Current Trends in Cardiac Health Care - Research Paper Example

? Current Trends in Cardiac Health Care Current Trends in Cardiac Health Care Disease and dysfunction of the cardiovascular system is the single most common cause of death in adults living in the Western world. Excluding those due to childbirth, it is also the single largest medical reason for hospital admissions. This has been true for some time and shows no signs of changing (Ronning, 2007). However, even if the relative proportion of heart disease in comparison to other causes of morbidity and mortality are not changing, other factors affecting cardiac health and care are undergoing constant changes. These factors include changes in mortality rates, the demographic descriptions and medical health background of a “typical” cardiac disease patient, and the types of medical treatment these patients receive. Mortality Rates Patients who are admitted to the hospital for cardiac or cardiovascular disease, including heart attack and stroke, have a mortality rate several times higher than that of general admissions. This is unsurprising, since cardiac disease is much more serious than many conditions that nevertheless require hospitalizations. On the positive side, studies have shown that the mortality rate for patients who are admitted promptly after the beginning of symptoms has been slowly but significantly declining. Statistics show that patients are more likely to admit themselves to the hospital upon signs of an urgent cardiac event; for example, though the number of heart attacks per 1000 persons in California and a decline in hospital admissions in general, there has actually been an increase in hospital admissions for heart attacks (Office of Statewide Planning and Development, 2011). This fits in with the general trend for heart attacks in hospital emergency wards that has been seen since the early 1980s. The rate of heart attack had been dropping steadily from 1980 onward, until about the middle of the 1990s, when a new test had been developed to detect heart attack. Predictably, the statistics then show the rate of heart attacks detected to rise again, but due more to the higher sensitivity of the new test and not to any actual change in the rate of heart attack in the population (Office of Statewide Planning and Development, 2011). Mortality rates for cardiac disease patients are unfortunately also affected by hospital profit and cost of care concerns. Treatment for cardiac disease is becoming a lucrative area of sub-specialization, and many smaller hospitals have begun opening cardiac ICUs and cardiac surgery departments in order to increase their profitability (Ronning, 2007). However, the mortality and adverse event rates for patients admitted to these smaller hospitals is much higher than those of bigger, more experienced hospitals; if the trend continues, a rise in mortality rates could very well occur (Joynt, Orav, & Jha, 2011). The combination of the cutting-edge nature of cardiac care with a doctor who is unfamiliar with the field in general and does not perform many such treatments greatly affects patient outcome. This correlation has been recognized to the point that cardiac surgeons are recommended to perform a minimum number of invasive cardiac surgeries a year, in order to maintain the proper level of training and familiarity with the procedure (Tu, Austin, & Chan, 2001). Patient Demographics and History The picture of the typical heart disease or cardiac disease patient is also showing changes over time. For example, women are becoming an ever-larger percentage of admissions; in Canada by 2004, women made up approximately half of such admissions (Tu, Jackevicius, Lee, & Donovan, 2010). Racial percentages for cardiac-related hospitalizations have also shifted, moving some of the preponderance of patients from the Caucasian segment to other racial groups, though Caucasians still represent the majority of cardiac patients. However, this could be due to the shifting racial proportions of the entire population, and not necessarily due to any change in actual disease incidence (Office of Statewide Planning and Development, 2011). In addition to changes in the demographics of cardiac disease patients, there has been a trend of increasing co-morbidities seen in patients with cardiac disease. In California the number of cardiac disease patients with a co-morbidity has doubled over the last ten years (Office of Statewide Planning and Development, 2011). Despite the overall decline in mortality rate for cardiovascular disease, the increase of co-morbid conditions has some physicians concerned that rates will again rise in the future. Especially worrisome to those medical professionals is the number of patients who present with obesity and obesity-related conditions co-morbid to their cardiovascular disease. These conditions hold a particular risk for adverse events during treatment and recovery, significantly raising the mortality rate for those patients (Tu et al., 2010). Treatments The changes in mortality rate can often be attributed to the new treatment trends, and sometimes a single treatment change may lead to widespread changes. For example, surgical intervention has been almost entirely replaced by percussive coronary intervention through catheterization; even hospitals without a dedicated cardiac surgery unit may have surgeons who can administer heart catheters (Ronning, 2007). Cardiogenic shock, where the heart tissue becomes so damaged that it cannot supply blood to the organs, has shown a decrease in incidence for hospitalized patients, though the number of arriving patients with the condition has remained steady. The mortality rate for the hospitalized patients has dropped sharply due to the increased and prompt use of percussive coronary intervention as treatment (Jeger et al., 2008). The incidence and mortality of another type of cardiac event, myocardial infarction, has been followed in Finland since 1998. The survival rates for myocardial infarction have also benefited from the increased