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Congestive Heart Failure

Rogert Castro

South University Online

Evidence Table Worksheet

I. PICOT Question:

Does an effective discharge plan (I) compared to routine care (C) influence Readmission rates (O) in patients, 65 years and older, who have been discharged after hospitalization with Congestive heart failure (P) over 30 days after discharge (T)?

Plus

1. Will you have a comparison group, or will subjects be their own controls? Yes, there will be a comparison group. The study population will have personalized post-discharge outpatient follow-up appointments, while the control group will not have the usual care.

2. Is a ‘time’ appropriate with your question—why or why not?

The allocated time is suitable for the study and will provide more time to follow up for patients after discharge.

II. Evidence Synthesis

Database: PubMed	(Parrinello et al., 2011)	(Ryan et al., 2013)	(Shao et al., 2013)	(Lee et al., 2016)	(Sharma et al., 2010)	Synthesis
(p) Population	Comprised of 22 discharged CHF patients	398 patients from heart failure discharge	The intervention group had 47 heart failure patients actively attending cardiac clinics.	11,985 eligible adults hospitalized for HF	62 746 COPD patients years old.	All the studies comprised of a study population that was either hospitalized for HF or heart related conditions such as COPD.
(i) Intervention	Early and personalized congestion guided ambulatory program.	7-day follow-up visits.	Self-management initiatives centered on the self-efficacy construct, in elderly patients with heart failure.	The timing and type of post-discharge follow-up	An early follow-up visit with the patient’s pulmonologist or primary care physician.	From the studies, there are several intervention methods and approaches that have been studied by scientists capable of decreasing readmissions
(c) Comparison	(c) Comparison 21 subjects for the control group	No control group	The Control group had 46 patients that received the usual care	7,935 eligible controls.	Usual care and no follow-up	These are primary studies, and it is proper for them to have controls as part of the research design to lower the effects of variables.
(o) Outcome.	Improved clinical compensation, enhanced quality of life, and a decrease in readmissions	A reduction in 30- day readmission rate.	Significantly improved confidence for salt and fluid control, self-management behavior, and reduction in heart failure-related symptoms.	Risks of readmission within 30 days after discharge.	A reduction in readmissions and emergency department visits.	Majority of the intervention measures taken significantly reduce readmission cases and risks for readmission.
(t) time	Six months of follow up visits.	30 days follow up visits.	12 weeks follow up visits.	30 days	30 days	Each study had a proper time frame that allowed the studies to be completed and answer the clinical question

III. Evaluation Table

Citation	Design	Sample	Major Variables: Independent Dependent	Study findings: Strengths and weaknesses	Level of Evidence	Synthesis
(Parrinello et al., 2011)	Case-control study design	43 participants The sample was inadequate	Major Variables: Independent: Readmission rates Independent Dependent: Early (Time)and personalized congestion-guided ambulatory initiatives	Study findings: Early and personalized ambulatory follow-up among CHF patients can effectively improve the management and maintenance of clinical stability in the post-discharge period. Strengths: No conflict of interest, the results have significant clinical practice implications and essential for future studies. Weaknesses: Inadequate sample size. No power analysis	Level IV	Despite a small sample size, the study provides significant evidence to answer the clinical question for this study. It evaluates alternative methods that can be used to lower readmission rates in elderly patients.
(Ryan et al., 2013)	Retrospective chart review	398 patients from heart failure discharge. Adequate	Major Variables: Independent: Change in readmission rate Independent Dependent: Seven-day follow-up appointment	Study findings: Hospital heart failure readmissions reduced within 30 days Strengths: Adequate sample size The result is of clinical significance Charts, graphs, and tables to illustrate the findings Sufficient statistical analysis Weaknesses: It is a single-center analysis Discrepancies in the number of patients recruited and completed follow-ups	Level III	The study provides compelling evidence to support the PICOT question. The research design and the time frame match the current research. It ascertains the fact that follow-ups can significantly reduce readmissions.
(Shao et al., 2013)	Randomized controlled trial	47 study participants for the intervention group and 36 for the control group The sample size is adequate	Major Variables: Independent: Self-efficacy for salt and fluid control, HF related self-management behavior, and heart failure symptom Independent Dependent: self-management initiatives	Study findings: self-management initiatives improve patient self-efficacy Strengths: It is an RCT study Clinical significance Used Bandura’s model for improving self-efficacy Weaknesses: Inconclusive results. Limited time frame. Lack of objective measures. The study cannot be generalized	Level II	The study provides strong evidence to answer the PICOT question. Furthermore, it looks at a different method for reducing readmission rates as compared to the other earlier studies
(Lee et al., 2016)	Nested matched case-control study	11,985 eligible adults for the intervention group the sample size is adequate	Major Variables: Independent: Readmission rates Dependent: Timing and type of post-discharge follow-up	Study findings: Outpatient follow-up with a care provider within 7 days reduced chances of 30-day readmission Strengths: clinically significant No conflict of interest large sample size Enough time frame Graphs, charts, and tables to illustrate the outcomes Weaknesses: Lost follow-ups due to a large number No power analysis	Level IV	According to the research design and the findings, this study will be crucial in this project. The article provides compelling evidence regarding what kind of intervention can be used to reduce readmissions.
(Sharma et al., 2010)	Retrospective e cohort study	62 746 COPD patients years old Adequate sample size	Major Variables: Independent: Readmission rates Dependent: Early follow-up visit with care providers	Study findings: Follow-ups with care providers can reduce readmissions rate Strengths: Had several inputs from other scholars Had tables and charts to present results. Weaknesses: Only examined follow-up visits with the patient’s own PCP or pulmonologist Inadequate patient data before first admission	Level IV	The study demonstrates that follow-ups with PCP or pulmonologist lower patient readmission. Just like the other studies, it shows there are different ways to reduce readmission cases.

