19]. The SHIFT trial, an RCT of ivabradine, a selective sinus-node inhibitor, found reduced hospitalizations when given to patients on maximally tolerated beta blockers with persistent heart rates greater than 70 beats per minute [20]. In response to these robust findings, the HF guidelines were updated in 2017 to include transitioning patients from an ACE or ARB to Entresto for further reduction in morbidity and mortality, and ivabradine in specific patients for reduction in HF hospitalizations in HFrEF patients [17]. NURS 6002 Walden Updates in Heart Failure 30 Day Readmission Prevention Summary Heart Fail Rev (2019) 24:177–187 Although there are no targeted therapies identified for HFpEF, specific medications have been shown to decrease hospitalizations and thus should be prescribed where appropriate. The TOPCAT (treatment of preserved cardiac function heart failure with an aldosterone antagonist) trial showed efficacy in a post-hoc analysis of HFpEF patients in America of reduced HF hospitalizations in the treatment arm randomized to use of spironolactone [21]. Additionally, the use of ARBs remains in the guidelines with a specific aim to reduce HF hospitalization in this patient population. However, initiation of proven medical therapies alone is not sufficient. Subsequent attention should be turned to achieving the target doses studied in the seminal trials. A retrospective study of BIOSTAT-CHF, a European database of HF patients, evaluated the effect of GDMT dosing on HF outcomes [22]. The database included 2100 patients from 69 European countries. The investigators noted that only 22% of patients were prescribed the recommended target doses of ACE-I/ARB and only 12% received the target doses of BB. Accordingly, they noted that patients on < 50% target dose had increased rates of death and HF hospitalizations. Similar findings were reported in QUALIFY, an international, prospective study including 6669 outpatients with HFrEF [23]. They concluded that at 6-month follow-up, patients who achieved greater than 50% target dose had better clinical outcomes, including lower mortality, HF exacerbation, and hospitalization. As described, expansive data is available on the utility of medical therapy to improve HF clinical outcomes, including reducing HF hospitalizations. However, recent studies have shown that the uptake in prescription of the newer GDMT agents has been slow. In particular, Luo et al. recently reported that rates of Entresto prescription in appropriate HF patients remains low 5 years after the ground-braking PARADIGMHF results were published [24]. Implementing strategies that improve awareness of and adherence to HF management guidelines is thus a prime focus for reducing HF readmission rates and improving quality of care for HF patients. Pitfalls in medical therapy: medication intolerance and non-adherence Many barriers exist to implementing GDMT effectively. Medication intolerance including renal and hemodynamic effects, as well as electrolyte disturbances are the most common limitations of these groups of medications. Hemodynamic limitations are perhaps the most ominous and necessary to recognize. The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT) included both acute and chronic HF patients from 21 European countries [25]. In this population, rates of use of ACE-I/ARB, beta blocker, and ivabradine differed significantly between chronic ambulatory HF patients and patients hospitalized with acute 179 decompensated HF (ADHF). Patients admitted with ADHF had lower rates of GDMT use compared to their ambulatory cohorts, highlighting the challenge of understanding the root of medication use limitations. Rather than concluding that patients admitted with ADHF are Bunder-treated^ and thus more likely to be admitted, one must recognize that inability to initiate or up-titrate GDMT due to side effects or intolerance often reflects overall low reserve, more comorbidities, and higher mortality. This is especially true when use of these agents is limited by low blood pressure or poor renal function. HF patients that do not tolerate use or up-titration of GDMT should be considered for evaluation for advanced heart failure therapies. Hyperkalemia is another potential limiting factor, particularly for ACE-I/ARB and the newer agent Entresto. A rise in serum potassium does not necessitate discontinuation of a medication with proven mortality benefits. A reduction of the dose, institution of a low potassium diet, or strategic use of loop or thiazide type diuretics can stabilize serum potassium and allow for continued use of t … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10