Annotated Bibliography Paper 2022

Annotated Bibliography
Author Name
University name
Author note

Introduction
Gorthi, J., Huntera, C. B., Mooss , A. N., Alla, V. M., & Hilleman, D. E. (2014). Reducing
heart failure hospital readmissions: A systematic review of disease management
programs. Cardiology Research, 5, 126-138. http://dx.doi.org/10.14740/cr362w
The paper is a review based on a randomised trail which focussed on the implementation of
disease management programs in cases of heart failure, to help reduce their hospital readmission
rates. This systematic review included outpatient clinic interventions, structured telephone
support, home care, as well as both non- invasive and invasive telemonitoring interventions. The
study revealed that the method of telemanagement had the potential to effectively reach out to a
wider set of audience, at lesser cost. Even structured telephonic support has been studied to have
a significantly positive effect on reducing admissions of heart diseases, mainly heart failure. The
paper also revealed that even though the non-invasive studies of telemonitoring were found to be
effective, the efficacy of the invasive telemonitoring methods are yet to be evaluated. The paper
states that one disease management approach applied to an extensive range of several patient
types may not be effective enough to treat heart failure and thus might cause a surge in hospital
readmissions and negatively impact clinical outcomes. It also suggests that the disease
management programs require to be flexible enough to be able to customise as per the
requirements of individual patients. The limitations of this paper would be the lack of
confirmation of the effectiveness of invasive telemonitoring methods and also the lack of
identifying an accurate disease management procedure which can help reduce the resubmission
rates of majority of the heart patients.

Sagar, V. A., Davies, E. J., Briscoe, S., Coates, A. J. S., Dalal, H. M., Lough, F., … Taylor,
R. S. (2015). Exercise-based rehabilitation for heart failure: Systematic review and
meta-analysis. Open Heart, 2, 1-12. Retrieved from
http://openheart.bmj.com/content/openhrt/2/1/e000163.full.pdf
The main objective of this review paper is to analyse the effect of exercising programs on
individuals suffering from cardiac failure. The paper is a systematic review, which conducted a
univariate meta-regression analysis of a randomised trial of patients suffering from cardiac
failure, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-
Analyses or PRISMA statement. This paper included 33 trials, consisting of 4740 participants,
majority of which suffered from heart failure with reduced ejection fraction of about 40% or less
as well as New York Heart Association class II and III. The study emphasized that exercise-
based cardiac rehabilitation decreased the risk of heart related hospitalisations. However this
study also highlighted that these benefits of exercise-related cardiac rehabilitation, were not
dependent of the exercise dose, type of exercise, as well as trial duration of follow-up and
quality. Thus, this updated Cochrane review confirms that patient outcomes, mortality rate, as
well as quality of life in heart failure patients with the implementation of physical exercise
regime sin hospitals and post-attack care services, regardless of the characteristics of the exercise
programs. The main limitation of the paper is that it fails to mention the most effective exercise
regime for heart failure patients and also differentiate between the different existing ones based
on the areas of health it can improve.

Sano, M., & Majima, T. (2018). Self management of congestive heart failure among elderly‐
men in Japan. International Journal of Nursing Practice, 24(S1), e12653-n/a.
doi:10.1111/ijn.12653
The study talks about significance of knowledge and implementation of self-management
techniques in elderly male patients diagnosed with congestive heart failure and had no records of
re-hospitalization in 2 years or more. The study setting was set in a cardiovascular hospital in
Japan with outpatient clinic services. Interviews were conducted by filling and signing of the
consent form used for explaining and giving information about the aim, references, procedures,
potential risks and benefits to the patients who were eligible. The interviews were documented
and transliterated verbatim and data were analysed using ground theory approach. It was found
that changing the lifestyle and process of living can help control the situation without making
any sign of deterioration, by making good and effective preferences and choices. Heart failure is
a progressive disease that gradually increases with emergency re hospitalization, repeated‐
exacerbations and remission with time. Studies have proven that overwork, physical and mental
stress, improper intake of medicine must be avoided in order to prevent heart failure. Therefore,
self-management strategies, for patients with Congestive Heart Failure, are considered as
important for preventing re hospitalisation and exacerbation of the disease.

Justification
The case study subject is a 75 year old overweight man, who has been exhibiting symptoms of
like breathlessness, tachycardia and peripheral oedema, with a medical history of chronic heart
failure due to hypertension and ischaemic cardiomyopathy. This indicates that the case study
subject, Charles, has been readmitted in the hospital, because of him exhibiting symptoms of
heart failure.
Heart diseases have been mainly seen to occur in diabetic, obese individuals, due to the
accumulation of fat and plaques on the walls of the blood vessels making them narrow and
restricting the flow of blood through them. Due to this, an increase in the blood pressure can be
observed causing the individual to have hypertension (Jiang, Lu, Zong, Ruan & Liu, 2016).
Prolonged untreated hypertension can lead to several heart related diseases and can also cause
heart failure. The case subject has been mentioned to be overweight and his medical history also
mentions that he has hypertension. His medical history also mentions him suffering from an
associated condition of ischemic cardiomyopathy, which results due to the weakening of the
heart muscle. The article by Sagar et al. on 2015 states that exercise-based rehabilitation has
improves the patient outcomes and their quality of life. The exercise regimes implemented on the
heart failure patients have been successful in decreasing the mortality rate of the disease
(Howden et al., 2013). Thus, to help Charles lose weight in order to reduce the risk of him
contracting any further heart diseases and avoid further hospital readmissions, he should be
suggested different weight reducing exercises to help him maintain a healthy lifestyle (Elliott,
Mahajan, Pathak, Lau & Sanders, 2016).

