GMED3009 Report On Congestive Cardiac Failure In Australia Assessment 2 Answer
Congestive cardiac failure is a chronic condition which adversely impacts the pumping power of the heart and results in build-up fluid around the heart which in turn leads to pumping inefficiently (Garry et al., 2017). In simple terms, it is called heart failure. In Australia, CCF is rising as a chronic co-morbidity for individuals above 45 years of age. Further, every year around 31,000 new cases of CCF are diagnosed and treated. This report aims at highlighting the epidemiology of CCF in Australia including its prevalence, incidence and aetiology. Also, it deals with the critical analysis of one treatment available for CCF evaluating its benefits and limitations. This is followed by one available resource working for the support and diagnosis for people with congestive cardiac failure and its impact on the patients and healthcare providers.
2.1 Incidence and prevalence
According to Sahle et al. (2016), the incidence of CCF in Australia shows that around 31,000 new cases are diagnosed every year and this indicates the crude incidence rate of 2.2 per 1000 person. Also, Parsons et al. (2020) state that the approximate incidence of probable or likely CCF was 0.294 per cent per year (94 per cent confidence intervals 0.287–0.297 per cent), and the age-standardised incidence reached 0.342 per cent per year (94 per cent confidence intervals: 0.344–0.352 per cent). The statistics of prevalence and occurrence indicate that almost 440,000 individuals were living with CCF in Australia in 2018, and over 68,000 new cases of CCF reported that year (Parsons et al., 2020).
The prevalence as calculated by the Australian government shows that at present around 300,000 Australian individuals are suffering from CCF (AIHW, 2017). In 2016 the prevalence rate of CCF were between 1.0% to 2.0% and is more prevalent among individuals aged above 45 (Sahle et al., 2016). The rates are more common among people living in remote or rural areas and among the aboriginal population. Further, according to the Australian Bureau of statistics, the prevalence of CCF in 2017 was approximately 2.1% (SAAHV, n.d.). CCF is more common males accounting for 7.0% of cases and slightly less prevalent among females that are 4.0% (SAAHV, n.d.).
Nussinovitch (2017) puts forth that a range of factors causes cardiac failure for an individual such as hypertension, heart abnormalities, previous cardiac attack, myocarditis, thyroid disease, and idiopathic cardiomyopathy, toxic damage cause to heart, metabolic or hormonal disease, nutritional abnormalities and infiltration. In a person suffering from CCF, the ventricles do not empty properly. This results in elevated pressure in atria and surrounding veins. Further, this causes build-up-fluid in legs, lungs and abdominal organs. The first and major cause is past heart attacks as this scar the heart muscles (Department of health, 2020). Next, hypertension ruptures the arteries by forceful pumping which increases the risk of a heart attack. Also, heart valve disease results in backward blood flow and forward flow is obstructed which enhances the chances of malfunctioning and cardiac attack (VSG, 2020).
Congenital cardiac disease is another potential comorbidity which is characterized by abnormal or defective valves (Hinton & Ware, 2017). Next, Idiopathic cardiomyopathy leads to enlargement of heart muscles which enables poor contraction and affects the functioning of the heart. According to Weintraub et al. (2017), infections including viral infections adversely affect the heart muscles thereby weakening them and making them prone to a heart attack one such example is myocarditis. Diseases such as thyroid produce an excess of thyroxin hormone and increase the workload for the heart muscles and heart arrhythmia when existing for a longer period leads to poor contraction (Kannan et al., 2018). Moreover, individuals who consume an excess of drugs and alcohol have nutritional abnormalities; metabolic disorders (such as growth hormone, diabetes) and obesity are at exposed risk for cardiac failure (VSG, 2020).
The chosen treatment for CCF is Beta-blockers.
Beta-blockers are classified as either selective or non-selective beta-blockers as per the three subcategories of beta-receptors. Beta-blockers can be given to the patient either orally or intravenously. The first generation beta-blockers include oxprenolol, sotalol and propranolol, the second generation beta-blockers are selective and include atenolol, metoprolol and so on, the third generation is a combination of non-selective and alpha-blocking such as carvedilol (Safi et al., 2017). In a study conducted by Choi et al. (2019) a mortality trail of Bisoprolol for 23 months showed that it is safe and reduced the hospitalization rates. Further, Perreault et al. (2017) contend that in a randomized control trial of Metoprolol it is evaluated that after 12 months of placebo trail the patients showed beneficial outcomes. This included improved quality of life in terms of exercise capacity, ejection fraction and a decrease in the need for the heart transplantation. In support of this Li et al. (2017) states that metoprolol reduces the hospitalization period and admission rates.
