NURS5130 Pathopharmacological Foundations For Advanced Nursing Practice

Investigative Disease Process

Heart failure also known as congestive heart failure is a condition where the body is unable to pump blood to meet the required needs of the body. The condition has become a common disease in developed countries as a result of people embracing sedentary lifestyle (McMurray et al.,2012).

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As of 2015, heart failure is believed to have affected 40 million people across the globe, and its prevalence predicted to increase beyond this figure. In developed countries, about 2 % have heart failure, and the condition is worse among adults whose figure indicates that 6-10 % is suffering from heart failure. Historically, documents reveal that the Ebers papyrus commented on the disease (McMurray et al.,2012).

There are two types of heart failure, that is, heart failure with normal injection and heart failure due to left ventricular dysfunction. However, this paper describes both types in broader perspectives, that is, in regards to pathophysiology, the standard of practice and management of the disease.


Heart failure is caused by any condition with the potential to reduce efficiency of heart muscle, either through overloading or damage. Thus, the statement rightly puts it that the condition can be caused by a wide number of factors which include but are limited to hypertension, amyloidosis and myocardial infarction (Borlaug, 2014). Depending on the primary etiology, Heart failure can manifest itself as either systolic or diastolic dysfunction. To start with systolic dysfunction, it is characterized by the changes in left ventricular contractility where the LVEF is less than 0.40, and this is characterized by the thinning of the heart wall and dilation of the filling chamber (McMurray et al.,2012). The result of all this is increased left ventricular filling pressure, which in turn increases fluid overload and elevated pressure especially in the left atrium and the pulmonary vasculature. The effects of both increased left heart and pulmonary pressures are attributed to causing fluids to escape into the pulmonary interstitial spaces causing pulmonary congestion.

On the other hand, looking at diastolic dysfunction, it starts from tampering with left ventricular relaxation which decreases filling of the ventricle when the heart is in diastole mode. Although both LVEF and ventricular contractility are normal, the problem arises from the defect in filling. In this condition, that is, diastolic dysfunction, the most common feature is concentric wall thickness that decreases the filling chamber and also leads to the decrease in compliance of the wall motion (McMurray et al.,2012).

Pharmacological Treatment Of Heart Failure

The latest form of pharmacological treatment for either prevention or regression as far as left ventricular dysfunction is concerned involves the use of medication and lifestyle changes. Evidence proves that this form of treatment can reduce patients’ hospitalizations should they follow their medication and monitoring in regards to prescribed plan of care. However, it is crucial to educate patients on prescription of medication before discharge from hospital. There are various choices of drugs that are recommended for patients suffering from heart failure (McMurray et al.,2012).

ACE inhibitors are drug that are commonly used for treating patients with heart failure. They are in class 1 and in level A in relation to evidence recommendation. It has a positive effect on cardiac function in many ways; firstly, it reduces preload and afterload. Secondly, it increases cardiac output and ejection fraction (Cowie et al., 2015). The drug have properties that enable them  bind to the active sites of ACE, thus blocking the change of angiotensin 1 to angiotensin 11, all of which acts as vasoconstrictors. In addition to that, the inhibition of angiotensin 11 helps in decreasing aldosterone-mediated sodium in the kidney, a factor that reduces the circulating volume (McMurray et al.,2012). The effect of this is reducing systemic vascular end diastolic pressure which creates vasodilation thus reducing afterload. A patient can therefore have his or her cardiac output increasing and therefore experience a reduction of heart failure symptoms.


These drugs include carvedilol, metoprolol and bisoprolol and are classified as class 1 and level A, in regards to evidence for the treatment of heart failure. The drugs can decrease the side effects that come from the impact of the SNS on the blood vessels and also on the heart. As a result of activation of SNS, catecholamine is released; something that triggers changes that enhance decrease of myocardial cells (McMurray et al., 2014). It is these cells that cause cell death. In addition to that, the agents reduce adrenergic effects that come from this process. According to clinical trials, there is a reduction of 65 % in death rates for people using these drugs.