References

Lee, K., Yang, J., Hernandez, A., Steimle, A., & Go, A. (2016). Post-discharge Follow-up Characteristics Associated With 30-Day Readmission After Heart Failure Hospitalization. Medical Care, 54(4), 365-372. https://doi.org/10.1097/mlr.0000000000000492

Parrinello, G., Torres, D., Paterna, S., Di Pasquale, P., Trapanese, C., & Cardillo, M. et al. (2011). Early and personalized ambulatory follow-up to tailor furosemide and fluid intake according to congestion in post-discharge heart failure. Internal And Emergency Medicine, 8(3), 221-228. https://doi.org/10.1007/s11739-011-0602-y

Ryan, J., Kang, S., Dolacky, S., Ingrassia, J., & Ganeshan, R. (2013). Change in Readmissions and Follow-up Visits as Part of a Heart Failure Readmission Quality Improvement Initiative. The American Journal Of Medicine, 126(11), 989-994.e1. https://doi.org/10.1016/j.amjmed.2013.06.027

Shao, J., Chang, A., Edwards, H., Shyu, Y., & Chen, S. (2013). A randomized controlled trial of a self-management programme improves health-related outcomes of older people with heart failure. Journal Of Advanced Nursing, n/a-n/a. https://doi.org/10.1111/jan.12121

Sharma, G., Kuo, Y., Freeman, J., Zhang, D., & Goodwin, J. (2010). Outpatient Follow-up Visit and 30-Day Emergency Department Visit and Readmission in Patients Hospitalized for Chronic Obstructive Pulmonary Disease. Archives Of Internal Medicine, 170(18). https://doi.org/10.1001/archinternmed.2010.345

PICOT QUESTION

Research Tool	Search Tips	Search Terms & Limits	Findings	Features
CINAHL CINAHL is a SU subscription resource database that offers nurses, allied health professionals, researchers, nurse educators and students a research base on subscription terms. With more than 6 million records, it indexes more than 5400 journals and 70 full text journals. Indexed journals do not provide access to full-text. Just because it is indexed in does not mean the library has full-text access to the journal. SU can always request articles for students via Interlibrary Loan, but the service is not instantaneous	Look at the Major Subject Heading in the Full Record Use the Limits Feature	Keyword search: Congestive heart failure, Readmission rates, Effective discharge plan, Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	875	The databases are very easy to use. The database makes it easy and user friendly by allowing additional keywords and search filters. The database is a subscription service.
PubMed PubMed is a free health science citation & abstracts index from the National Center for Biotechnology Information at the U.S. National Library of Medicine	Look at the Major Subject Heading in the Full Record Use the Limits Feature	Keywords Congestive heart failure, Readmission rates in older patients, Effective discharge plan Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	1845	Not all the articles were exactly relevant to study. But it was very helpful to research many different treatment options. I found this database the best. It was the easiest to navigate and it has the most relevant articles related to my topic
Cochrane Library Cochrane Library provides access to the Cochrane	Use the Simple Search and the Advance Search Features from the Menu Allows you to search with MeSH Terms Browse reviews by topic	Keyword search: Congestive heart failure, Readmission rates, Effective discharge plan Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	30	Much harder to navigate and a lot less relevant articles. I only found 30 articles that were relevant. However, the 30 were more specific to the study. Not all the databases were that specific with the treatment options.
Dynamed	Use the Simple Search and the Advance Search Features Allows you to search with MeSH Terms Check out the New Reviews Browse reviews by topic	Keyword sear congestive heart failure, Readmission rates, Effective discharge plan:	3	When I typed in Congestive heart faiulre for my keyword it came up with multiple articles on different mental illnesses. I didn’t find this database very useful. It wasn’t as easy to navigate as some of the others.
TRIP Database TRIP is a clinical search engine to locate publicly available clinical evidence.	Limit to: Systematic Reviews Guidelines-US	Keyword search: Congestive heart failure, Readmission rates Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	156	I found it easy to navigate. It offered many articles that were relevant to my PICO question.
SU Library Search	Library Search is setup just like an EBSCO The Library even has a specialized PICOT search setup in Library Search— must go to Advance search to get to PICOT option	Keyword search: Congestive heart failure Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	1423	This includes multiple databases which are very helpful in researching more specific topics. I found it very easy to use
Other Databases: ScienceDirect	Advance search to get to PICOT option	Congestive heart failure Limits: peer reviewed less than 5 years old, journal article, clinical trial, full text	205	I found it easy to navigate. It offered many articles that were relevant to my PICO question.