Paper by Sano & Majima, 2018 talks about the positive impact of self-management in elderly
heart patients. The self-management processes described in the paper can be beneficial to
Charles, in helping him manage the frequency of his relapse. Processes like diet or lifestyle
changes can help a heart patient improve their heart health. Also the incorporation of stress
management and intake of proper medications timely can significantly help in ensuring the
improvement in their quality of life. Stress has been known to be a huge risk factor when it
comes to heart diseases, especially heart failure.
To help with self-management of heart failure the elderly can use different interventions.The
paper by Gorthi, Huntera, Mooss, Alla, & Hilleman published on 2014, focus on other
interventions of reassuring the decrease in the readmission of heart patients in healthcare
services. The paper highlighted on the various forms of clinical interventions and mainly about
the importance of telemonitoring and telemanagement in such cases. Considering that Charles is
an elderly, one of the most effective ways to help him, would be telemonitoring. The process of
telemonitoring refers to telephone-based interactive voice-response systems that are employed to
collect daily information regarding the issues faced by the patients as well as for keeping track
on the risk factors like weight of the patients (Gingele et al., 2017). This structured telephonic
method has been very effective for elderly patients, to manage and maintain their heart health,
especially for those who live alone and have no assistance at home (Inglis, Clark, Dierckx,
Prieto-Merino & Cleland, 2015). With the help of this method their clinicians get an idea of their
health and understand the signs of deterioration, to ensure timely admission to the hospital or
effectively guide them on improving their health.

Recommendations
In heart failure patients, the best recommendations that can help improve their quality of life are
diet changes, lifestyle changes, following regular exercising regimes along with medications like
diuretics and digitalis (Gheorghiade, Vaduganathan, Fonarow & Bonow, 2013). The patients
should implement low fat and cholesterol foods in their diets to help prevent further
accumulation of fat around the walls of their arteries, leading to severe case of hypertension
(Ashraf & Baweja, 2013). The patients should also implement certain changes in their lifestyles
like stress management, reducing smoking and alcohol consumption as well as regular
exercising. Smoking and alcohol have been known to be silent killers, as they deteriorate the
condition of the arteries by facilitating their blockage further (Villiers-Tuthill, Copley, McGee &
Morgan, 2016). Exercising regularly has been known to increase the quality of life of heart
patients, an in turn help in reducing the mortality rate of the disease. Many other interventions,
like telemonitoring has further prevented the readmission of heart patients, especially the elderly
population. Clinical practices can however be more individual-based, tending to the various
special needs of individual patients and in turn improving the patient outcome and further
reducing the mortality rate of the disease (Clarke, Bourn, Skoufalos, Beck & Castillo, 2017). In
case of the elderly, who form the majority of the heart patient population, there should be more
out-patient healthcare facilities to avoid any duress or depression faced by them, which in turn
would also decrease the hospital readmission rates (McIlvennan, Eapen & Allen, 2015).

References
Ashraf, M. J., & Baweja, P. (2013). Obesity: the ‘huge’problem in cardiovascular diseases. Missouri
medicine, 110(6), 499. Retrieved from :
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179812/
Clarke, J., Bourn, S., Skoufalos, A., Beck, E., & Castillo, D. (2017). An Innovative Approach to Health
Care Delivery for Patients with Chronic Conditions. Population Health Management, 20(1), 23-
30. doi: 10.1089/pop.2016.0076
Elliott, A., Mahajan, R., Pathak, R., Lau, D., & Sanders, P. (2016). Exercise Training and Atrial
Fibrillation. Circulation, 133(5), 457-459. doi: 10.1161/circulationaha.115.020800
Gheorghiade, M., Vaduganathan, M., Fonarow, G., & Bonow, R. (2013). Rehospitalization for Heart
Failure. Journal Of The American College Of Cardiology, 61(4), 391-403. doi:
10.1016/j.jacc.2012.09.038
Gingele, A., Brunner-la Rocca, H., Ramaekers, B., Gorgels, A., De Weerd, G., & Kragten, J. et al. (2017).
Telemonitoring in patients with heart failure: Is there a long-term effect?. Journal Of
Telemedicine And Telecare, 25(3), 158-166. doi: 10.1177/1357633x17747641
Howden, E., Leano, R., Petchey, W., Coombes, J., Isbel, N., & Marwick, T. (2013). Effects of Exercise
and Lifestyle Intervention on Cardiovascular Function in CKD. Clinical Journal Of The
American Society Of Nephrology, 8(9), 1494-1501. doi: 10.2215/cjn.10141012
Inglis, S., Clark, R., Dierckx, R., Prieto-Merino, D., & Cleland, J. (2015). Structured telephone support or
non-invasive telemonitoring for patients with heart failure. Cochrane Database Of Systematic
Reviews. doi: 10.1002/14651858.cd007228.pub3

Jiang, S., Lu, W., Zong, X., Ruan, H., & Liu, Y. (2016). Obesity and hypertension. Experimental And
Therapeutic Medicine, 12(4), 2395-2399. doi: 10.3892/etm.2016.3667
McIlvennan, C., Eapen, Z., & Allen, L. (2015). Hospital Readmissions Reduction Program. Circulation,
131(20), 1796-1803. doi: 10.1161/circulationaha.114.010270
Villiers-Tuthill, A., Copley, A., McGee, H., & Morgan, K. (2016). The relationship of tobacco and
alcohol use with ageing self-perceptions in older people in Ireland. BMC Public Health, 16(1).
doi: 10.1186/s12889-016-3158-y