To determine suitability of these two treatments in my community was carried out on 10 health care centers, also included in the survey were local medics and patients under the management program of the disease. The results were then compared with those of the state, the survey found out that there is a similarity between the recommendation of the state on the use of these two agents or drugs with those of my community, however, the only difference was that my community was putting more emphasis on educating the patients on when, how and who should use the drugs which has not been well captured in the recommendation of the state programs on the treatment and management of heart failure. However, The American Board of Medical Specialties emphasizes on the need of educating the patients on the management programs and treatment, as it is one way of making him or her take charge of the responsibilities that he or she ought to undertake in the right manner as far as treatment and management of heart failure is concerned (Hawkins et al., 2013).

Clinical Guidelines For Heart Failure

This process is important for patients with heart failure for some reasons, these include, prevention, treatment, diagnosis, and prognosis. Thus, it is crucial to elaborate on the various stages that a patient undergoes in clinical guidelines.


It is vital to evaluate the patient to determine the correct way to diagnosis heart failure. In assessing patients, medics consider symptoms of consistent with the condition which include but are not limited to a cough, orthopnea, confusion, PND and decreased activity tolerance. Secondly, is to look for clinical signs of heart failure, these are, JVD, pulmonary congestion, hepatojugular reflux, S3 gallop, edema, and ascites (Mebazaa et al., 2015). Other major steps include noting valve function and diastolic/systolic function.

Moreover, in the assessment, it is always advisable to determine the etiology the of the condition taking note of correctable causes. This may include ischemic heart disease, for instance, radionucleotide study for people suffering from angina or cardiac catheterization for people with same angina. Lastly, is the enrollment of the condition with management program. This may include all patients having systolic dysfunction or combined systolic/diastolic dysfunction. Lastly, taking note of patients that tend to have diastolic dysfunction which appears difficult to manage, it can be by looking at hospital admission or multiple comorbidities (McMurray et al.,2012).


There are various ways of diagnosis that one can offer a patient suffering from heart failure. To start with systolic heart failure, medics can use a loop diuretic to reduce the overload of fluid. However, there must be the need to educate the patient on the use or reuse if there is the need for an additional diuretic for fluid (Lamin, 2012). Lastly, there has to be a mechanism to monitor for any side effects of renal dysfunction or hypotension. Medics are to make changes for each dosage changes. Additionally, one can opt for dose decrease consultation for K+>5.3 or Cr>3. On the other hand, for patients that are intolerant to the drug, is advisable to use ACE receptor blocker (Emin et al., 2013). Another agent is beta blockers, useful for patients that have shown signs of COPD, peripheral vascular disease, and diabetes (McMurray et al., 2012).

On the hand, there is diastolic heart failure. Also, a loop diuretic is good to reduce the overload of fluid. Both ACE and beta blockers are used, but their usage is dependent on the patient’s condition. For the sake of beta blockers, it is good for patients who had hypertension, myocardial infarction or those that require management of ventricular rate

Education For Patients

In clinical guidelines, educating patients is a crucial step in treating patients on how to conduct themselves during the treatment period and even after treatment. On the broader sense, patients need education on the diet they should take the pharmacy education and also help them where concern arises. In addition to that, patients need to be educated on the exercise that she should undertake or ways to stop smoking and reducing the amount of alcohol intake if the condition necessitates for the same (McMurray et al.,2012).

Management Of The Disease

Management largely depends on the disease that is causing heart failure. For instance, anemic patients need primary care physician for either further assessment or management. On the other hand, those with sleep apnea must be questioned on their prescribed therapies then efforts put in place to optimize their compliance.  There is also suffering from depression. This group must be sent to primary care for further management. Lastly, diabetes mellitus patients must be screened for the disease then also sent for primary care for management (McMurray et al.,2012).

