The Catheter Ablation Effect for Fibrillation - Assignment Example

Congestive Heart Failure Matrices Congestive Heart Failure: non-pharmacologic vs. pharmacologic management 1 Hsu et al Matrix Citation Variables/ Key Concepts Sampling Design/ Method Instruments/ Data Collection Results Strengths/ Limitations Critique Hsu, L., Jaïs, P., Sanders, P., Garrigue, S., Hocini, M., Sacher, F., Takahashi, Y., Rotter, M., Pasquié, J., Scavée, C, Bordachar., Clémenty, J., Haïssaguerre, M. (2004). Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure. Retrieved from http://rc.kfshrc.edu.sa/besc/sections/RCF/E_Library/TEDR/Catheter%20Ablation%20for%20AF%20in%20CHF.pdf The purpose of the study was to evaluate the catheter ablation effect for fibrillation which is atrial, on the left ventricular function in patients who experience heart failure. The key concepts included: left ventricular function, exercise capacity, symptomsand quality The sample included 58 consecutive Patients who experienced heart failure which is congestive from any cause, and who were being treated through curative ablation for atrial fibrillation. Age, sex, and classification of atrial fibrillation was a match for fifty-eight Patients who were chosen to act as controls which are procedural from a total of 591 patients, who did not have congestive heart failure Design: A cross-sectional, descriptive design was used for this study. The sample size was 116 participants. Method: Direct observation method was used; Two days before the ablation procedure for baseline evaluation, patients were routinely admitted . A questionnaire was also used to obtain data. Data collection occurred over 3 years (from March 2001 to March 2004). The left ventricular function of the patients and the dimensions, exercise capacity, symptom score and quality of life were done in two phases: at baseline and at Months 1, 3, 6, and 12. Statistical Package for the Social Science (SPSS), version 16.0, was used for data analyses. Those patients who were experiencing heart failure which is congestive had improvements in terms of the left ventricular function. The method used (observation) was appropriate for this kind of study. Also the use of a control sample was an excellent means of verifying the results. In addition, the authors used over 30 references which make the study credible. Limitations: The sample size used was quite small and selected from one location. It is also notable that the time of study was long and the results may not have been consistent. To improve the results of the study, a large sample size should be chosen from various locations. The period of study should also be reduced. Quality of Research: The authors used many references which mean the research problem was well defined. It is also notable that the paper is presented in an understandable and simple language. Maintenance and restoration of sinus rhythm by catheter ablation, which does not incorporate drug use in patients with congestive heart failure, as revealed by the study, significantly causes improvements in cardiac function, exercise capacity symptoms and quality of life (Hsu et al., 2004). It supports the use of non-pharmacologic management techniques to improve the health of heart failure patients. However, the study could be improved by increasing the sample size and widening the study population. 1.2 Rich et al Matrix Citation Variables/ Key Concepts Sampling Design/ Method Instruments/ Data Collection Results Strengths/ Limitations Critique Rich, W. M., Beckham, V., Wittenberg, C., Leven, C. L., Freedland, K. E., Carney, M. R. (1995). A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure. The New England Journal of Medicine, Vol. 133. The purpose of the study was to determine the extent to which re-admission of elderly people -with congestive heart disease- could be reduced by addressing their behavioral and social issues such as diet, medication and quality of life. Key concepts revolved around one issue: multidisciplinary approach to treatment and its effects on on the rate of readmission, quality of life, and the overall cost of medical care, among the elderly, congestive heart failure patients’. Samples of 282 patients were chosen out a total of 1306 patients with congestive heart disease and are 70 years and above. The criteria for exclusion from the study included residence outside the catchment area of Jewish Hospital Home Care, discharge to a care facility which is planned, severe dementia or other serious psychiatric illness, anticipated survival of a refusal to participate in less than three months, by either the physicians or the patients. Patients