The associations between direct and delayed critical care unit admission with mortality and readmissions among patients with heart failure

This chapter is centred on a case study on acute heart failure. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Download Full-text

Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

Pharmacy ◽

10.3390/pharmacy8030159 ◽

2020 ◽

Vol 8 (3) ◽

pp. 159

Author(s):

Seif El Hadidi ◽

Naglaa Samir Bazan ◽

Stephen Byrne ◽

Ebtissam Darweesh ◽

Margaret Bermingham

Keyword(s):

Heart Failure ◽

Critical Care ◽

Guideline Adherence ◽

Clinical Pharmacist ◽

Critical Care Unit ◽

Angiotensin Receptor Blockers ◽

Multidisciplinary Care ◽

Converting Enzyme Inhibitors ◽

The Impact ◽

Adherence Index

Discharge prescriptions for heart failure (HF) patients may not adhere to the clinical practice guidelines. This study aimed to assess the impact of the clinical pharmacist as a member of a multidisciplinary team on the quality of prescribing to HF patients at discharge from a Critical Care Unit (CCU) in Egypt. This was a retrospective cohort study of HF patients discharged from the CCU between January 2013 and December 2017. Guideline Adherence Index (GAI-3) was used to assess guideline-directed prescribing at discharge. Multidisciplinary care was introduced to the CCU on 1 January 2016. The study included 284 HF patients, mean (±SD) age 66.7 ± 11.5 years, 53.2% male. Heart failure with reduced ejection fraction affected 100 patients (35.2%). At discharge, loop diuretics were prescribed to 85.2% of patients; mineralocorticoid receptor antagonists to 54.9%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to 51.4%; and β-blockers to 29.9%. Population Guideline Adherence Index (GAI-3) was 45.5%. High-GAI was prescribed to 136 patients (47.9%). Patients with High-GAI were younger; less affected by chronic kidney disease and had fewer comorbidities than those without High-GAI. Prescription of β-blocker increased (24.1% vs. 38.6%, p < 0.001) and digoxin utilization decreased (34.7% vs. 23.7%, p < 0.049) after the introduction of the multidisciplinary care. The inclusion of a clinical pharmacist in the multidisciplinary care team may have a role in optimizing the prescribing of HF guideline-directed therapies at discharge from this setting.

Download Full-text

Care of the Lower Extremities in Patients With Acute Decompensated Heart Failure

Critical Care Nurse ◽

10.4037/ccn2011337 ◽

2011 ◽

Vol 31 (4) ◽

pp. 21-29 ◽

Cited By ~ 2

Author(s):

Karen L. Cooper

Keyword(s):

Heart Failure ◽

Critical Care ◽

Acute Decompensated Heart Failure ◽

Lower Extremities ◽

Decompensated Heart Failure ◽

Critical Care Nurses ◽

Peripheral Edema ◽

Hemodynamic Status ◽

Patients With Heart Failure ◽

Pulmonary Status

Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. Nursing care is based on available evidence, findings on chest radiographs, and hemodynamic status. Medications that contribute to peripheral edema should be evaluated and discontinued if possible. An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient’s lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Multilayer compression wraps should be avoided until the patient’s hemodynamic status is stable and the patient can get out of bed.

Download Full-text