Prevention pertains to a wide range of actions that are performed to reduce the occurrence of a specific medical disease. The accumulation of information from both clinical and basic research has generated a large amount of information that assists healthcare professionals in performing their task of caring for patients. For example, the identification of gross, as well as molecular signs of a specific disease helps a physician in the ascertainment of the actual condition of a patient.
In the field of nursing, disease prevention plays an essential role in providing care of the patient, as this results in a reduction of morbidity in the human population. Disease prevention also decreases the amount of healthcare costs that are associated with the diagnosis and treatment of specific diseases. According to Hinton (2008), the employment of various up-to-date medical and molecular approaches “promises to cultivate a paradigm shift in medical treatment emphasizing primary prevention and early intervention.
” Measures of disease prevention are technically divided into three levels. Primary prevention pertains to the first line of actions that are performed to inhibit the development of diseases. One approach for primary prevention is to perform activities that would result in the protection of an individual from a disease. Common examples of these primary prevention measures include immunizations as well as using protective materials for specific areas of the body to prevent possible injury.
Another approach for primary prevention is through the promotion of good health activities such as the establishment of proper hygiene and following a healthy diet. This report will describe primary prevention measures for patients that have been diagnosed with congestive heart failure. CONGESTIVE HEART FAILURE AND PRIMARY PREVENTION MEASURES Congestive heart failure is one of the leading causes of morbidity and mortality in the human population, affecting almost 15 million individuals around the world. This condition often occurs among individuals of 40 years of age and older.
The occurrence of congestive heart failure is regarded as the most common cause for delivery to the emergency room, as well as for admission to the hospital. The improvements in medical equipment and treatment regimens has resulted in a significant improvement in the survival rate of patients who have developed congestive heart failure, yet there is still a great need to improve the quality of life of these patients in order to prevent future occurrences. A number of primary prevention measures will be described in this report. 1. EXERCISE
Physical exercise has been recognized as one of the primary prevention measures that could improve the quality of life of patients diagnosed with congestive heart failure. The simplest mode of physical exercise is walking, as this enhances blood circulation as well as the respiration of an individual. Unfortunately, the actual impact of this primary preventive measure has been poorly understood and the minimum amount of exercise that should be performed remains undetermined. The usual recommendation of a primary physician is to engage in walking exercises for approximately 30 minutes on a daily basis.
However, the differences in physical exercises, such as walking and other more strenuous activities have not yet been established. In a recent study conducted by Zuazagoitia et al. (2010), approximately 600 individuals positively diagnosed with heart failure were evaluated in terms of the effectiveness of an exercise program that consisted of high-intensity activities and strength training. The exercise program was also introduced to determine whether it resulted in the improvement of the quality of life of these patients.
The study participants of the study came from six primary health institutions around Spain, who were subjected to selection for inclusion according to the Framingham, as well as the New York Heart Association criteria for heart failure. The study participants were randomly assigned to either one of two study groups, one following the standardized care for heart failure, the other one following a combination of standardize health care and exercise. The study participants were monitored at three time points, namely 3, 6 and 12 months from the start of the research study.
The study showed that there was a significant improvement in the quality of life of the study participants after at least 3 months of engaging in physical exercise. In addition, the functional capacity, as well as the muscular strength of these subjects improved when exercise was integrated into the daily regimen. The body composition of the study participants was also observed to improve, together with the structural features of their heart during echocardiography. These observations support the hypothesis that physical exercise improves the health of individuals positively diagnosed with heart failure.
2. IMPLANTATION OF DEFRIBILLATOR Another primary prevention measure for patients diagnosed with congestive heart failure is the implant a defibrillator devise that would prevent the occurrence of sudden cardiac death. The main principle behind this primary prevention measure is that the survival time of a patient with congestive heart failure is generally shorter than those who do not have a cardiovascular history. This device is generally introduced into the patient in the left subclavicular area, right underneath the subfascial space.
Fibrillation occurs when a T wave is created of approximately 50 Hz. Research has shown than this devise significantly decreases mortality by 30% to 55%. The American Heart Association has supported the guideline that defibrillator devices be implanted among selected patients diagnosed with congestive heart failure. Other countries around the world are also actively campaigning for the adaptation of this measure as part of their primary prevention scheme. In a study conducted by Tai-bo et al. (2010), approximately 34 patients received a defibrillator implant as a primary prevention measure.
All patients were also given pharmacologic treatment regimens consisting of beta-blockers, as well as angiotensin-converting enzyme inhibitors. The study participants were monitored in terms of health progress for the next 15 months. The study showed that the implantation of the defibrillator device resulted in beneficial results, decreasing the number of deaths related to heart failure. Despite the small size of the study population and the short duration of follow-up of patients, the study showed positive results that could be employed as initial indicators for the need to further expand on this primary prevention activity.
3. ADMINISTRATION OF BETA-BLOCKERS Another primary prevention measure for patients diagnosed with congestive heart failure is the administration of beta-adrenergic receptor drugs. These pharmaceutical reagents are recognized to decrease the chances of sudden cardiac death, as well as the occurrence of ejection in relation to the left ventricle. Beta-blockers decrease the activity of the sympathetic nervous system, as this has been strongly associated with mortalities among congestive heart failure patients.
The most common beta-blockers include carvedilol and metoprolol, which prevent the accumulation of platelets and other clotting factors that impede blood circulation to and from the heart. According to a systematic study conduced by De Peuter et al. (2009), the combination of beta-1 and beta-2 blockers significantly reduced the occurrence of death among patients diagnosed with congestive heart failure. Comparison of the effect of administration of one beta-1 blockers was not as effective as introducing both beta-1 and beta-2 blockers, resulting in the improvement of the vascular condition of the treated patients.
This systematic review strongly suggests that this pharmacologic treatment should be adapted as the prime prevention measure for patients. CONCLUSIONS Primary prevention measures are important components in the delivery of healthcare services to patients diagnosed with specific medical conditions. A number of primary prevention actions have been identified for patients positively diagnosed with congestive heart failure. Physical exercise has been found to be an effective measure for the prevention of sudden cardiac death among heart failure patients.
In addition, the implantation of defibrillator devices has also benefited patients by regulating cardiac activity and ejection rates. The administration of two types of beta-blockers shows significant improvement in the cardiac condition of patients with congestive heart failure. Further studies on these primary prevention schemes may further improve the understanding of the mechanisms behind these approaches. REFERENCES De Peuter, O. R. , Lussana, F. , Peters, R. J. G. , Buller, H. R. & Kamphuisen, P. W. (2009).
A systematic review of selective and non-selective beta blockers for prevention of vascular events in patients with acute coronary syndrome or heart failure. The Netherlands Journal of Medicine, 67(9), 284-294. Hinton, R. B. , Jr. (2008). The family history: Reemergence of an established tool. Critical Care Nursing Clinics of North America, 20, 149–158. Tai-bo, C. , Kang-an, C. , Peng, G. , Zhong-wei, C. , Jing-bo, F. , Xiu-chun, J. & Quan, F. (2010). Primary prevention of sudden cardiac death by implantable cardioverter-defibrillator therapy in Chinese patients with heart failure: A single-center experience.
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