Running head: CONGESTIVE HEART FAILURE TREATMENT EVALUATION 1

Congestive Heart Failure Treatment Evaluation

Sydonie Stock
Ferris State University

CONGESTIVE HEART FAILURE TREATMENT EVALUATION 2

Abstract
There is no question that ACE, or angiotensin converting enzyme, inhibitors such as enalapril
work to prolong the life of someone diagnosed with congestive heart failure, CHF. The question
being asked is does the drug positively affect the patients life. People are living longer, but are
they living well? This topic has been researched before with inconclusive results. It was
determined that a possible barrier to increased quality of life was co-morbidities. A survey study
was conducted, comparing the patients quality of life after treatment in those with CHF and
those with CHF and co-morbidities. Little difference was found in their perceived quality of life
using standardized surveys and charts.

CONGESTIVE HEART FAILURE TREATMENT EVALUATION 3

Congestive Heart Failure Treatment Evaluation
Congestive heart failure (CHF), as defined by Smelter, Bare, Hinkle, and Cheever (2010),
is a fluid overload condition associated with heart failure (p. 823). Heart failure is defined as
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen
and nutrients (Smelter et al, 2010, p. 823). The problem this poses for medical staff is assessing
the extent of the disease. The study conducted by Jenkinson, Jenkinson, Shepperd, Layte, and
Peterson (1997) looked into using generic measures of health status to evaluate the effectiveness
of CHF treatment, taking into account various limitations in previous studies.
Study
In order to conduct the study, the researchers approached patients at the Radcliffe
Infirmary NHS. Patients were diagnosed with CHF based on the criteriaused in the
Framingham study and a research nurse determined if there were any co-morbidities by taking a
complete health history (Jenkinson et al, 1997). They were split into subgroups; those with co-
morbidities and those without. The patients were treated with 10-20 mg enalapril daily in 1-2
divided doses (Jenkinson et al, 1997).
Population
The population being studied was patients, aged 60 years or older, diagnosed with CHF
and who show symptoms of the disease (Jenkinson et al, 1997).
Type of Study
This is a qualitative study, meaning it focuses on feelings and opinions more than
numbers. The survey/interview style of data collection lends itself to qualitative studies.
Gathering Data
CONGESTIVE HEART FAILURE TREATMENT EVALUATION 4

Patients who agreed to participate were given a short health survey and the Dartmouth
COOP charts and an oxygen cost diagram prior to and after one month of treatment to
determine the effectiveness of the treatment on improving their quality of life. The surveys,
charts, and diagrams were administered by an interviewer (Jenkinson et al, 1997).
Results
Originally, it was thought that co-morbidities were the reason that patients did not report
increased quality of life with CHF treatment. This study, however found that the two groups,
those with co-morbidities and those without, had similarly low scores on self-reported health-
related quality of life (Jenkinson et al, 1997). As Jenkinson et al (1997) discovered, while
enalapril may extend the patients life, it has a relatively limited impact on its quality. What
this means for nursing care is that we need further studies done on methods to improve the
patients quality of life, or perhaps further studies to determine what factors affect ones quality
of life in this population.
Limitations
It was identified in the study that the use of a standardized assessment method may not
have been appropriate. People in the populations age group, it was determined, do not expect
much improvement in their physical activity. So, even a small improvement may have a greater
impact on the patients life than the standard questionnaire is able to identify (Jenkinson et al,
1997).
Differing Care
Congestive heart failure is a problem that can affect any age group, though it is more
common in the elderly. The nurses care would differ given the different ages of the patient.
The nurse may have to be more emotionally supportive of a child upset that he or she cannot run
CONGESTIVE HEART FAILURE TREATMENT EVALUATION 5

and play like the other kids, where an adult, still needing emotional support, may better
understand the reason or process this disease has occurred. Also, the analysis of a childs quality
of life would differ from the elderlys perception of quality of life.
Plan of Care
There are several nursing diagnoses appropriate for a patient with CHF; three are listed
here. Activity intolerance related to weakness. Decreased cardiac output related to impaired
function. Powerlessness related to illness-related regimen (Ladwig & Ackley, 2011, p. 32). One
outcome criteria for activity intolerance is for the patient to demonstrate increased tolerance to
activity (Ladwig & Ackley, 2011, p. 166). This increase can be shown by walking longer
distances each week. Two ways a nurse will be able to assist the patient would be to assess the
ambulating patient for intolerance, noting nausea, pallor, dizziness, visual dimming, and
impaired consciousness, and by monitoring the patients vital signs, noting the presence of
postural hypotension (Ladwig & Ackley, 2011, p. 167).
Relevance of Study
This study is relevant to actual nursing practice. Even though there is no significant
increase in quality of life found, nurses will still encourage patients to abide by their drug
therapies in order to prolong their life. However, knowing that the enalapril may not have a
large impact on the patients physical activity tolerance, will prompt the nurse to suggest other,
non-medicinal, therapies as well to increase physical activity without straining the body.

CONGESTIVE HEART FAILURE TREATMENT EVALUATION 6

References
Jenkinson, C., Jenkinson, D., Shepperd, S., Layte, R., & Petersen, S. (1997). Evaluation of
treatment for congestive heart failure in patients aged 60 years and older using generic
measures of health status (SF-36 and COOP charts). Age and Aging, 26, 7-13.
Ladwig, G. & Ackley, B. (2011). Mosbys guide to nursing diagnosis (3
rd
ed.). Maryland
Heights, MO: Mosby Elsevier.
Smelter, S., Bare, B. Hinkle, J., & Cheever, K. (2010). Brunner & Suddarths textbook of
medical-surgical nursing (12
th
ed.) (Vol. 1). Philadelphia, PA: Wolkers, Kluwer Health/
Lippincott, Williams & Wilkins.