What does this mean for the nursing practice?

What does this mean for the nursing practice?

What does this mean for the nursing practice? 150 150 Nyagu

Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure
Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Research Critique on B-type natriuretic peptide-guided treatment for heart failure

Working most of my years of nursing in the home health field, one of the goals was to help decrease the readmission rate of patients that have Congestive Heart Failure (CHF). In doing so, we worked closely with the CHF clinic to help monitor and teach these patients on the disease process and early signs and symptoms to monitor for exacerbation of CHF. This is an area that has peaked this writer’s interest. Patients that have CHF require monitoring such as detailed clinical assessment and a review of their medications. This will also include “the need for titration and optimization in line with guidelines and to pick up possible side effects. The pharmacological treatment options for patients with left ventricular systolic function (LVSD) include diuretics, angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blockers if ACE inhibitors are not tolerated), beta-blockers and mineralocorticoid receptor antagonists (MRA)” (CHF is a serious problem and result in a big financial burden to hospital Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure. “Because excessive readmissions tend to indicate suboptimal care, government and commercial payers are focusing on 30-day readmission rates as a new quality measure for hospitals. The intent behind the measures is for the hospitals to provide better care by following evidence-based practice guidelines, which in turn, will reduce heart failure readmission rates” (Merkley, 2019, para. 4).

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Background of Study

CHF occurs when the heart muscle does not pump blood as well as it should. Therefore, it cannot meet all the needs of the body. “Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however, on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalization care. B-type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure but could offer to clinicians a possible tool to guide drug treatment. This could optimize drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance” (McLennan et al., 2016, para. 1). The objective of this study was to see if CHF guided by serial BNP or N-terminal pro b-type natriuretic peptide (NT-proBNP) monitoring improves outcomes compared to treatment guided by clinical assessment alone.

Method of Study

Numerous search methods were used in this study such as the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluations Database in Cochrane Library. The study “included randomized controlled trial of NT-proBNP guided treatment guided by clinical assessment alone with no restriction on follow-up. Adults treated for heart failure, in both in-hospital and out-of-hospital settings, and trials reporting a clinical outcome were included” (McLennan et al., 2016, para. 3). The authors of this study also contacted the authors of relevant studies and experts in the relevant fields that pertained to this study. Out of 3379 references that were screened, 3044 were removed due to not being relevant to this study. The remaining 335 references were then examined and from these 18 studies were included for this study. In these 18 studies, 3,660 patients with heart failure took part. The ages of these patients were between 62 and 80 years old. All areas were cited and references where current. The author of this study also evaluated the strengths and weaknesses of the available studies. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure

Results of Study

The findings of this study showed “that patients with CHF low-quality evidence showed a reduction in heart failure admission with NP-guided treatment while low-quality evidence showed uncertainty in the effect of NP-guided treatment for all-cause mortality, heart failure mortality, and all-cause admission. Uncertainty in the effect was further shown by very low-quality evidence for patient’s quality of life. The evidence for adverse events and cost of treatment was low quality, and we were unable to pool results” (McLennan et al., 2016, para. 10). These findings indicated that hospital admissions due to CHF may be reduced when monitoring the BNP compared to clinical assessment only, but that the evidence was unclear on if there were fewer deaths from CHF being monitored with the BNP versus clinical assessment only groups. The study will help to contribute to the nursing knowledge by shedding light on the education of BNP-guided treatment to these patients to reduce the number of hospital admissions/re-admissions due to CHF.

Ethical Considerations

The study was not approved by an Institutional Review Board (IRB) as it was a research of 18 research studies that had previously been performed to see if BNP-guided treatment would help with managing CHF. IRB is required only on research that involves human subjects. Being that this study did not actually perform its own trial studies, patient privacy was not an issue to consider. Some of the studies used in this study were partly or fully funded by a pharmaceutical company. This might show some risk for bias in their results. No ethical considerations were noted in these studies regarding the treatment or lack of treatment on patients.

Conclusion

By researching 18 randomized controlled trials with 3660 participants, the study was able to compare BNP-guided treatment with clinical assessment alone on patients that have CHF to see if hospital admission/re-admission rates would decrease. Now that hospitals must comply with new quality measures or face financial penalties due to hospital re-admissions due to CHF, it is important to try to keep these patients at home and stable. Evidence of this study did show that BNP-guided treatment in patients with CHF had a reduction in hospital re-admission rate. However, the evidence did not show an improvement in the quality of life. The evidence found in this study did suggest that CHF admission rates were reduced by BNP-guided treatment (26%) versus clinical assessment alone (38%). What does this mean for the nursing practice? It means that more follow-up is needed once these patients are released from the hospital. This would include the use of more frequent visits to the physician, the use of CHF clinics, and home follow-up by using home care nurses. Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure.

References

McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E., Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016)

Merkley, K., (2019). Reduce heart failure readmission rates. Health Catalyst. Retrieved from https://www.healthcatalyst.com/reduce-heart-failure-readmissions-with-healthcare- analytics/

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McLennan, J., Heneghan, C.J., Perera, R., Clements, A. M., Glasziou, P. P., Kearley, K. E., Pidduck, N., Roberts, N.W., Tyndel, S., Wright, F.L., & Bankhead, C., (2016) B-type Natriuretic Peptide-guided treatment for Heart Failure. The Cochrane Database of Systematic Reviews (Dec. 22, 2016) Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449577/ Intro to Nursing Research NRS-433V Research Critique on B-type Natriuretic Peptide-Guided Treatment for Heart Failure