Management of Chronic Complex Condition: Chronic Heart Failure

This document discusses the management of chronic heart failure, including prevention, detection, treatment, and palliative care. It highlights the importance of person-centered care and explores the NSW clinical service framework for CHF. The document also emphasizes the role of multidisciplinary approach and the impact of policy changes on improving health outcomes.

Management of Chronic Complex Condition: Chronic Heart Failure 1
Management of Chronic Complex Condition: Chronic Heart Failure
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Management of Chronic Complex Condition: Chronic Heart Failure 2
Part A
Patients with complex and chronic conditions experience many morbidities which often
require the attention of multiple healthcare providers (Kuluski et al., 2013, pp.111-123) for
example people with cardiovascular issues. In Australia, Chronic Heart Failure (CHF) is a
significant chronic and complex cardiovascular condition that has a prevalence of about one
million people (Chan et al., 2015, p.446). CHF is a leading stressor of the Australian healthcare
system with high rates of preventable admission and readmission to healthcare facilities (Chew
et al., 2016, pp.128-133). These high rates of preventable readmission offer a chance for
improvement of the CFH outcomes at both individual and societal through levels policy changes
that enhance improved quality care (Davidson et al., 2015, pp.2225-2233).
An excellent example of such a policy is the NSW clinical service framework for CHF
2016 which is composed of nine-evidence based guidelines that help the healthcare professionals
to manage CHF (Chew et al., 2016, pp.128-133). The framework helps in the prevention,
detection and interventions on the condition to generally improve the health of the nation.
The first standard is the prevention of CHF by preventing myocardial destruction which
often results in CHF. Diseases such as Coronary heart disease and hypertension are the major
diseases that damage the myocardial muscles (Heush et al., 2014, pp.1993-1943). A study
conducted in 2004-2005 on the Aboriginal people shows that 53% of the population had three or
four predisposing factors for a cardiovascular condition. These factors were smoking, physical
inactivity, high alcohol consumption, eating less than five serves of vegetables in a day, eating
less than two serves of fruits daily, hypertension, obesity, long-term kidney maladies and
diabetes (Hoy, Mott and McDonald, 2016, pp.916-922).

Management of Chronic Complex Condition: Chronic Heart Failure 3
Next is to detect and control factors that bring about and advance CHF. All clinicians
need to be aware of the cardiac factors that cause and advance the disease so as to focus at
identifying, preventing and treating them. The factors include myocardial ischemia, elevated
blood pressure and arrhythmias and other non-cardiac factors such as anaemia. The Australian
Health workers (AHWs) are to be educated on these factors as well to facilitate a concerted effort
towards combating the disease.
Standard number three requires a comprehensive diagnosis of the disease through clinical
assessment and investigations to assess the severity of the condition and identification of the
reversible interventions (Atherton et al., 2018, pp.1123-1128).
The next guideline is the treatment of the acute symptoms of CHF by relieving these
symptoms thereby promoting cardiac functioning. Upon facilitating the cardiac operation then
follows the pharmacological management of the condition. Sticking to the recommended
pharmacological therapy in the right dosage is vital to ensure optimal control of the disease and
quality of life for the patients.
The healthcare providers should then consider providing the CHF patients with suitable
devices and surgical therapies that may improve the quality of life as well as reduce other
adverse events related to the treatments and mortality cases. The patient should be subjected to
receiving multidisciplinary continuing care and rehabilitation. Proper coordination between
primary care clinicians and general physicians reduces admissions cases improving the prognosis
for CHF patients (Atherton et al., 2018, pp.1123-1128). Other physician specialties such as
respiratory specialist may also have an input into the management of CHF facilitating optimal
care for the patients.

Management of Chronic Complex Condition: Chronic Heart Failure 4
The other standard promotes palliative care on patients even those with a substantial
likelihood of death within a year through having access to quality primary care from the
multidisciplinary workforce. The ninth standard ensures there is monitoring of quality of the
services as well as the result indicators. Both the hospitalized and community managed patients
have to be monitored to ascertain the effectiveness of the care given to these patients. From this
monitoring, gaps are identified, and appropriate changes are made.
Part B
Person-Centered care (PCC) is a model of care delivery that underpins a collaborative
approach in the care of patients and their healthcare professionals. Studies have shown that PCC
reduces financial expenditures on chronic conditions and it reduces the length of hospitalised
CHF patients with a significant reduction in the rate of hospital readmission. The PCC facilitates
a quality health-related life among patients with chronic conditions (Hansson et al., 2016,
pp.276-284).
Mr. Harry requires a PCC to enhance a quality healthy life. His age, 68 years old is a risk
factor in itself to chronic myocardial dysfunction. He has led a lonely life since the demise of his
wife five years ago. His loneliness is compounded by the fact that his children are all grownups
that have their homes. Although sometimes his son pays him visits they are for brief periods and
periodical.
Further, he has secluded himself from the men’s shed for feeling not fit to manage trips to
and from such sites despite having recovered from his chronic condition by adopting an active
physical life. His physical activities were achieved by tending his rose garden and participating

