Purpose: The purpose of this prospective evaluation is to document in-hospital management and discharge trends of patients presented for acute heart failure.
Design: A prospective evaluation of the patients presented for heart failure exacerbation at eight sites over 1 month using the method of the New South Wales Heart Failure Snapshot.
Methods: Trained personnel situated at each of the study sites recruited eligible patients to the study and collected data on their sociodemographic characteristics, clinical presentation, self-care, frailty, and depression.
Findings: Eight sites, out of the 27 contacted, agreed to participate in this study. A total of 137 admissions were reported in the 1-month time window. Mean age was 72 (SD = 13) years and the majority were female (52%). More than half (n = 60%) had heart failure reduced ejection fraction with a mean ejection fraction of 41%. The mean Charlson Comorbidity Index score was four with hypertension (80%) and diabetes (56%) being the most frequent. The majority were frail (86%), self-care mean scores were low; self-care maintenance (29), self-care management (48) and self-care confidence (42). The mean depression score was 14 indicating major depression. In reference to international guidelines recommendations, hospital administered medications and discharge medications were suboptimal. Some items of the discharge education recommended by the international guidelines were provided to 84% of the patients but none of the patients received the complete items of the discharge education.
Conclusions: The snapshot revealed that patients admitted for acute heart failure were frail with high levels of illiteracy and low self-care scores. Despite these findings, these patients were not provided with complete discharge education in reference to the international guidelines. Additionally, when provided, discharge education was inconsistent across the study sites. This study highlights the need for enlisting complete education as part of the discharge process, in addition to abidance to the guidelines in prescribing medication. The study draws major implications for nursing practice, research and policy.
Clinical relevance: Literacy among patients with heart failure is low and should be addressed in educational intervention to improve outcomes. Discharge education is under practiced across the country and should be implemented in accordance with the international guidelines.
Keywords: Cardiovascular/cardiac care/circulatory; Care delivery system; Epidemiology; Health care reform; Patient advocacy/Patient rights protection; Quality improvement/Quality of care/Quality of services.
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