Disparity Among Patients And The Disease

Heart failure is prevalent among poor people. Studies have demonstrated that lower financial status is autonomously connected with a more danger of creating heart failure and readmission after hospitalization contrasted with higher financial status, even in the wake of changing for different socioeconomics and hazard factors. Studies have detailed an expanded risk of death with bringing down financial status, albeit one investigation in England announced no such differences. Most confirmation proposes that prescription utilize is not identified with financial status, in spite of the fact that information is restricted and one investigation has revealed recommending rates for a few classes of medication among more denied patients (Gupta, Ghimire, & Hage, 2014).

 In England and Wales, the National Heart Failure Audit uncovered impressive contrasts crosswise over doctor’s facilities in various zones of heart failure, including the extents of patients experiencing key indicative tests, getting cardiovascular medicines on release, and being alluded to cardiology catch up services (Hawkins et al., 2013). Huge provincial contrasts in results were seen for patients hospitalized for intense heart failure in Canada, with readmission rates and in doctor’s facility demise rates fluctuating crosswise over territories (Gupta, Ghimire, & Hage, 2014).

Characteristics Disease Factors

There are various factors that determine and are common among patients who are able and tend to manage heart failure disease. These can broadly be put as financial cost, access to care and health literacy.  This can be as follows;

Financial ability, those patients, who are financially stable and have the budgetary capacity to buy quality nourishments, pharmacologic operators if endorsed and pay for mind administration arrangements exhibit better adherence to mind proposals (Zannad, 2015). Better adherence to management proposals will bring about a clinical introduction of a patient with a very much oversaw heart failure.

Health literacy, All together for such care administration methodologies to be of significant worth in sickness administration, the patient must exhibit a level of health care proficiency suitable for the instruction materials and methodologies being used (Zannad, 2015).

Access to care, care administration guidelines layout the requirement for occasional wellbeing appraisal by medicinal services proficient learned of the benchmarks of watch over the infection. Because of recurrence of such administration observing exercises, patients should have sensible access to health care treatment for such care administration exercises (Yancy, 2013). Unmanaged disease factors

There are conditions contributes to a patient not able to manage the disease well. Below are some of the reasons that some patients can still not be able to manage the disease.

Access to care, because of recurrence of such administration observing exercises, patients who do not have sensible access to administrations for such care administration exercises – whether that is because of the absence of suppliers of such care administrations or the patient’s absence of assets to access such care administrations – will exhibit poor adherence to proposals (Guo, Lip, & Banerjee, 2013). The absence of openness might just likely outcome in a clinical introduction of a patient with heart failure.

Literacy level, another reason that patients tend to avoid or be unable to manage the disease is as result of low literacy level. The medics often advise a patient how to manage himself or herself, and the most prescription is in written form. Also, others need a thorough analysis which is not likely going to come easily among people who are illiterate (Mebazaa, 2015). Thus, illiteracy contributes a lot and is one of the traits of a great number of patients who do not manage their heart failure appropriately.

Financial ability, treatment and management of heart failure are quite expensive relative to other diseases like malaria. For patients to effectively cover and afford treatment and management as per the recommendation of the doctor, must stable financially. Among the reasons that make patients not able to cover medical bills are financial constraints (Sakata, & Shimokawa, 2013). Thus, people not able to manage heart failure have the characteristics of being finically unstable.

Patients, Families, And Populations

Patients with inadmissible self-administration of their heart failure will probably create infection related entanglements. Advancement of inconveniences may bring about the loss of self-management capacity and afterward the patients and may require a significant measure of casual parental figure bolster (Heidenreich et al., 2013). Casual providing care is portrayed as in-home help gave by relatives or nonpaid nonfamily individuals. This kind of casual providing care has both positive and negative impacts on the family guardians of patients. Albeit numerous family guardians depict considering their friends and family a positive affair, negative angles can incorporate physical, enthusiastic, social, and budgetary issues (Gupta, Ghimire, & Hage, 2014).

