Core Measures For Heart Failure
Core measures for Heart Failure
In the year of 1999, The Joint Commission recognized a demand for a set of processes pertaining to common medical conditions, which could enable the evaluation of patient care and improve overall outcomes. The Joint Commission established a committee called the Cardiovascular Conditions Clinical Advisory Panel, with which embodied the collaboration to develop the core measures. The Joint Commission developed the original four core measures in 2001, which included Heart Failure, Acute Myocardial Infarction, Pneumonia, and Pregnancy conditions. The core values establish a set of algorithms that assess the hospitals performance and are evidence-based, diagnostic specific, and directed at specific groups. These core measures must be reported to the Joint Commission and the Center for Medicare and Medicaid services, which further evaluates compliance to these standards, and regulates admissibility to receive insurance compensation.
Heart failure effects over 5.8 million people and annually cost about 35.5 billion dollars (Stella 1). With the increase of hypertension, diabetes, and obesity, the condition and cost of heart failure will continue to rise. Heart failure characteristics, depending on the side effected, include shortness of breath upon exertion, unexplained fatigue, edema or inability to tolerate exercise.
Heart Failure Measures
The most essential role of the nurse, in relation to the core measures is documentation. The nurse must provide documentation with specificity, with regards to time. The core measures for heart failure are defined as
1. Evaluation of the left ventricular function: Left ventricular function should be assessed by utilizing the diagnostic tool of an echocardiogram with Doppler or cardiac catheterization. These diagnostic tools can evaluate the ventricular thickness, size, and valve dysfunction. The echocardiogram is an evaluation on the structures of the heart. With heart failure, the echocardiogram typically shows the ejection fraction being reduced as well as a lessening in ventricular function. The ejection fraction should be between 50% – 70%, but can be less which represents the severity of heart failure.
2. ACE-I or ARB prescribed at discharge if ejection fraction is less than 40%:
ACE-I can be used for patients with left ventricular dysfunction, while ARBs can be used for patients with patients who can’t tolerate ACE-I. This single core measure has reduced mortality by 20%. ACE-I work by blocking the conversion of angiotensin which essentially reduces afterload, and increases the cardiac output. Examples of ACE-I include benazepril, captopril, Lisinopril. Angiotensin II receptor blockers work by decreasing the effects of angiotensin II. Examples of ARBs include, losartan or valsartan. An additional role of the nurse, in regards to core measures, is to ensure that the medications are documented, ordered, administered and provide patients with education regarding the medications.
3. Written HF education provided at discharge: The nurse should ensure that the patient has written instructions regarding diet (low sodium, low fat diet, cardiac diet), discharge medications instructions, the importance a weighing self-daily (same time of day, same amount of clothing), adhering to follow up appointments and signs and symptoms of worsening of his/her condition. A weight gain of greater than 2 pounds is an indicator of fluid overload. Signs and symptoms to report to the doctor include, new onset of dyspnea or chest pain. The nurse should adapt to the patient’s educational level and include the teach back method to ensure that the patient understands the information that is being presented. The nurse can also explain that non-compliance to medications, follow up appointments and various teaching, will increase the patient’s mortality rate.
Reasoning for choosing this measure
I have personally cared for copious amounts of heart failure patients, I felt that it would be applicable to write my core measures paper on heart failure. In addition to having cared for numerous patients with this condition, I have found an interest in the cardiac floor at the hospital. My grandparents both passed away from heart failure- first my Grandfather and within the same week, my Grandmother. I have become fascinated with trying to understand the pathophysiology of various cardiovascular disorders and ways to improve patient outcomes.