Capella FPX 4025 Assessment 3

Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying the PICO(T) Process

Acute Heart Failure (AHF) continues to be a major cause of death globally. Its impact steadily increases in developed nations like the United States. Around one million new HF patients are identified annually across the country (Heidenreich et al., 2022). Optimal management of AHF is vital for improving patient prognosis and reducing costs. This paper examines diuretic resistance and investigates evidence-based fluid management interventions in AHF patients. It draws on current research findings to evaluate their relevance and potential benefits in clinical settings.

Explaining a Diagnosis

AHF is a life-threatening condition that impacts patients’ quality of life. Common indicators such as limited physical strength, tiredness, breathlessness and fluid deposit contribute to recurrent hospital visits and diminished quality of life. Key risks tied to AHF include excessive fluid retention, pulmonary congestion and irregular heart rhythms. It can develop into acute decompensated heart failure (ADHF). It is a critical state requiring intensive monitoring and specialized cardiovascular support. AHF is a leading contributor to mortality in the United States. It accounts for over 380,000 deaths annually (Savarese et al., 2022).

Vulnerable populations like older adults are at increased risk from age-related diseases, multiple medications and decreased physical resistance. Health inequities are more distinct among racial and ethnic minorities. African Americans have higher hospitalization and mortality rates due to AHF. It is linked to healthcare access barriers, poverty and variability in care strategies (Mwansa et al., 2021). Financial uncertainty makes outcomes more problematic. Low-income people are more likely to face diagnostic delays and limited services. These biases amplify the burden of AHF. It underlines the need for equitable care plans prioritizing access to vital health resources.

PICO(T) Research Question

The PICO(T) research question developed for AHF management is: In patients with acute heart failure (AHF) who experience diuretic resistance (P), how does the use of evidence-based fluid management interventions (I) compared to standard diuretic therapy (C) affect fluid retention and patient outcomes (O) over 12 weeks (T)?

This query meets the PICO(T) standards as follows:

- P (Population/Problem): The population in this research question is patients with AHF. This group faces challenges such as diuretic resistance. It makes it difficult to prevent decompensation and rehospitalization.

I (Intervention): The intervention being explored involves using evidence-based fluid management strategies. This approach focuses on the patient’s clinical status rather than a one-size-fits-all diuretic regimen.

C (Comparison): This question compares standard diuretic therapy with the standard management approach for preventing fluid overload and improving AHF outcomes.
O (Outcome): The measured outcomes are fluid retention and patient outcomes. These indicators of AHF management success reflect clinical outcomes and patient well-being.
T (Time): The time frame for this query is over 12 weeks, sufficient to evaluate the effects of evidence-based fluid management interventions on patient outcomes.

This PICO(T) query helps focus the research on assessing the efficiency of use of evidence-based fluid management interventions compared to standard diuretic therapy in improving outcomes for patients with AHF who experience diuretic resistance.

Literature Search

A systematic literature review was done to obtain information regarding adopting evidence-based fluid management techniques in AHF patients. Some peer-reviewed scholarly databases such as PubMed, CINAHL, the Cochrane Library and Google Scholar were searched to determine access to most peer-reviewed and credible sources. The initial search strategy involved the utilization of targeted search words such as “acute heart failure,” “management of fluid overload,” “diuretic resistance,” “routine diuretic therapy,” “evidence-based fluid therapy,” and “chronic heart failure management.” Boolean terms (AND, OR) were used to enhance the specificity of search outcomes. This strategy was to identify studies comparing traditional diuretic treatment with fluid management strategies in AHF patients who exhibit resistance to conventional diuretic treatment.

The legitimacy of the evidence gathered was determined through the CRAAP approach. It examines Currency, Relevance, Authority, Accuracy and Purpose to assess the validity of sources. Peer-reviewed journal articles, reviews and meta-analyses from the last five years were prioritized to guarantee incorporating the most recent evidence. Data from well-established administrations like the American Heart Association (AHA) was emphasized for clinical significance (AHA, 2021). Filters were applied to limit the search to full-text articles, English-language journals and adult patient studies with AHF. The literature search initially included general AHF management. Integrating more specific terms such as “evidence-based fluid management” and “effect of fluid control on AHF outcomes. The search was narrowed to obtain the most relevant studies to answer the research question. This focused strategy protected the application of the most pertinent and applicable evidence to guide best practices in fluid regulation in AHF.

Relevant Articles

During the search for suggestions on evidence-based fluid therapy in AHF, various quality sources were consulted to address the intricacies of fluid management interventions and their impact on patient outcomes in diuretic-resistant scenarios. Among the sources of interest was a systematic review by Rahman et al. (2020). It was published in a quality journal. In the review, mechanical fluid removal methods were addressed. The study emphasized evidence-based fluid management interventions. Peritoneal dialysis and paracentesis are included as potential fluid management measures in AHF.

