Heart Failure Comprehensive Nursing Paper Example


Heart failure (HF) is a chronic and progressive condition in which heart muscles cannot pump adequate blood needed by the body to function (Inamdar, A. & Inamdar, C. (2016). Although improved medical management of HF and associated risk factors have stabilized the incidence globally (Ziaeian & Fonarow, 2016), HF remains a common affliction globally due to the dynamism of causal factors across different parts of the world (Davison & Cotter,2014). This research paper provides a general review of HF’s incidences and prevalence, the type of HF pathogenesis, and diagnostic features. The paper also discusses the severity and mortality associated with HF. The paper also attempts to elucidate published resources on the causes of HF, signs and symptoms, and aetiologies.(Heart Failure Comprehensive Nursing Paper Example)

Heart Failure Comprehensive Nursing Paper Example

Causes, Aetiologies, and Parthenogenesis of HF

HF’s causes vary depending on a person’s gender, ethnic group, comorbidities, and environment (Ziaeian & Fonarow, 2016). These factors cause functional and structural impairment in the myocardium leading to the deficiency of ventricular function and blood ejection (Dassanayaka & Jones, 2015). Commonly, the left myocardium’s reduced functionality, great vessels, pericardium, endocardium, or heart valves are significantly associated with heart disease (Dassanayaka & Jones, 2015).(Heart Failure Comprehensive Nursing Paper Example)

Risk factors associated with HF include several cardiac conditions, genetic defects, and systematic illnesses. Aetiologies are associated with mutually exclusive aetiologies that vary significantly among high-income and low-income populations (Yusuf et al., 2014). There is an estimate of 17 HF aetiologies include coronary heart disease (CAD), chronic obstructive pulmonary disease (COPD), hypertensive heart disease, and rheumatic fever (Naghavi et al., 2017). Other associated diseases and risk factors for HF include primary and secondary cardiomyopathies. Primary cardiomyopathies include genetic factors attributed to HIV, Giant cell myocarditis, Substance-abuse-induced, and Mitochondrial myopathies. In contrast, secondary cardiomyopathies include thyroid disease, amyloidosis, storage disease, Connective tissue disorder, and endomyocardial fibrosis. Significant pathogenic mechanisms causing HF include an increase in hemodynamic overload, abnormality of the myocyte calcium cycle, extreme variation in the proliferation of the extracellular matrix, increased apoptosis and mutation of genes, remodeling of ventricular structure, and excessive stimulation of the nervous system (Dassanayaka & Jones, 2015).(Heart Failure Comprehensive Nursing Paper Example)

Classifications of Heart Failure

HF is predominantly classified depending on the heart’s side with a defect, e.g., left, right, or bi-ventricular. Clinically, HF is classified depending on the heart’s functionality, e.g., HFpEF and HFrEF (Inamdar A. & Inamdar C., 2016). HFpEF is characterized by thickening and stiffening the LV wall and standard volume of the LV cavity. HFrEF patients have an enlarged LV cavity with a normal or reduced volume ratio of LV mass and diastolic. Moreover, HF can be classified depending on the time of onset, i.e., acute HF or chronic HF. Equally, the myofibrils diameter and volume of an HFpEF patient is higher than in an HFrEF patient (Inamdar A. & Inamdar C., 2016).

According to the New York Heart Association (NYHA), the HF functional classes include:

  1. Class I: Patients are not limited in physical activity (PA).
  2. Class II:  Patients are slightly limited in PA, which results in symptoms.
  3. Class III: Patients are significantly in PA, which causes HF symptoms.
  4. Class IV: Patients cannot carry out any PA and are not comfortable at rest.

Similarly, the American Heart Association (AHA) and American College of Cardiology (ACC) HF classification system include the following functional classes:

  1. Stage A: A person is at high risk of HF, yet there is no structural heart disease (SHD) or HF symptoms.
  2. Stage B: A person is diagnosed with SHD and no HF symptoms.
  3. Stage C: A person has SHD and HF symptoms.
  4. Stage D: A person diagnosed with refractory HF requires specialized intervention. 

