Management: Congestive Heart Failure

Congestive heart failure is a serious condition which prevents the heart from pumping enough blood to the rest of the body. In the United States, congestive heart failure accounts for more than 30,000 deaths and over 700,000 cases of hospitalization annually (Blinderman, et al., 2008). Hypertension is a major cause of congestive heart failure, but it can be caused by other factors as well. Some people experience very little or no symptoms at all and do not even know they have the disease. Others experience a myriad of symptom such as swelling in the hands and feet, fatigue, irregular heartbeat, inability to concentrate and several others.

Case management in nursing is becoming increasingly important because it is the nurse who coordinates all of the necessary care and treatment for the patient. For congestive heart failure patients, the nurse case manager is extremely important because of the seriousness of the disease. If left untreated, congestive heart failure can be fatal, so the case manager and the patient must work closely together to effectively manage the care and treatment for the patient.

In addition to keeping the congestive heart failure patient as healthy as possible, the nurse case manager must also be concerned with the economics of the health care system she is working for. By working with the patient in areas such as managed care, the case manager can closely monitor the patient's health to make sure he is following the guidelines to keep himself healthy and out of the hospital. The case manager can also recommend home health care so that that the patient can be discharged early to cut down on rising healthcare costs (Markle, 2004). These measures and others are cost effective because as long as the patient follows the guidance of the case manager. By doing so, healthcare expenses can be drastically lowered.

The case manager has a high concern for the congestive heart failure patients because this group has a high rate of admission and readmission to hospitals. Not only should a healthcare plan be recommended, but the patient's overall welfare should be taken into consideration because studies have shown that various social factors are related to the patient being readmitted to the hospital such as: low income status, being single, depression and lack of support (Hamner and Ellison, 2005).

Because many things can be the cause of congestive heart failure and because congestive heart failure can cause many other illnesses, a case manager must monitor her case load diligently. Over fifty hospitals in the Midwest were selected for a study on congestive heart failure in patients. The case manager of these patients has much to be concerned about regarding the patients who have been diagnosed with congestive heart failure. Out of 6,760 hospital patients in this chosen region, 98 of these patients (1%) have been diagnosed with congestive heart failure. This appears to be a small percentage given the number of patients selected in the region. However, if we look at this subpopulation of 98 patients, the case manager should be highly concerned because there are other serious illnesses which are often associated with congestive heart failure. The breakdown of this subpopulation is as follows:

57% - female

43% - male

20% - between the ages of 30 and 39

33% - between the ages of 40 and 49

33% - between the ages of 50 and 59

10% - between the ages of 60 and 69

3% - between the ages of 70 and 79

1% - between the ages of 80 and 89

Of the 98 patients diagnosed with congestive heart failure, thirty-nine of these (or 38%) have been diagnosed with coronary artery disease. This is an extremely high percentage and cause for concern. This is a disease in which plague builds up in the artery walls making blood flow difficult. Couple with congestive heart disease where the transfer of blood is already limited, the patient runs a serious risk of angina because oxygen…