Literature Review - Assignment Example

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In elderly patients with congestive heart failure: Does non-pharmacologic management prevent the reoccurrence of heart failure compared to pharmacologic management? Name Institution INTRODUCTION: CONGESTIVE HEART FAILURE (CHF) Congestive Heart Failure (CHF) is a clinical syndrome characterized by ineffective myocardial pumping…
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Download file to see previous pages Clinical symptoms of CHF include: breathing problems, fatigue, exercise intolerance and peripheral oedema, and frequent thirst. According to Donner et al. (2012, p. 442), some of the causes of heart failures include high sodium consumption, consumption of foods that are poor in vitamins, mineral and fiber, high intake of saturated fat, cholesterol, and simple carbohydrate. Among adults with over 65 years, CHF is the leading cause of hospitalization. Doris et al. (2007) argue that effective management of heart failure requires pharmacological management combined with non-pharmacological interventions. This position is significant in this literature review because of the need to evaluate the best option between pharmacological and non pharmacological management interventions. It will be vital to evaluate which option will provide the best management that will ensure no reoccurrence of hear failure in elderly patients. In this literature review, three themes stand out in the management of congestive heart failure namely; pharmacological treatment therapies, non pharmacological treatment therapies, and a combination of the two management therapies. PHARMACOLOGICAL MANAGEMENT THERAPIES Pharmacological management therapies involve administration of a drug to alleviate the symptoms of CHF. Diuretics such as furosemide, torsemide, bumetanide and thiazide are important drugs in the management of CHF. Administration of these drugs can either be through intravenous bolus every 12 hours or by continuous intravenous infusion. Debates still exist on the most effective way of administrating these drugs. Similarity Some studies have shown that administration by continuous intravenous infusion is more effective in the management of CHF. Differences However, these studies have received a fair share of criticism. Similarly it is not clear as to whether administration of high dose of diuretics is more effective in management of CHF than administration of low doses of diuretics. This means that current guidelines on administration of diuretics are based on expert opinion. This has resulted in variation in the mode of administration and the dosing. The integration/synthesis of the evidence There is still some controversy on the administration of pharmacological management therapies. This may have some negative impact on the treatment of CHF among elderly patients. For example, in a study done by Felker et al. (2011), it was observed that among patients with acute decompensated heart failure (HF), there no significant differences in “patients’ global assessment of symptoms” or in the change in renal function on administering diuretic therapy by bolus when compared with continuous infusion or at a high dose as compared with a low dose (p.797). These findings do not agree with findings of previous study, which recommended that continuous intravenous infusion is more effective than intravenous bolus. Critique of the evidence This leaves the medical doctor at a dilemma and thereby, no agreement on the best way to administer pharmacological treatment to patients. Unless this is done, varying expert opinion will still be used in the administration of diuretics by clinicians, and this poses a danger to the patients because such treatment will be based on try and error. NON PHARMACOLOGICAL CHF MANAGEMENT THERAPIES Non pharmacological CHF management therapies involve the use of non drug approaches to alleviate the symptoms (Kostis, et al., 1994). ...Download file to see next pagesRead More
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