Global Incidence and Prevalence of HF

As of 2013, the worldwide HF incidence was between 100 and 900 in every 100,000 people (Roger, 2013). According to Ziaeian, B., & Fonarow (2016), the global information on HF’s incidence and trends is limited and defective. Most literature on HF’s incidence is derived from developed countries, in which stability of HF has been recorded with possible future reduction. This trend results from effective preventive measures against cardiovascular diseases and Coronary artery disease treatment (Zhao et al., 2015; Djoussé et al., 2009). However, approximately 80% of cardiology-related disease burden affects middle-income and low-income countries (Dokainish et al., 2015; Yusuf et al., 2014).(Heart Failure Comprehensive Nursing Paper Example)

Considering the estimated global prevalence of over 37 million people, HF is a rapidly growing health issue. According to (Ziaeian & Fonarow, 2016), HF causes most older people’s hospitalization. In the USA alone, approximately $53.1 billion is projected to be incurred by 2030 in medical cost up $ 20.9 billion spent in 2012. In developed countries, HF’s prevalence rate is between 1% and 2% of the adult population. Initially, HF’s burden was associated with infections and deficiencies associated with nutrition. However, the current trend has attributed HF to comorbidities of chronic diseases in the adult population (Ziaeian & Fonarow, 2016).(Heart Failure Comprehensive Nursing Paper Example)

Despite the decreasing HF incidence and prevalence, the number of people diagnosed with HF has significantly increased due to the global population growth (Ziaeian & Fonarow, 2016). Additionally, the HF burden is unequally distributed in the older population, and enhancements in control measures have delayed early HF onset. Equally, those diagnosed with HF have prolonged lives. The HF prevalence and incidence vary extensively with ethnic background, geographical location, social and economic status.(Heart Failure Comprehensive Nursing Paper Example)


Estimating the mortality cause singularly with HF is challenging, considering the condition is often diagnosed as an effect of another underlying medical condition. According to Naghavi et al. (2017), a cause of death is often attributed to an underlying cause of ischemic heart disease. If there is no known etiology, the cause of death is reselected as ischemic heart disease. In this sense, cardiovascular mortality deaths are about 293 persons in every 100 000 population (Naghavi et al., 2017). Equally, patients with HF have higher fatality rates despite higher survival rates in recent years due to remarkable treatment advances in a developed country. In contrast, fatality rates are 3 and 2 times higher in low- and middle-income nations relative to developed countries.(Heart Failure Comprehensive Nursing Paper Example)

Symptoms and Diagnosis of HF

HF is characterized by cardiac function impairment, which is secondary to most aetiologies. HF patients experience several symptoms that affect wellbeing, e.g., such as fatigue, intolerance of physical activity, dyspnoea, and fluid retention (Ziaeian & Fonarow, 2016). More specific symptoms include orthopnoea, elevated pressure in jugular veins, paroxysmal nocturnal dyspnoea, and displaced apical impulse. Most of the symptoms are associated with water and sodium retention.(Heart Failure Comprehensive Nursing Paper Example)

Diagnosis of HF clinically difficult yet possible. This is because symptoms are not specific, thus, do not effectively identify HF. HF diagnosis includes cardiovascular imaging, physician assessment, laboratory tests, or hemodynamic catheterization (Ziaeian & Fonarow, 2016). According to the American Society of Echocardiography, the most significant diagnostic criterion involves the echocardiographic assessment of left ventricular function, which is considered abnormal for ejection fraction when reading is  ≤52% for men and ≤54% for women.(Heart Failure Comprehensive Nursing Paper Example)

Heart Failure Comprehensive Nursing Paper Example

Moreover, a patient’s medical history is critical in diagnosis. The most useful HF tests are the echocardiogram and electrocardiogram (ECG). These tests provide heart chamber volumes, wall thickness, ventricular diastolic and systolic, and valve functions.  Other tests such as the natriuretic peptides, chest X-ray, ambulatory electrocardiographic monitoring, standard biochemical and hematological tests are useful in determining the extent of a heart condition.  Equally, cardiac catheterization and endomyocardial biopsy exercise, and genetic tests are often used to determine causal factors.(Heart Failure Comprehensive Nursing Paper Example)

Treatment Intervention

There are several proven and unproven treatment interventions for patients with established HF. Treatment interventions aim to prevent hospitalization, reduce edema, and increase survival rates. According to McMurray et al. (2012), known treatment interventions include:(Heart Failure Comprehensive Nursing Paper Example)

