Health Risks of Coronary Heart Disease: Literature Review

health Risks of coronary Heart Disease Literature ReviewCoronary Heart Disease (CHD) is the main be eat of death and dis mogul in the United Kingdom (UK) and the sole most frequent cause of early death. In spite of a drop in CHD mortality in recent years, there are approximately 120,000 deaths per year in the UK making the quotient amongst the uppermost compared to the rest of the world (British Heart Foundation (BHF), 2003). Additionally, to a greater extent than 1.5 million people in the UK are living with angina and 500,000 present tone bankruptcy (Department of Health (DH), 2004) comm only, although not wholly, caused by CHD. The World Health composition (WHO) has forecast that by 2020, CHD will be the principle cause of death and morbidity throughout the world (Tunstall-Pedoe, 1999).However, not only does CHD bear on the increasing evaluate of early deatjh, it can as well cause individuals to draw semipermanent continuing health problems. There are numerous different k inds of cardiac illnesses that include inherent abnormalities, aggregate rhythm disturbances, valvular disease, bang-up coronary syndromes and means trial (Jones, 2003). It is historic to note that the latter two conditions are more likely to affect older people and are the most prevalent among those with CHD (Rawlings-Anderson and Johnson, 2003). This essay will critically analyse the literature pertaining to the one of the most relevant health risks of CHD, that of inveterate magnetic core failure. The literature to be reviewed will analyse the issues that affect self-care in heart failure.To enable this review a comprehensive search of relevant databases much(prenominal) as CINAHL and the British Nursing Index was undertaken. Similarly, a thorough search of relevant nursing journals such(prenominal) as Nursing Standard, Nursing Times, British journal of cardiac Nursing, and British ledger of Nursing was also carried out. Also a general internet search using the keywords CHD, BHF, long-term chronic health problems, acute coronary syndromes, chronic heart failure, prevalence and associated factors was also employed.The rationale for choosing heart failure is that e very(prenominal) year 63 000 new cases are reported in the UK and it is increasing in prevalence and incidence affecting more than 900 000 people per annum (Petersen et al, 2002). Heart failure presents a major predicament with regard to its effect on the individual sufferers, their significant others and also on healthcare measures and supply. People with heart failure by and large suffer from recurrent episodes of acute exacerbation of their symptoms. As a consequence, admission to hospital is great and accounts for approximately 5 percent of all admissions to general medical or elderly care hospital beds indoors the UK. Readmission rates are as high as 50 percent in the six months following the original stay in hospital (Nicholson, 2007). It is posited that experience of illness and g rim clinical outcomes are fundamentally as a result of uncontrolled symptoms through non- alliance to suggested medicine and lifestyle modifications (DH, 2000a).There are non-homogeneous current Governmental runlines that expound the virtues of self-care of long-term conditions. However, The Department of Healths (DOH, 2006) Supporting people with long-term conditions to self-care A guide to developing local strategies and practices guide proposes that self-care is any actions or behaviours that help individuals to cope with the effects that their long-term condition has on their activities of daily living. These actions or behavioural changes hope to empower sufferers to deal with the unrestrained aspects, adhere to treatment quotidians and maintain the important aspects of life such as work and well-disposedising.A thorough research of the literature surrounding self-care for long-term conditions such as heart failure has shown that several factors are in existence that sub mit self-care in heart failure. These include socio-economics, condition- connect, treatment related and affected role related factors (Sabate, 2003, Leventhal et al, 2005).Socio-economic standing, degree of education, monetary restrictions and neighborly support have all been emphasised as effecting self-care in longanimouss with heart failure.Low socio-economic status and lack of education have been established to be significant factors relating to non-adherence and unretentive self-care (Gary, 2006 Van der Wal et al, 2006). Wu et al (2007) put together that those on minimal incomes were regarded as high risk for non-adherence to medication. While a superior(p) level of education was also ready to be a major predictor of adherence in research papers by Evangelista and Dracup (2000) and Rockwell and Riegel (2001).Financial restraints attached to the price of medication have been ac companionshipd as a hindrance to adherence (Evangelista et al, 2003 Horowitz et al 2004 Wu et al, 2008). However, these reports have been performed in the United States (US) and in the main check to lack of medical insurance under a Medicaid scheme. It is therefore suggested that additional research is required to ascertain whether the price of medication notably impacts on adherence in the National Health Service (NHS).A number of studies have observed that social support is an important issue in influencing self-care (Ni et al, 1999 Artininan et al, 2002 Scotto, 2005 Schnell et al, 2006 Wu et al, 2008). Ortega-Gutierrez et al (2006) appoint a significant contrary relationship between perceived level of social support and level of self-care. Similarly, Chung et al (2006a) examined the bearing of marital status on medication adherence and found that married patients had considerably enhanced adherence to medication than those living by themselves.Patients with a partner took more doses, were aware of the greatness of taking medications on time and were more erudite abou t names and doses. By contrast however, Evangelista et al (2001) found no association between social support and adherence to medication and lifestyle behaviours, although the authors suggest this whitethorn be due to the high levels of social support reported in this sample.The method of social support has been illustrated in numerous qualitative studies. Stromberg et al (1999) explained the important role spouses performed in medicationmanagement such as giving their partners their tablets at positively charged times. Wu et al (2007) found that a supportive family helped with medication adherence by collecting medications from the pharmacy and filling dosage boxes. These authors deduced that those devoid of the effective commitment of relatives in self-care, some patients would have trouble sticking to their drug routine. The high intensity of social support was alsoshown to be a feature of patients considered to be knowledgeable in self-care (Riegel et al, 2007a).A number of fac tors relating to specific aspects of the condition have