Access to exercise‐based rehabilitation across Europe for patients with heart failure: where evidence‐based practice is hampered by lacking resources

Abstract The American Physical Therapy Association (APTA) has supported the development of clinical practice guidelines to promote and support evidence-based practice and reduce unwarranted practice variation. Essential to the success of this effort is the generation of knowledge translation—a concept that emphasizes the translation of global knowledge to an application that can be effectively integrated into clinical practice. The Physical Therapy Clinical Practice Guideline for the Management of Individuals with Heart Failure published in the Physical Therapy Journal in January 2020 provides a broad base of knowledge related to evidence-based treatment interventions for patients with heart failure. However, the application and integration of this knowledge in clinical practice need further elucidation. Therefore, this perspective paper aims to serve as a complementary knowledge translation resource to the recently published practice guideline to maximize the utilization of contemporary evidence in clinical practice. This resource provides the physical therapist with practical guidance in the management of patients with heart failure by placing research findings in the context of other knowledge and practice norms that can be applied at the point of care and across the continuum of care. We propose a novel ABCDE (Assessment, Behavior, Cardiorespiratory Fitness, Dosage, and Education) practical framework. This clinical paradigm is grounded in ongoing physical therapist assessment throughout the episode of care, along with behavior modification, assessment of cardiorespiratory fitness, appropriate selection and dosing of interventions and patient education. Examples highlighting the use of this model in patients with heart failure across the continuum of care are provided for application in clinical care.

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Confronting Challenges in Reducing Heart Failure 30‐Day Readmissions: Lessons Learned With Implications for Evidence‐Based Practice

Worldviews on Evidence-Based Nursing ◽

10.1111/wvn.12336 ◽

2018 ◽

Vol 16 (1) ◽

pp. 43-50 ◽

Cited By ~ 3

Author(s):

Racheal L. Wood ◽

Laurie A. Migliore ◽

Sandra J. Nasshan ◽

Sara R. Mirghani ◽

Annette C. Contasti

Keyword(s):

Heart Failure ◽

Evidence Based Practice ◽

Lessons Learned ◽

Evidence Based

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Initiating compression therapy for those living with heart failure

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.sup9.s12 ◽

2021 ◽

Vol 26 (Sup9) ◽

pp. S12-S17

Author(s):

Dumitriu Saucedo ◽

Nicholas Evans ◽

Chung Sim Lim

Keyword(s):

Heart Failure ◽

Compression Therapy ◽

Decompensated Heart Failure ◽

Chronic Venous Disease ◽

Venous Disease ◽

Evidence Based ◽

Patients With Heart Failure ◽

Precautionary Measures ◽

Evidence Based Guideline ◽

Nursing Professionals

Compression therapy is used to treat leg symptoms arising from chronic venous disease and lymphoedema. Heart failure, which is traditionally regarded as a contraindication for compression therapy, is prevalent among patients with such leg symptoms. This article aims to assess the evidence on the safety and effectiveness of compression therapy, as well as recommending the assessment and measures required when initiating compression therapy in patients with heart failure. Recent evidence suggests that initiating compression therapy in patients with stable and compensated heart failure is safe if appropriate precautionary measures are undertaken. However, there is still insufficient evidence to support the safety of compression therapy in patients with severe and decompensated heart failure. A standardised, evidence-based guideline on compression therapy in patients with heart failure will help medical and nursing professionals and improve informed consent for the patients.

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Academy of Nutrition and Dietetics Evidence-Based Practice Guideline for the Management of Heart Failure in Adults

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2018.03.004 ◽

2018 ◽

Vol 118 (12) ◽

pp. 2331-2345 ◽

Cited By ~ 5

Author(s):

Toni Kuehneman ◽

Mary Gregory ◽

Desiree de Waal ◽

Patricia Davidson ◽

Rita Frickel ◽

...

Keyword(s):

Heart Failure ◽

Practice Guideline ◽

Evidence Based Practice ◽

Evidence Based ◽

Nutrition And Dietetics

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Role of the Acute Care Nurse in Managing Patients With Heart Failure Using Evidence-Based Care

Critical Care Nursing Quarterly ◽

10.1097/cnq.0000000000000036 ◽

2014 ◽

Vol 37 (4) ◽

pp. 357-376 ◽

Cited By ~ 6

Author(s):

Sara Paul ◽

Amber Hice

Keyword(s):

Heart Failure ◽

Acute Care ◽

Evidence Based ◽

Care Nurse ◽

Patients With Heart Failure ◽

Evidence Based Care

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Implementation of an Evidence-Based Practice Discharge Medication Protocol for Heart Failure Patients to Reduce 30-Day Readmissions