  1. Angiotensin-converting enzyme inhibitors and beta-blockers: Studies have shown that this pharmacological intervention is significant in patients with progressive symptoms and low ejective fraction. Beta-blockers intervention is complementary with ACE inhibitor with a modest effect on LV remodeling and EF improvement. Further, beta-blockers are anti-ischemic and reduce risks of sudden cardiac death.(Heart Failure Comprehensive Nursing Paper Example)
  2. Mineralocorticoid/aldosterone: Mineralocorticoid/aldosterone receptor antagonists are used to bind aldosterone and other corticosteroids.
  3. Angiotensin receptor blockers: Angiotensin is an alternative for patients who cannot tolerate ACE inhibitors but are not the first choice medication for HF.(Heart Failure Comprehensive Nursing Paper Example)
  4. Ivabradine: Ivabradine is used to inhibit the sinus node channel and slow the heart rate.
  5. Digoxin: Digoxin and other digitalis glycosides are used to slow the rate of ventricles and general heart rate.
  6. Other known pharmacological medications include the combined use of hydralazine and isosorbide dinitrate and omega-3 polyunsaturated fatty acids.

Because HF is associated with low oxygen uptake and impaired muscle function, interventions involving physical activity are crucial in improving inflammation, relieving cardiac pressures, and improving oxygen consumption (Inamdar A. & Inamdar C., 2016). (Heart Failure Comprehensive Nursing Paper Example)


Due to the projected rise in HF, prevention is the crucial mechanism of mitigating HF’s effects, i.e., poor quality of life and financial expenditure. Equally, improvement in the control of risk factors could reduce HF incidence and prevalence.  Despite steadying evidence on HF in developed countries, further research is necessary to further reduce HF prevalence and incidence. Equally, maximum use of evidence-based treatment interventions for inpatient and outpatient populations will be critical in improving HF management.(Heart Failure Comprehensive Nursing Paper Example)


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Davison, B., & Cotter, G. (2014). Why is heart failure so important in the 21st century? European journal of heart failure17(2), 122-124. https://doi.10.1002/ejhf.219  

Djoussé, L., Driver, J. A., & Gaziano, J. M. (2009). The relation between modifiable lifestyle factors and lifetime risk of heart failure. Jama302(4), 394-400. https://doi.10.1001/jama.2009.1062 

Dokainish, H., Teo, K., Zhu, J., Roy, A., Al-Habib, K., ElSayed, A., … & Yusuf, S. (2015). Heart failure in low-and middle-income countries: background, rationale, and design of the INTERnational Congestive Heart Failure Study (INTER-CHF). American heart journal170(4), 627-634(Heart Failure Comprehensive Nursing Paper Example). https://doi.org/10.1016/j.ahj.2015.07.008

Inamdar, A. A., & Inamdar, A. C. (2016). Heart failure: diagnosis, management, and utilization. Journal of clinical medicine5(7), 62. https://doi.org/10.3390/jcm5070062

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., … & Ponikowski, P. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European heart journal33(14), 1787-1847(Heart Failure Comprehensive Nursing Paper Example). 10.1093/eurheartj/ehs104

Naghavi, M., Abajobir, A. A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., … & Fischer, F. (2017). Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet390(10100), 1151-1210(Heart Failure Comprehensive Nursing Paper Example). https://doi.org/10.1016/S0140-6736(17)32152-9

Roger, V. L. (2013). Epidemiology of heart failure. Circulation Research113(6), 646-659. https://doi.org/10.1161/CIRCRESAHA.113.300268

Yusuf, S., Rangarajan, S., Teo, K., Islam, S., Li, W., Liu, L., … & Dagenais, G. (2014). Cardiovascular risk and events in 17 low-, middle -, and high-income countries. New England Journal of Medicine371(9), 818-827. https://doi.10.1056/NEJMoa1311890 

Zhao, D., Liu, J., Xie, W., & Qi, Y. (2015). Cardiovascular risk assessment: a global perspective. Nature Reviews Cardiology12(5), 301. https://doi.org/10.1038/nrcardio.2015.28

Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and etiology of heart failure. Nature Reviews Cardiology13(6), 368-378.(Heart Failure Comprehensive Nursing Paper Example) https://doi.org/10.1038/nrcardio.2016.25

Heart Failure Comprehensive Nursing Paper Example

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