been described in the literature. These include the nature and severity of symptoms, functional ability, prior experience, the figurehead of comorbidities and cognitive functioning. Severity of symptoms and functional ability are important indicators of behaviour. Symptomseverity was an independent predictor of self-care in a study by Rockwell and Riegel (2001). Wu et al (2007) found that patients with poor functional ability as measured by the New York Heart Association functional classification (NYHA) had poorer self-care.However, prior experience of hospitalisation may also affect self-care with patients having prior hospitalization episodes more likely to carry out self-care effectively. It is suggested that this may be due to a high level of pauperization to stay well and avoid hospitalization. Level of experience or time since diagnosis may also be important factors in determining self-care ability (Carlson et al, 2001) . Although the precise mechanism is unclear, it may be related to an enhanced ability to recognise changing symptoms and the use of tried and tested strategies in response to symptoms. The presence of comorbidities, especially if symptoms are similar to those of heart failure, makes the recognition and subsequent management of symptoms difficult. Chriss et al (2004) found the number of comorbidities to be a significant predictor of self-care, those with hardly a(prenominal) comorbidities having enhanced self-care.Self-management requires patients to make decisions and take actions in response to recognition of symptoms. However, cognitive deficits in heart failure have been well documented (Ekman, 1998 and Bennett, 2003). It is estimated that between 30 percent and 50 percent of heart failure patients have cognitive impairment (Leventhal et al, 2005). Wolfe et al (2005) found specific cognitive deficits of memory, attention and executive functioning, which were not related to illne ss severity. These deficits may impair the perception and interpretation of early symptoms and reasoning ability required for self-management. This is supported by Dickson et al (2007b) who found a correlation between impaired cognition and individuals inconsistently demonstrating effective self-care behaviour. Paroxysmal nocturnal dyspnoea, common in heart failure, also deprives the body of sleep and has consequences for cognitive functioning and decision-making (Trupp and Corwin, 2008). Perhaps as a result, sleepiness during the day has also been linked to poor self-care (Riegel et al, 2007b).Adherence to medication and lifestyle guidance has been linked to treatment-related factors such as the effects of medication or treatments, the intricacy of regimes and numerous changes in treatment. Riegel and Carlson (2002) and Van Der Wal et al (2006) found that adherence to a low sodium fast was hindered by the foul-tasting low season food and problems when eating out in a restaurant. Limiting fluid intake was also controlled by thirst. Bennett et al (2005) found that the taking of diuretics disrupted sleep and this was a significant factor in non-adherence. Concerns about medication side effects are also of major business concern to patients (Stromberg et al, 1999 Riegel and Carlson, 2002). The complexity of the treatment regime as indicated by a high number of administration times, for example, has been shown to decrease medication adherence (Riegel and Carlson, 2002 George et al, 2007 Van der Wal et al, 2007).It is suggested that individual patient characteristics have a major part in self-care behaviour. Age and gender may have some bearing on behaviour although there is comparatively limited evidence. The presence of depression also had a negative impact on self-care ability.Chung et al (2006b) examined gender differences in adherence to a low salt diet in patients with heart failure. They found that adherence was higher in women. Women were also further ca pable of making nutritional decisions. This is in contrast to Gary (2006) who researched the self-care routine of women with heart failure and established that a only a small number of women in this sample abided by the suggested low salt diet, exercised or weighed themselves daily. The only behaviour that was practiced without fail was taking medication. Hardly any women recognised symptoms of heart failure or checked and monitored their symptoms on a regular basis.Chriss et al (2004) found that males and increasing age were separate, significant predictors of self-care. However, the relationship between age and self-care behaviour continues to be ambiguous. Evangelista et al (2003) found that elderly patients with heart failure had break in adherence to medication, diet and exercise guidance than younger patients. Notably, depression influences the capacity to perform self-care behaviours successfully. There appears to be a preponderance of people who have heart failure who are a lso depressed. Approximately, 11 percent of out-patients and over 50 percent of hospitalised patients with heart failure are depressed (Leventhal et al, 2005). Depression has been revealed to be an important aspect predicting self-care (Dickson et al, 2006 Lesman-Leegte et al, 2006 Riegel et al, 2007b). DiMatteo et al (2000) declares that non-adherence is three times higher in depressed patients compared with those who are not depressed. The coexistence of depression in patients with heart failure makes them vulnerable to inadequate self-care.CHD is a major cause of death and disability in the UK and is also the main cause of premature death. CHD also causes its sufferers to have long-term chronic comorbidities. unitary of those comorbitities is heart failure. Heart failure is increasing in prevalence and incidence every year in the UK. It not only affects the patient but also their family. Similarly, the incidences of heart failure have a massive impact on health care provision an d resources. This is a consequence of the frequent acute exacerbations of the patients symptoms. Self-care of long-term conditions such as heart failure appear to be the Governments current preoccupation and guidelines exist that offer strategies to those with long-term conditions that may help sufferers cope with the impact that their illness has on their everyday lives. However, evidence exists that show that there are certain factors that act as barriers and influence self-care in heart failure. These factors include lack of education, financial constraints and social support. Cognitive ability, modification of life-styles, relationships, gender, age and mental illness have all been found to have an impact on the self-care of heart failure particularly with regards to medication adherence. There appears to be a dearth of research undertaken in the UK on the issues influencing self-care in heart failure. Therefore, it is recommended that further research is undertaken in the UK, a s the health care and welfare provision is vastly different from that in the US. 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