Management of Chronic Complex Condition: Chronic Heart Failure 5
at the Bowling Club. Now he no longer goes to this club for fear that his health cannot enable
him to be physically active. Harry purchases ready to cook foods which are mostly processed
foods for he rarely uses fresh produce anymore.
His children believe that he developed hypochondriasis which is the psychological worry
of having a severe illness even though diagnosis indicates otherwise (Mcguire et al., 2014,
pp.106-116).
Regarding Harry’s needs, this PCC will consider the management of his behavioural risk
factors that is nutrition, social behaviours, physical activity and healthy weight. Also, it is
important to evaluate his biomedical risk factors on lipids, blood pressure and diabetes which are
commonly associated with CHF. Lastly, the plan will cover the management of his condition
pharmacologically (Woodruffe et al., 2015, pp.430-441).
According to the NSW policy on the management of CHF, the first step entails the
prevention of the chronic condition, therefore I will have to conduct various assessments on
Harry. The plan will involve regular measurements of blood pressure at Central Coast Local
Health District to check for the possibility of hypertension. The regularity of the measures is
influenced by the absolute cardiovascular risk assessment at the facility whereby if the risk is
high then it will be conducted at an interval of every 6-12 weeks. Tests on blood pressure will
help reduce the risk for hypertension and other cardiovascular risks (Sindone et al., 2013, p.634).
Blood lipids will also be measured after every five years to ensure dietary saturated fats are kept
at low levels by the aid of lipid levels profile information. Among other nutritional requirements,
Harry requires plant-based foods such as fruits, vegetables, pulse and whole grain to maintain his
saturated fatty acid levels below 7% and that of the Trans fatty acids to less than 1% of the intake

Management of Chronic Complex Condition: Chronic Heart Failure 6
(Davis et al., 2015, p.35). To implement this plan, I will suggest plant produce to substitute for
his favourite processed foods. Such a diet is also important in preventing obesity and maintaining
health weight.
Harry feels not fit to get back into his physically active life because of hypochondriasis.
He has avoided the social sites that could relieve him of his loneliness. These are symptoms for a
mental condition. The goals of this plan are to ensure that Harry is socially active and engage in
physical activities such as walking and some exercise with the Bowl club. He should continue to
tend his rose garden and do some walking around the compound when he feels too weak to walk
far distances.
I would also recommend him to a mental healthcare professional at the Central Coast
Local Health District to help him with his hypochondriasis situation. Hypochondriasis is the
primary reason for his physical inactivity for he feels that the chronic condition he had some time
back is not yet recovered. To further aid the alleviation of this condition I would request his son
to visit him more often and create more time with him. The visitations would reduce boredom
and stress that may have compounded as a result of losing his companion.
If Harry’s condition does not change positively upon the implementation of the PCC and
pharmacological therapy, then an assessment for palliative care will be done. Also, it might be
vital to consider devices in the management of CHF if the condition continues to deteriorate.
Upon consultation and discussion with the cardiologist together with the patient, if necessary
cardiac surgery may be recommended. The assessment will be done according to the Central
Coast Local Health District guidelines. Lastly, a monitoring strategy to evaluate the effectiveness
of the plan will be assessed.

Management of Chronic Complex Condition: Chronic Heart Failure 7
In conclusion, CHF is an essential complex chronic condition that affects quite some
Australians. The multiple comorbidities exhibited by patients of CHF are responsible for the
escalated budgetary expenditure on managing it. Risk factors such as ageing are evident among
the Australian population necessitate for change in policy to reduce the health impacts of CHF
and improve health outcomes. The NSW policy on CHF advocates for a multidisciplinary
approach to the control of this cardiovascular condition. Besides, PCC improves the general
health and aids the recovery process of the patients. These models of health care provision cut
on cost by reducing rates of hospital admissions and readmissions.

Management of Chronic Complex Condition: Chronic Heart Failure 8
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