were educated thoroughly on the key aspects and frequent follow-ups done to ensure compliance. The sample for this study was 282 patients living within the catchment area of Jewish Hospital Home Care. 140 were classified under control group while the rest under treatment Data collection occurred over four years (from July 1990 to June 1994) Data was collected in various phases: At the time of enrollment, during follow-ups and Re-admissions. Data on quality of life and costs were only collected from the sub-groups to minimize the burden on the patients. Questionnaires were used to collect data on the quality of life. The intention-to-treat Principle was applied in conducting all the analysis. 90 days survival with the absence of real admission was the Pre-specified outcome measure. 90 days survival with the absence of real admission was the Pre-specified outcome measure, and was attained by 91 out of the 142 patients in the first group, while in the control group, 75 out of the 140 patients received conventional care Strengths: By targeting a more risky population (over 70 years old) and using an intensive intervention approach, led to favorable results. The benefit of reducing the rate of re-admissions and improving the quality of life was as great as expected. Weaknesses: Measuring the quality of life was difficult and was not a good parameter. And the results cannot be generalized on other pollutions. Moreover, the follow duration (90-day) was too short to provide credible results. The study could be improved upon by lengthening the follow up period from 90-day to at-least 1 year. Also the approach should be narrowed down to few specific issues Quality of research: To begin the study The study was approved by the institutional review board of Jewish Hospital, and all patients provided informed consent. The study explains the sample population, location, and characteristics of the sample. The study had a high level of clarity and simplicity and was easily understood. The purpose of the study was well defined. However, the study was not generalizable. The findings of the study may not be applied to other populations. A multidisciplinary intervention which is nurse-directed can greatly help in reducing hospital use and medical costs, and in improving quality of life for elderly patients with congestive heart failure (Rich et al., 1995). 1.3 Kostis et al Matrix Citation Variables/ Key Concepts Sampling Design/ Method Instruments/ Data Collection Results Strengths/ Limitations Critique Kostis, J. B., Rosen, C. R., Cosgrove, N. M., Shindler, D. M., Wilson, A. C. (1994). Nonpharmacologic Therapy Improves Functional and Emotional Status in Congestive Heart Failure. CHEST, 106 (4), 996-1001. To make a comparison on the multimodal nonpharmacologic intervention effects to digoxin, in patients who experience heart failures which are congestive A sample of three groups, each consisting of 20 patients was chosen for this study. Each of the three groups was treated differently. Briefly, non-pharmacological group did exercises; Placebo and Digoxin group were given drugs. Parallel assignments which are randomized to three treatment groups, each having 20 patients who experience heart failures which are congestive Structured questionnaires were the major data collection method used. Ejection fraction which is echocardiographic greatly improved One of the strengths is the randomization of the study, it produced un-biased results. Questionnaires and observational techniques used were a great boost to the validity of the results. Limitations: The authors used medical jargon that is confusing and may mislead the readers. The study could be improved upon by increasing the sample sizes. However, the paper considered several prior research work. It was also approved by the responsible authority. 1.4 Monaco et al Matrix Citation Variables/ Key Concepts Sampling Design/ Method Instruments/ Data Collection Results Strengths/ Limitations Critique Monaco, M. R., Cesari M., Cocchi, A., Carbonin, P., & Bernabe,I. R. (2004). Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. Retrieved from http://eurheartj.oxfordjournals.org/content/26/3/226.full.pdf+html?sid=7dbbe82b-45a9- 477b-a5cb-31febf4b44e0 To assess whether starting treatment with ACE-inhibitors during stay in hospital is associated with improving cognitive functioning in patients with HF-enrolled in multi-centre pharmaco-pidemology study. Among 17,526 participants enrolled during these study years, 2639 patients who took ACE-inhibitors before Hospitalization were excluded, and 2806 with missing data for the main study variables. Thus, the study sample included 12,081 participants. A quantitative research design was used. