The Lebanese Heart Failure Snapshot: A National Presentation of Acute Heart Failure Admissions

Abstract

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.

A Multi-Site Thailand Heart Failure Snapshot Study

“…For instance, the majority of patients with HF in Thailand have been found to have low education, income, and use the UHC scheme. Compared with international HF registries, Thai patients with HF in this study were diagnosed at a younger age (64.9615.3) compared with the NSW HF snapshot study (77613) [14], Lebanese Heart Failure Snapshot (72613) [23], and United States ADHERE study (72.5614) [31].…”

“…The PHQ-9 score can range from 0-27, since each of the nine items can be scored from 0 (not at all) to 3 (nearly every day); a lower score means less depression [20]. This study also categorised depression into five levels: minimal or none (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). In this study, the internal consistency using Cronbach's alpha was 0.81.…”

“…The New South Wales (NSW) HF Snapshot Study questionnaire was developed in English and this methodology has been utilised in Australia, Nepal, and Lebanon [23]. The NSW HF snapshot study explored patient profile and management of acute HF, and identified areas that could be improved through a multidisciplinary collaboration in the pre-HF, hospitalisation, and post-HF phases.…”

Follow up from the Lebanese Heart Failure Snapshot: Reflection of geopolitical instability

“…This coincided with a period of severe political and social unrest in the country. The aim was addressed by following up with patients who were previously recruited for the HF Snapshot in Lebanon (Deek et al, 2020). The follow‐up duration coincided with the Lebanese revolution that broke in late 2019 (Youssef, 2020) and the COVID‐19 pandemic that began in the first quarter of 2020 and worsened as time passed (Bizri et al, 2020).…”

“…The Lebanese HF Snapshot was a prospective depiction of presented HF cases during a one‐month period in June 2019 (Deek et al, 2020). The results of this study are reported in line with the STROBE checklist in reporting cross‐sectional studies (Knottnerus & Tugwell, 2008).…”