According to Farha et al. (2017), carvedilol is another beta-blocker and works against beta1, beta2 and alpha1. Farha et al. (2017) further conducted a study on its efficacy. The trial showed a mortality rate of 3.3 per cent in comparison to the placebo with 7.9 per cent. There is also observed a reduction in the cardiovascular cause and hospitalization rates. In addition to this Safi et al. (2017) put forth that in the "Multicenter Oral Carvedilol Heart Failure Evaluation" (MOCHA), a greater impact on mortality with higher concentrations of carvedilol was found. On the other hand, the CIBIS II subgroup study indicated that bisoprolol had a comparable decline in mortality for each of the three-dose tertiles, and the MERIT-HF study indicated a similar result for lower and higher metoprolol levels.
Along with benefits beta-blockers does have several disadvantages. First is they have the high number of side effects ranging from fatigue, diarrhoea or constipation, dizziness, trouble sleeping, depression, loss of erectile dysfunction, shortness of breath, headache and cold hands (Montenegro et al., 2019). Further, the limitations show that beta-blockers have numerous adverse effects. The clinical trial shows that due to beta-adrenoreceptor patients face physiologic and metabolic malfunctioning (Yap et al., 2018). Conversely, in patients with congestive cardiac failure and those with previously existing borderline compensation and myocardial impairment, beta-blockers can intensify symptoms, as the preservation of cardiac production in such patients is partly dependent on the sympathetic drive (Yap et al., 2018). Beta-blockers can also not be administered as new treatment until compensation is obtained following cardiac failure. However, this procedure should be extended in patients still undergoing beta-blockers if decompensated cardiac failure happens. In this context, increased peripheral vascular resistance caused by non-selective beta-blockers can also lead to a decrease in myocardial activity (Fauchier et al., 2016).
4.0 Available resource
The heart foundation is a well-known foundation for the management of heart diseases. It is supporting over 570,000 individuals living with heart diseases (Heart foundation, 2020). The foundation works on research, patient care, multidisciplinary care, prevention and detection of cardiac failure advocates industries and governments for providing heart health resources and plays an important role in community awareness programs. Also, it supports the medical professionals in preventions, management and diagnosis of heart diseases and heart failure (Heart foundation, 2020).
Heart foundation provides numerous support services for both patients and healthcare professionals. First, for patients, the online website helps in searching for the nearest rehabilitation centre near the patient. Also, patient education is the key criteria of this foundation. Educating patients help in managing their condition and they know about cardiac failure and implications (Mitcheltree, 2020). During this pandemic, the heart foundation is delivering heart health education for awareness and management of heart failure through webinars that are accessible by various individuals (Heart Foundation, n.d.).
Moreover, other educational tools such as factsheets and resource materials, pamphlets are available online in a readable format and heart foundation entails the principle of the bio-psyhco-social model. Hence, it aims at improving both physical and psychological needs which have beneficial health outcomes for the patients. Heart foundation's major motive is to provide on-time diagnosis and multidisciplinary care approach (Heart Foundation, n.d.). According to Siouta (2018), multidisciplinary care is integrated with best-practice treatment of chronic cardiac failure (CCF). There is compelling literature that people seeking multidisciplinary care have greater survival results for patients diagnosed with CCF and those who are not. Next, it provides cardiac failure toolkit for healthcare professionals which aid them in addressing approach for hospital admissions. It also delivers clinical resources for healthcare professionals such as the development of scorecard of readmissions and diagnostic services and tools (Heart Foundation, n.d.).
From the above assessment, it can be concluded that congestive cardiac failure is a chronic condition and has a high prevalence rate. Incidence of CCF in Australia shows that around 31,000 new cases are diagnosed every year. Prevalence of CCF is raised to 2.1%. the factors causing congestive cardiac failure include hypertension, heart abnormalities, previous heart attack, myocarditis, thyroid disease, and idiopathic cardiomyopathy, toxic damage cause to heart, metabolic or hormonal disease, nutritional abnormalities and infiltration. Beta-blockers are an effective treatment approach for congestive cardiac failure as it helps in reducing heart diseases, blood pressure, reduces mortality rates and hospitalization rates. Heart foundation in Australia is a well-known and developing organization that provides efficient diagnostic resources to healthcare professionals and positive health outcomes for patients.