It was considered highly credible due to the thorough literature review in a prestigious cardiology journal. Wobbe et al.’s (2020) meta-analysis was another source, where ultrafiltration (UF) therapy was evaluated in patients with AHF. The review stressed the efficacy of UF in maximizing fluid removal. It improves weight loss and reduces rehospitalization. UF treatment was compared to standard diuretic therapy through randomized controlled trials. This trial applies to the research question. It discussed the effect of fluid management on patient quality of life and compliance with standard diuretic therapy. Its credibility was supported by publication in Heart Failure Reviews and the authors’ credibility in cardiology.

The third source is a clinical guideline by the European Society of Cardiology (ESC). It issued evidence-based endorsements for sodium and fluid therapy in AHF (ESC, 2021). ESC guidelines are generally accepted as the pillars of heart failure treatment. It gives credibility and relevance to this source in determining current clinical practice. A systematic review by Stachteas et al. (2024) assessed sodium-glucose co-transporter-2 (SGLT-2) inhibitors as a potential therapy for diuretic resistance in AHF. The review examined medical evidence regarding the effects of SGLT-2 inhibitors on managing fluid levels, alleviating symptoms and enhancing health outcomes. The authors evaluated their safety profile and adverse effects in AHF. This review of observational studies was highly credible due to its rigorous methodology in a respected journal. These sources offered a broad and current understanding of fluid management in AHF.

Analyzing Evidence

The data for the PICO(T) query is that fluid management strategies have improved prognosis versus a restrictive fluid strategy in patients with diuretic resistance. Rahman et al. (2020) studied that restrictive fluid therapy in AHF patients leads to malnutrition, dehydration and worsening quality of life. They highlight the importance of evidence-based mechanical fluid removal methods such as peritoneal dialysis and paracentesis in managing fluid overload in AHF. Wobbe et al. (2020) confirmed that UF therapy enhances fluid removal and reduces rehospitalization compared to standard diuretic therapy.

ESC (2021) strategies adopt this practice by encouraging adaptable sodium and fluid management in AHF. Stachteas et al. (2024) discoursed the therapeutic potential of SGLT-2 inhibitors over diuretic resistance in AHF. It summarizes their effects on fluid balance, clinical outcomes, and safety issues. These sources indicate more modified approaches. The review states that mechanical fluid removal and UF therapy are integrated into daily clinical practice across healthcare settings. The assumption is that proper training and facilities are available for healthcare professionals to implement these evidence-based therapies. It safeguards effective implementation and compliance in AHF patient care.

Conclusion

The evidence favoring the employment of evidence-based fluid management strategies over conventional diuretic therapy in AHF and diuretic-resistant patients is strong. Research shows that tailored fluid management techniques. It includes ultrafiltration, mechanical fluid removal techniques and SGLT-2 inhibitor use, benefiting patient outcomes, decreasing rehospitalization rates and improving quality of life. These strategies concur with existing clinical guidelines and the value of individualized interventions to control fluid overload appropriately. Utilizing these approaches, in conjunction with necessary training and resources for healthcare providers has significant potential to maximize treatment and alleviate AHF burdens.

References

AHA. (2021). Heart failure. Www.heart.org. https://www.heart.org/en/health-topics/heart-failure

ESC. (2021, August 25). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Escardio.org. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure

Heidenreich, P. A., Fonarow, G. C., Opsha, Y., Sandhu, A. T., Sweitzer, N. K., & Warraich, H. J. (2022). Economic issues in heart failure in the United States. Journal of Cardiac Failure, 0(0), 453–466. https://doi.org/10.1016/j.cardfail.2021.12.017

Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/ethnic and gender disparities in heart failure with reduced ejection fraction. Current Heart Failure Reports, 18(2), 41–51. https://doi.org/10.1007/s11897-021-00502-5

Capella FPX 4025 Assessment 3

Rahman, R., Paz, P., Elmassry, M., Mantilla, B., Dobbe, L., Shurmur, S., & Nugent, K. (2020). Diuretic resistance in heart failure. Cardiology in Review, Publish Ahead of Print(2), 73–81. https://doi.org/10.1097/crd.0000000000000310

Savarese, G., Becher, P. M., Lund, L. H., Seferovic, P., Rosano, G. M. C., & Coats, A. J. S. (2022). Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research, 118(17). https://doi.org/10.1093/cvr/cvac013

Stachteas, Nasoufidou, Patoulias, Karakasis, Karagiannidis, Mourtzos, & Samaras, A. (2024). The role of Sodium-Glucose Co-Transporter-2 inhibitors on diuretic resistance in heart failure. International Journal of Molecular Sciences, 25(6), 3122–3122. https://doi.org/10.3390/ijms25063122

Wobbe, B., Wagner, J., Szabó, Rostás, Farkas, N., Garami, Balaskó, Hartmann, P., Solymár, M., Tenk, Ottóffy, Nagy, A., Habon, T., Hegyi, P., & Czopf. (2020). Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: A meta-analysis. Heart Failure Reviews, 26(3), 577–585. https://doi.org/10.1007/s10741-020-10057-7