use of percussive coronary intervention, at least as reported in Finland, and from an understanding that patients presenting with the symptoms of myocardial infarction need immediate treatment (Hakkinen et al., 2011). A debate has been opened on the possibility that surgical intervention and even the currently popular percussive coronary intervention are no more effective than current pharmaceutical treatment in preventing future adverse cardiac events (Ronning, 2007). Aldostrone-blocking treatments have been called a pharmaceutical answer to heart failure; these aldosterone anatagonists block the receptor sites on the heart. By doing so, these medications can actually de-fibrillate the atrium of the heart without the use of electricity. They could also be used to treat previously medication-resistant hypertension (Bramlage, Turgonyi, & Montalescot, 2011). Many more hospitals have been opening cardiac specialty wards and dedicated cardiac surgery departments. There are both positive and negative treatment effects of this. As discussed previously, a relatively small hospital with relatively inexperienced physicians is going to suffer a much higher rate of complications from surgery and a higher mortality rate than a larger hospital with more experience in such patients (Tu et al., 2010). Conversely, however, many of the gains in treating myocardial infarction and cardiogenic shock relate to rapidly moving the patient to the correct kind of treatment. More hospitals with such facilities means patients can be treated sooner and this should ultimately decrease the mortality rate for such conditions (Hakkinen et al., 2011; Jeger et al., 2008). Proper staffing and training for these departments is of utmost concern, then, if they are going to have the best outcome for patients. Many nurses, for example, feel that they are still under qualified to work in a cardiac-specific ICU or surgery unit. Years of clinical experience does not seem to replace proper training in their perception of skill level (Kane & Preze, 2009). While cardiovascular disease is still the leading killer of adults, many changes have occurred and many are still occurring, in the areas of mortality rates, patient demographics, and treatment methods. Mortality rates are generally decreasing, even as hospital admissions for conditions in this category increase. The rate of detected heart attacks has increased, though this is most likely due to more sensitive testing for the event, and does not have much effect on mortality rate. Cardiac disease patients are now equally likely to be men or women, instead of the heavy favoring on men, and the number of non-white racial backgrounds in patients is shifting away from the previous Caucasian majority. The number of patients presenting with one or more co-morbid conditions, especially obesity, has greatly increased in recent years, which could have a future negative effect on survival. Treatments are now primarily performed either through catheterization or medication, moving away from the invasive surgery treatments in previous years. Time is of the essence in many cases, meaning that urgent cardiac treatments may be performed even at hospitals without dedicated departments for them. However, more training and preparation is still needed for those medical professionals who perform such treatments, whether or not they work within a dedicated unit. References Bramlage, P., Turgonyi, E., & Montalescot, G. (2011). Aldosterone blockade: current research and future trends. European Heart Journal Supplements, 13(Suppl B), B46-B50. doi:10.1093/eurheartj/sur005 Hakkinen, U., Hartikainen, J., Juntunen, M., Malmivaara, A., Peltola, M., & Tierala, I. (2011). Analysing current trends in care of acute myocardial infarction using PERFECT data. Annals of Medicine, 43(S1), S14-S21. doi:10.3109/07853890.2011.586363 Jeger, R. V., Radovanovic, D., Hunziker, P. R., Pfisterer, M. E., Stauffer, J.-C., Erne, P., Urban, P., et al. (2008). Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock. Annals of Internal Medicine, 149(9), 618 -626. Retrieved from http://www.annals.org/content/149/9/618.abstract Joynt, K. E., Orav, E. J., & Jha, A. K. (2011). The Association Between Hospital Volume and Processes, Outcomes, and Costs of Care for Congestive Heart Failure. Annals of Internal Medicine, 154(2), 94 -102. doi:10.1059/0003-4819-154-2- 201101180-00008 Kane, J. M., & Preze, E. (2009). Nurses? Perceptions of Subspecialization in Pediatric Cardiac Intensive Care Unit. Journal of Nursing Care Quality, 24(4), 354-361. doi:10.1097/NCQ.0b013e3181aa4908 Klein, D. G. (2007). Current trends in cardiac transplantation. Critical Care Nursing Clinics of North America, 19(4), 445-460, vii. doi:10.1016/j.ccell.2007.08.001 Office of Statewide Planning and Development. (2011, Spring). Trends in Cardiac Care in California, 1988 to 2008 - Part II: Trends in Heart Attack Hospitalizations. State of California. Retrieved from http://www.oshpd.ca.gov/HID/Products/Health_Facts/HealthFacts_Cardiac2.pdf Ronning, P. L. (2007, May). Cardiac care driving change and stability: if you think the healthcare landscape is already cluttered with cardiac services, you may be in for a surprise. Healthcare Financial Management. Retrieved from http://findarticles.com/p/articles/mi_m3257/is_5_61/ai_n19170731/ Tu, J. V., Austin, P. C., & Chan, B. T. B. (2001). Relationship Between Annual Volume of Patients Treated by Admitting Physician and Mortality After Acute Myocardial Infarction. JAMA: The Journal of the American Medical Association, 285(24), 3116 -3122. doi:10.1001/jama.285.24.3116 Tu, J. V., Jackevicius, C. A., Lee, D. S., & Donovan, L. R. (2010). National Trends in Cardiovascular Care and Outcomes. Healthcare Quarterly, 13(1), 22-25. Retrieved from http://www.ccort.ca/Portals/0/PDF/Articles/PDF/2010%20Tu %20National%20Trends%20in%20Cardiovascular%20Care%20and %20Outcomes.pdf Wenger, N. K. (2008). Current Status of Cardiac Rehabilitation. Journal of the American College of Cardiology, 51(17), 1619-1631. doi:16/j.jacc.2008.01.030 Read More