Studies have showed that cardiovascular disease is the leading cause of mortality in developed countries. Heart failure is one of the chronic diseases that disrupt everyday life of the patient, their families and the wider community. The patients and their families spend enormous resources to attempt to seek out the most effective strategies, support and information to manage the disease and minimize interruptions (Mainar, et al., 2015). The prevalence of heart failure in developed countries especially the United States, Australian and United Kingdom is high. Some of the common symptoms associated with heart failure include fatigue, peripheral oedema and breathlessness, which causes multiple interaction with daily life. Depending with the severity of the attack, the patient may develop multiple chronic co-morbidities which may require complex treatment regime.
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World Health Organization has made the education of a patient to monitor their own health and being able to recognize illness severity as well as self-management of multiple chronic diseases as the current health care policy. Research have showed that symptom unpredictability leaves the patients to feel helpless and completely dependent on those around them, hence leading to lack of control on the illness and increasing the burden on the health care system and on the family (Fry, et al., 2016). In most circumstance, the responsibility for care shifts from the patient to the caregivers, spouses or immediate family. Under these conditions, the patient typically adopt to the ‘sick role’ thus depending on their families to provide support with their illness as well as in the previous responsibilities. During this time, a patient with greater levels of family support tend to build strong confidence between the patient and the family. The ties and bond between the family also tend to strengthen. This buttress the importance of strong support to the patients in times of illness to enhance patient well-being and achieve successful family functioning. This paper researched the impacts of heart failure to the national and international community, and review the goals of Health People 2020 in regards to the heart failure.
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The impacts of heart failure to the national and international community
Research showed that the patients who have experienced heart failure in the course of their life acknowledged that symptoms of heart failure as disruptive to the daily life activities since it limits the ability of the patient as well as their families to carry out their everyday activities. The restriction of daily activities makes the patients to loss confidence and start questioning their self-esteem as well as their own identity. The situation is worsened when the initial diagnosis was wrong because it delays the appropriate treatment strategy. Also, when the patient is misdiagnosed in the initial step, they tend to lose confidence on their physicians.
Most of the studies have confirmed that the patients with heart attack relied mostly on their close friends and family members for the support. For those patients that didn’t received immediate support from the family and close friend lacked the confidence and this negatively impacted on their ability to self-monitor their symptoms and self-manage (Mainar, et al., 2015). The review of the findings from several studies corroborate the findings by Bury which described heart failure as ‘biographical disruption’. Further review indicated that the prevalence of heart failure continues to increase due to various factors including improved survival rate, inadequate treatment and management of risk factors such as diabetes and hypertension. In addition, it is evident that patients with heart failure receives improved care thus increasing longevity.
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Statistics showed that more than 1/3 of the patients with heart failure have had their conditions precipitated by acute coronary syndrome. The most affected people by heart failure are those from socially disadvantaged population. The impacts of heart failure put more pressure on the growing health budgets as well as increasing burden on many health services. Most of the financial cost have been attributed to repeated hospital readmission. Studies have showed that the early hospital readmission of patients with heart failure is very common. The rehospitalization rate were 24 % and 44 % at 12 weeks and at one year after discharge from hospital (Fry, et al., 2016). As a result, the World Health Organization and other leading agencies are focused on reducing readmission rate by adopting various strategies and intervention including care in the community within disease management programmes. The comparison between heart failure and cancers in regards to the mortality rate showed that heart failure leads to higher mortality rate with about half of the patients with heart failure dying within 4-5 years from the period of diagnosis.
In addition to financial burden on the family and health care service, patients with heart failure also experience some common psychological effects such as depression, anxiety and fear which is caused by social isolation and uncertainty. Further findings showed that more that 1/3 of the patients with heart failure experience prolonged and severe depressive illness (Fry, et al., 2016). The patients with low or lack of social support tend to have poorer quality of life. In response to these challenges, Health People 2020 have focused on improved quality of life as one of the important treatment goals for patients. For many years, increased functional capacity, the relief of symptoms and improved quality of life was never the primary focus.
Although the self-care has been identified as one of the important interventions in the management of heart failure. The disparities in economic and social status in the society makes it very challenging for patients especially those from disadvantageous social and economic background. Self-care enables the patients to have naturalistic decision-making process, which include taking purposeful action and promoting physical health in response to symptoms with the core objective of restoring health (Mainar, et al., 2015). In most cases, the national and international communities have put place health care policies aimed at bridging the inequality gap between the advantageous and disadvantageous in the community, but the adoption and implementation of these policies is the problem thus failing to achieve the intended goals.
The review of the goals of Healthy People 2020 in regards to health failure
The goal states that “Improved cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke, early identification and treatment of heart attacks and strokes; prevention of repeat cardiovascular events; and reduction in death from cardiovascular disease” (Health People 2020, 2016). To achieve this goal, there are 50 objectives where 14 objective relates to developmental and 36 of the objectives were related to measurable. Some of these objectives include:
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- Identification and control of heart disease and stroke risk factors: A review showed that the number of individuals who accessed screening and prevalence information improved from 90.6 % to 91.8 % in 2014. However, the findings from the studies highlighted statically significant disparities based on disability status, family income, education, race and ethnicity as well as sex. These are among the factors that impede the realization of the goal in Health People 2020.
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- The control of heart disease and stroke risk factors: The findings from the studies indicated that there were no statistically significant changes with the recommendation for the patients to observe and maintain Body Mass Index (BMI). The major hindrances were the disparities and caused by disability status, family income, education and sex. As a result, it has been challenging for some national and international communities to effectively implement this objective.
- Early identification and treatment of heart attack and stroke: A review showed that many patients understand the early warning signs and symptoms of a heart attack. The awareness had increased from 39.6 % to 49.7 %, which exceeded the respective target of Health People 2020. This is one of the objectives that surpassed the 2020 targets despite the disparities that existed in the implementation stages.
- Prompt treatment of heart attack and stroke: The number of patients that received fibrinolytic therapy within 30 minutes arrival to the hospital decreased significantly from 70.0 % in 2009 to 54.3 % in 2014. This is a significant divergent from the baseline and 2020 target.
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In general, 15 objectives of heart failure and stroke on Health People 2020 exceeded the 2020 targets, eight of the objectives recorded improvement, seven of the objectives showed little or no detectable improvement, two of the objectives moved in the negative direction from achieving the 2020 targets, three of the objectives was just at the baseline of the data and one objective was informal.
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