Gardetto Nancy J, Carroll Karen C
Department of Nursing and Patient Care Services, San Diego Veterans Affairs Medical Center, VA San Diego Healthcare System, La Jolla, California 92161, USA.
Crit Care Nurs Q. 2007 Oct-Dec;30(4):307-20. doi: 10.1097/01.CNQ.0000290364.57677.56.
Despite enormous advances in the medical management of heart disease, heart failure (HF) persists as a leading cause of hospitalization in our elderly. In 2001, the American Heart Association and the American College of Cardiology published Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease. The guidelines proactively responded to a growing body of evidence confirming that comprehensive risk factor management and risk reduction improve quality of life and survival, while reducing recurrent cardiovascular events. In spite of the well-crafted, comprehensive HF guidelines, morbidity, mortality, and hospital readmission rates for acute decompensated heart failure remain high, and adherence to HF guidelines is not always optimal. The Joint Commission has implemented a number of quality care performance indicators based on the Guidelines for Secondary Prevention; among them are the Core HF Measures for hospitalized HF patients. The Core HF Measures are endorsed by the Center for Medicare and Medicaid and has been adopted as a national benchmark for measurement and public reporting of healthcare performance and for Medicare payments (Joint Commission). The implementation and monitoring of Core HF Measures has prioritized attention toward patient education and risk factor modification to prevent future hospitalization. Critical care nurses are on the frontline to champion uptake and adherence of Core HF Measures. The purpose of this article is to highlight the critical component that nursing care, guided by the Core HF Measures, can offer to improve the quality of patient care in acute decompensated heart failure.
尽管在心脏病的医疗管理方面取得了巨大进展，但心力衰竭（HF）仍然是我国老年人住院的主要原因。2001年，美国心脏协会和美国心脏病学会发布了《冠状动脉和其他动脉粥样硬化性血管疾病患者二级预防指南》。这些指南积极回应了越来越多的证据，这些证据证实全面的危险因素管理和风险降低可改善生活质量和生存率，同时减少心血管事件的复发。尽管有精心制定的、全面的心力衰竭指南，但急性失代偿性心力衰竭的发病率、死亡率和住院再入院率仍然很高，而且对心力衰竭指南的依从性并不总是最佳的。联合委员会已根据二级预防指南实施了一些质量护理绩效指标；其中包括针对住院心力衰竭患者的核心心力衰竭措施。核心心力衰竭措施得到医疗保险和医疗补助中心的认可，并已被用作衡量和公开报告医疗保健绩效以及医疗保险支付的全国基准（联合委员会）。核心心力衰竭措施的实施和监测将重点放在患者教育和危险因素调整上，以防止未来住院。重症护理护士处于倡导采用和遵守核心心力衰竭措施的前沿。本文的目的是强调以核心心力衰竭措施为指导的护理可以为改善急性失代偿性心力衰竭患者护理质量提供的关键要素。