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. A questionnaires was filled for each patient. Regression analysis was used to analyses data. For each patient, a questionnaire was filled by a study physician who was trained. A dedicated software was used to record the data. The collected data was analyzed using SPSS. Among participants with heart failure, cognitive performance improved in 30% of 446 participants who started ACE-inhibitors, but only in 22% of remaining patients (P ¼ 0.001). Among participants without heart failure, cognition improved in 19% of those receiving ACE-inhibitors, and in 18% of untreated patients (P ¼ 0.765). The data used and the sampling technique applied were excellent. In addition, questionnaires were filled by a trained physician, ensuring accuracy and credibility of the data collected. However, the data used was secondary. An observational study would have been more reliable. An observational study would have been most appropriate for this kind of study. Otherwise, the study was well researched after referring to over 30 previous research works. 1.5 Elesber Et al Matrix Citation Variables/ Key Concepts Sampling Design/ Method Instruments/ Data Collection Results Strengths/ Limitations Critique Elesber, A. A., Rosales, A. G., Herges, M. R., Shen, W., Moon. B. S., Malouf, J. F., Naser, M., Ammash1, Virend Somers1, David O. Hodge2, Bernard J. Gersh1, Stephen C. Hammill1, and Friedman, P. A. (2006). Relapse and mortality following cardio version of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. Eur Heart J., 27 (7), 854-60. To better understand the therapeutic management of older patients presenting with a new-onset sustained atrial arrhythmia. Key Concepts: Out of a total of 1016 cardioversions between May 2000 and December 2001, 477 were included in the study. For the 47 patients who had direct-current cardioversion (DCCV) on two separate occasions on separate days, only the first episode was entered in the study. A quantitative research design was used. Continuous data were compared between the four study groups by the Kruskal–Wallis test, and categorical data were compared by the x2 test. The data used was obtained from secondary sources; databases more than three hospitals. Information on relapse of atrial arrhythmia was collected from review of medical records, which included information from visits to Mayo Clinic and to other medical facilities. The study showed that patients with new-onset atrial flutter are more likely to maintain sinus rhythm after DCCV than the patients with new-onset atrial fibrillation, patients with recurrent atrial fibrillation. Strengths: The data used was reliable since it was obtained from credible sources. Limitations: The study was not randomized hence there could have been bias in the results. The results cannot be applied to the younger generations. The study could be improved upon by randomizing the selection of patients. Quality of Research: The study was approved by the Mayo Foundation Institutional Review Board. It was carried out in a systematic manner and the results analyzed and presented clearly. References Elesber, A. A., Rosales, A. G., Herges, M. R., Shen, W., Moon, B. S., Malouf, J. F., Naser, M., Ammash1, Virend , S.1, David, O. H., Bernard ,J. , Gersh,1., Stephen ,C. H., and Friedman, P. A. (2006). Relapse and mortality following cardio version of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly. Eur Heart J., 27 (7), 854- 60. Hsu, L., Jaïs, P., Sanders, P., Garrigue, S., Hocini, M., Sacher, F., Takahashi, Y., Rotter, M., Pasquié, J., Scavée, C, Bordachar., Clémenty, J., Haïssaguerre, M. (2004). Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure. Retrieved from http://rc.kfshrc.edu.sa/besc/sections/RCF/E_Library/TEDR/Catheter%20Ablation%20for %20AF%20in%20CHF.pdf Kostis, J. B., Rosen, C. R., Cosgrove, N. M., Shindler, D. M., & Wilson, A. C. (1994). Nonpharmacologic Therapy Improves Functional and Emotional Status in Congestive Heart Failure. CHEST, 106 (4), 996-1001. Monaco, M. R., Cesari, M., Cocchi, A., Carbonin, P., & Bernabei, R. (2004). Use of angiotensin- converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. Retrieved from http://eurheartj.oxfordjournals.org/content/26/3/226.full.pdf+html?sid=7dbbe82b-45a9- 477b-a5cb-31febf4b44e0 Rich, W. M., Beckham, V., Wittenberg, C., Leven, C. L., Freedland, K. E., & Carney, M. R. (1995). A Multidisciplinary Intervention to Prevent the Readmission of Elderly Patients with Congestive Heart Failure. The New England Journal of Medicine, Vol. 133. Read More