What are key characteristics of adults with advanced heart failure discharged from ICU?

Abstract

BackgroundAs the number of people with heart failure and treatment complexity increases, many hospitals are implementing Advanced Heart Failure Intensive Care Units (AHFICU). However, little evidence concerning the clinical characteristics of people admitted to AHFICUs exists. Understanding the clinical characteristics of people admitted to the AHFICU will assist nurses with implementing tailored interventions to ensure high‐quality care delivery.AimThe purpose of this study was to describe the clinical characteristics of people who are admitted to and discharged from an AHFICU.Study DesignBaseline data from a longitudinal descriptive study were collected on adults (N = 43) admitted to an AHFICU. Heart failure severity, self‐management ability, cognition, sleep quality, and other clinical characteristics were assessed.ResultsMost study participants were New York Heart Association functional class IV (n = 24) or class III (n = 14), indicating poor functional capacity. Over half had mild cognitive impairment and poor sleep quality was prevalent (92.7%). Participants had adequate levels of heart failure knowledge, but low levels of heart failure self‐management decision‐making and ability.ConclusionsInterventions to address the unique clinical characteristics of AHFICU patients include sleep hygiene, integration of cognitive, sleep, and self‐management assessments into the electronic medical record. Addressing the unique clinical needs of people with heart failure will lead to patient‐centered, evidence‐based, and safe care.Relevance to Clinical PracticeUnderstanding characteristics of this population addresses this evidence gap and targeted clinical interventions to address unique discharge needs of this population are proposed. Sleep quality education should be done throughout hospitalization on sleep strategies and self‐management coaching to facilitate adoption of new sleep routines. Healthcare providers should ensure each patient has care support upon discharge and take cognitive status into consideration during teaching. Addressing self‐management readiness should include providing scenarios as part of discharge preparation. Providers must include addressing comorbidities and how they may affect heart failure self‐management, such as teaching about sleep apnea device use and encouraging compliance.

Making the Case for a Change in Patient Education Techniques: Moving Toward Scenario and Simulation-Based Approaches

“…This recommendation for greater use of simulation in patient education is supported by the results of a study (Edmiston et al, 2023a(Edmiston et al, , 2023b in which advanced heart failure patients were assessed concerning three self-management components: knowledge, ability, and problem-solving in a scenario. The people with advanced heart failure consistently scored adequate or high in heart failure knowledge; however, they performed poorly in heart failure self-management ability and problem-solving in a scenario.…”

Spotlight on cardiac critical care and early mobilisation

“…Important psychosocial aspects of care are considered in Yang et al's longitudinal study 6 on factors associated with sleep quality in patients undergoing cardiac surgery, and in Yildirim et al's study 7 investigating correlations between death anxiety, loneliness and hope levels in cardiac intensive care unit (ICU) patients. The next paper 8 describes the clinical characteristics of adults admitted to, and discharged from, an Advanced Heart Failure Intensive Care Unit (AFICU) in the Midwestern United States. The final two papers in this series focus on pain following cardiac surgery, from the perspective of patients, families and nurses 9 and through an application of Roy's Adaptation Model 10…”