10.46409/sr.qtur9486 ◽

2021 ◽

Author(s):

◽

Dawn Onstott

Keyword(s):

Heart Failure ◽

Evidence Based Practice ◽

Statistical Significance ◽

Heart Association ◽

Evidence Based ◽

Post Intervention ◽

Healthcare Budget ◽

Discharge Medication ◽

Intervention Protocol ◽

The One

Practice Problem: An estimated 6.5 million American adults ≥20 years of age have heart failure (HF) and worldwide 1 to 2% of the total healthcare budget is spent on HF. To improve outcomes and streamline the treatment of HF patients, The American Heart Association (AHA) joined with the American College of Cardiology (ACC) and created the Get With The Guidelines Program (GWTG). PICOT: The PICOT question that guided this project was in adult HF patients admitted to the cardiovascular unit under the care of the hospitalist service, does implementing an evidence-based practice (EBP) discharge medication protocol for physician use based on the AHA GWTG program’s HF discharge medication protocol, compared to no standardized discharge protocol, improve patients’ 30-day readmission rate, in 12 weeks? Evidence: Evidence from 10 studies supported implementing an evidence-based GDMT tool into a standardized HF discharge medication protocol for this project. Intervention: Education and encouragement of use of the AHA GWTG discharge medication protocol for HF in the electronic health record (EHR) was provided to a group of physicians on a cardiovascular unit. The intervention was over a four-week period and pre- and post-intervention protocol use was observed with specific measures analyzed for observation of improvement. Outcome: The results determined there was minimal statistical significance, however, there was a decrease in the financial measure of the cost of HF readmissions denoting a clinical significance. Conclusion: Continued use of a guideline-based discharge medication protocol, such as the one utilized in this project, is recommended based on the results and evidence provided in this project.

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Optimizing Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction During Hospitalization

US Cardiology Review ◽

10.15420/usc.2020.29 ◽

2021 ◽

Vol 15 ◽

Author(s):

Neal M Dixit ◽

Shivani Shah ◽

Boback Ziaeian ◽

Gregg C Fonarow ◽

Jeffrey J Hsu

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Outpatient Setting ◽

Evidence Based ◽

Mineralocorticoid Receptor Antagonists ◽

Reduced Ejection Fraction ◽

Sodium Glucose Cotransporter ◽

Neprilysin Inhibitor ◽

Patients With Heart Failure ◽

Annual Direct Cost

Heart failure remains a huge societal concern despite medical advancement, with an annual direct cost of over $30 billion. While guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality, many eligible patients with heart failure with reduced ejection fraction (HFrEF) are not receiving one or more of the recommended medications, often due to suboptimal initiation and titration in the outpatient setting. Hospitalization serves as a key point to initiate and titrate GDMT. Four evidence-based therapies have clinical benefit within 30 days of initiation and form a crucial foundation for HFrEF therapy: renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, β-blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors. The authors present a practical guide for the implementation of these four pillars of GDMT during a hospitalization for acute heart failure.

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LOOP DIURETICS IN HEART FAILURE: EVIDENCE-BASED CHOICE

Wiadomości Lekarskie ◽

10.36740/wlek202104136 ◽

2021 ◽

Vol 74 (4) ◽

pp. 1003-1006

Author(s):

Мaryana М. Rоsul ◽

Мiroslava М. Bletskan ◽

Nataliya V. Ivano ◽

Marina O. Korabelschykova

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Comparative Evaluation ◽

Convincing Evidence ◽

Evidence Based ◽

Pharmacological Properties ◽

Comparative Efficacy ◽

Patients With Heart Failure ◽

Reduced Risk

The aim: Of the article is to conduct a comparative evaluation of the effectiveness of torasemide and furosemide in patients with heart failure. Materials and methods: Analysis of the existing clinical trials and meta-analyzes that combine the results of the completed studies aimed at the investigation of comparative efficacy of furosemide and torasemide in patients with heart failure (НF). Conclusions: There is enough convincing evidence to speak about the advantages of torasemide over furosemide both in terms of its pharmacological properties and taking into account the reduction of hospitalizations, functional progress and improvement in the quality of life of patients with НF. The safety profile of torasemide is more favorable, as it is associated with a reduced risk of hypokalemia compared to furosemide. The abovementioned facts favor the use of torasemide in patients with symptomatic НF, as well as the transition from furosemide to torasemide in patients with edema caused by НF, which remain uncontrolled despite receiving optimal doses of furosemide.

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