Comparing Standard Practice Management Of Our Community To That Of State

When comparing the standard practice that my community put in place with that of the state, there seem to be no contradiction in any way whatsoever. To determine this, a survey of hundred medics working local health care centers was carried out. To start with the assessment, the findings of the survey reveals that it is in tandem with what American Heart Association proposes. Additionally, both the state and my community, as the survey shows, recommends and encourage medics to use ACE inhibitors and beta blockers for diagnosis (Daubert et al., 2012). Lastly, the survey shows that my community educates patients suffering from heart failure on the management of the disease just as the state encourages education on patients.

According to the world health organization, educating patients is vital in ensuring that he or she is well informed on the responsibilities that she or he is about to undertake. The survey reveals that although the state recommends for educating the patients, my community has put more emphasis on enlightening them on when to use the drugs, who should use and the diet that they ought to maintain during management of heart failure. Lastly, there is strict adherence of the recommendations of WHO in regards to treatment and handling of patients with heart failure in my community, the same way the state recommends.

Characteristics Of The Patient Who Manages The Disease Well

A patient who manages heart failure well tends to have certain features that one can identify them with. Firstly, they are able to access health care. It is for many reasons that this group seem to be able to access care, this ranges from financial stability to availability of health care in their locality (MEMBERS, 2014). Additionally, this group can undergo surgery or heart transplant as a form of treatment. Unlike those who do not manage the disease well, those who manage it well have a longer life expectancy and registers improved blood pressure and blood flow (Gupta, Ghimire, & Hage, 2014). These are some of the features and treatment characteristics to this group of patients.


The cost of the heart failure is $ 39.2 billion in the United States annual budget, but economist foresees a gradual increase in the figure as cases of the condition increases. Additionally, at an individual level, the cost varies depending on the associated disease or cause of the disease. For instance, rheumatic heart failure cost $171.96; acute diastolic heart failure cost $ 388.18, chronic systolic heart failure cost 309.84 while acute systolic heart failure cost $ 198.08 (Gupta, Ghimire, & Hage, 2014).

Best Practice Promotion

The best promotion practice involves encouraging the medics to embrace modern medicines which could pave the way for more effective drugs reaching patients at a convenient time. Also, new technology can be used to enhance doctor and outpatient communication for the benefits of the patients regarding medication and management (Khatibzadeh et al., 2013).

 In addition to that, there is also need for awareness of heart failure to be made public so that many people can be able to visit a physician at the most appropriate time before the condition worsens.

Implementation Plan

Firstly, is the collaboration of research institute and hospital of health care providers by way of encouraging partnership which can be enhanced by legislation? Legislation will legitimize the collaboration and something that has become law is easier to be put into practice than one that is on mutual agreement. Additionally, health care organizations, both at my community and state level will be obliged to follow the law and actively engage research institutes for new methods of heart failure management programs. It will encourage doing away with the shortcomings in the current management programs used in health care centers, both at my community and those recommended at state level.

Secondly, development of a portal for outpatient where patients can log in and check for updates from medics regarding their management and treatment. The method is in line with the implementation of the recommendation of The American Board of Medical Specialties which advocates for use of technology to connect with patients (Eckel et al., 2014). The rise of internet users has seen patients using the internet to seek for solution and breaching this gap can help. Health care centers both local and the state can build such an interaction of patients and medics on matters concerning Heart failure via online platform and this can reach a large number of patients and people with the same concerns.

Education programs to be developed either in the media or in a special medical forum that involves public participation, this will enlighten the public on the disease. Enlightening patients on how to use the drugs will focus on the time, which should use and the effects of not using the drug and other managements programs, for instance, the diet that one ought to maintain. The program will be in line with the current management and treatment program used in health care centers and those advocated in new research.


The effective way to determine whether there is such a mutual benefit of hospital and research institute is to look at the type of drugs used, as to whether they are they are the latest, or not. Secondly, the effective way to determine whether there is use of technology to enhance communication with the patients in to look at how the hospital communicates with patients. Lastly, it is important to survey to evaluate hos knowledgeable the public is in regards to the new form of public enlightenment of the condition.


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