Defining The Clinical Question

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Defining The Clinical Question Valerie Sanford RN, MSN, CRNP, AACC Duke University School of Nursing Dr. Deirdre Thornlow, PhD, RN, CPHQ September 22, 2011 Introduction Heart failure is a chronic condition that affects an estimated 5 million Americans. The one year survival rate has been estimated at 80-90% in patients classified as NYHA class I-II and 50-60% in NYHA class III-IV; which is more than breast cancer, ovarian cancer, and colon cancer.


Some studies have shown that education given to patients may be insufficient. Noncompliance with medication, diet, or symptom monitoring caused 15-64% of hospital readmissions. One way to combat these barriers is to design advanced practice nurse led heart failure clinics for outpatient management of heartfailure . Many studies have shown that heart failure clinics designed with advanced practice nurse post hospital follow-up improved patient education and compliance thus decreasing hospital readmissions (Paul 2008). The types of heart failure patient typically followed in advanced practice nurse led clinics are New York Heart Association Classifications II-IV. These patients were classified based on either echocardiography or radiography evidence of pulmonary congestion or signs or symptoms of heart failure. Background Despite advancements in the management of this debilitating condition, such as introduction of beta blockers, aldosterone antagonist, and angiotensin receptor blockers mortality and morbidity among heart failure patients remain high. Generally 25-50% of hospitalized patients will be readmitted within 6 months of discharge (Gustafsson, Schou et al. 2009). ...
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