1. Daleiden-Burns, Anne MS, RN, APRN, BC

Article Content

The treatment of heart failure (HF) continues to challenge the healthcare practitioner. Key to understanding HF management lies with the recognition and anticipation of abnormalities associated with preserved versus decreased systolic performance. An endeavor for preventing acute decompensation has fostered advances in pharmacologic management, fluid removal, guideline adherence, and implantable device monitoring with the ultimate goal of improving quality of life, reducing hospital length of stay, and minimizing healthcare costs. Critical care nurses are faced with ever-changing therapies. This issue of Critical Care Nursing Quarterly 'Advances in Heart Failure Management' was developed with these in mind.


Heart failure due to preserved systolic function, formerly known as HF due to diastolic dysfunction, is associated with significant morbidity and healthcare costs similar to HF from decreased systolic function. Albert's article describes the assessment, diagnosis, and treatment strategies unique to this clinical problem. A nurse's understanding of diagnostic criteria and treatment strategies can have significant impact on patient outcome.


Quinn's article on pharmacologic treatment of HF focuses primarily on the management of left ventricular systolic dysfunction. It illustrates, utilizing an evidence-based approach, the current drug therapy and treatment standards recommended by the American College of Cardiology and the American Heart Association. It offers nurses the knowledge of current pharmacologic treatments to provide quality patient care and adhere to core standards.


Gardetto and Carroll highlight the crucial and essential component that nursing care, guided by HF Core Measures, can offer to improve the quality of care provided to HF patients. Evidence-based guidelines exist, which outline the care and management of acute and chronic HF, yet adherence to these guidelines remains suboptimal. The Joint Commission has implemented a number of quality care performance indicators including HF Core Measures for hospitalized patients. The guidelines support the belief that thorough risk factor management including risk-reduction improvesquality of life and survival, while reducing cardiovascular events.


The devastating effects seen with acute decompensation have prompted the development of a method to continuously and proactively monitor hemodynamics and intrathoracic impedance. Information obtained from implantable hemodynamic and/or thoracic impedance monitoring systems may provide early warning of an impending HF exacerbation and could identify subclinical congestion. 'Proactive Monitoring: Implications of Implantable Devices for Future Heart Failure Management' describes how implantable devices can continuously trend hemodynamics and fluid status, offering individualized treatment regimens based on real-time data.


It is estimated that as many as 25% to 30% of HF patients may have diuretic resistance. Walsh and Wagemester describe a new technique called peripheral ultrafiltration for the treatment of fluid overload, which may be especially beneficial to patients with diuretic resistance. Peripheral ultrafiltration utilizes convection to remove salt and water. The treatment does not require a hemodialysis nurse and can be managed by the bedside registered nurse. The article illustrates how completion of a competency-based educational program can be an effective way to prepare nurses to administer this technique.


Finally, the limited number of available donor hearts combined with an increase in the number of patients awaiting heart transplantation has driven the development of a permanently implanted left ventricular system as an alternative to cardiac transplantation. Ventricular assist devices (VADs) are becoming more commonplace in the hospital and community settings as the number of patients living with HF increases. The use of VADs for these patients can dramatically improve both the quality and length of life. Stahovich et al describe the types and unique characteristics of individual VADs. The critical care nurse is in a unique position to educate patients with chronic HF on options, including VAD therapy, available to improve their quality of life.


This important issue of Critical Care Nursing Quarterly provides a discussion on current HF management with the goal of preventing an acute decompensation. In the most recent issue of Critical Care Nursing Quarterly on Cardiac Emergencies (30:2), Varughese provides an excellent review of the management of acute decompensated HF and complements this issue well. In this current issue, special attention was given to HF due to preserved systolic function. Its prevalence makes it an equal to that of systolic dysfunction and its impact on healthcare just as significant. Also included is a detailed discussion of recent advances in pharmacology as well as methods to incorporate Core HF Measures into bedside practice. New strategies such as peripheral ultrafiltration and invasive hemodynamic monitoring are promising and may be valuable tools to add to our HF armamentarium. The content in this issue can serve as an excellent resource to all critical care nurses caring for patients with both acute and chronic HF.


Though not specifically related to HF management, 2 articles are also included which have direct impact on critical care nursing practice.


The article by Ferguson describes the role of the advanced practice nurse (APN) in the evaluation and treatment of fever in intensive care unit patients. A thorough review of the literature and current practice patterns is included.


Norton et al explore the issues surrounding family presence during cardiopulmonary resuscitation. Following completion of a 3 hour class on death and dying by senior nursing students, which included information on family presence (FP), there was an increase in acceptance of FP during a resuscitation in one baccalaureate program.


Through evidence-based practice, the APN can effectively and efficiently manage the febrile patient and is in a unique position to educate patients, families, and nursing staff while minimizing the impact that febrile treatment may have on the healthcare system.


Anne Daleiden-Burns, MS, RN, APRN, BC


Issue Editor Cardiology Nurse Practitioner San Diego Cardiovascular Associates Encinitas, CA