Capella 4025 Assessment 3

Name

Capella university

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name

Date

Applying the PICO(T) Process

Acute Heart Failure (AHF) remains a critical public health issue contributing significantly to mortality worldwide. Its prevalence is particularly pronounced in developed nations like the United States, where approximately one million new diagnoses occur annually (Heidenreich et al., 2022). Effective management of AHF is crucial to improving clinical outcomes and minimizing healthcare expenditures. This paper explores the challenge of diuretic resistance in AHF and investigates evidence-based fluid management strategies aimed at enhancing patient care. Through a review of recent studies, it evaluates how these interventions can be integrated into clinical practice to improve prognosis.

Explaining a Diagnosis

AHF is a severe condition that drastically affects patients’ daily functioning and well-being. Clinical manifestations include reduced physical endurance, fatigue, dyspnea, and fluid accumulation, all of which contribute to frequent hospital admissions. Key complications such as fluid overload, pulmonary edema, and arrhythmias often exacerbate the condition and can lead to acute decompensated heart failure (ADHF), a medical emergency requiring specialized care. AHF is responsible for over 380,000 annual deaths in the U.S. alone (Savarese et al., 2022). Older adults face heightened risk due to comorbidities, polypharmacy, and declining physiological resilience. Racial and ethnic disparities also persist. African American populations experience disproportionate rates of hospitalization and mortality related to AHF, attributed to socioeconomic inequities, healthcare access limitations, and inconsistency in treatment approaches (Mwansa et al., 2021). Individuals from low-income backgrounds often encounter delays in diagnosis and receive fewer healthcare services, compounding disease burden. These disparities stress the importance of creating equitable treatment models that enhance access to essential resources.

PICO(T) Research Question

The developed PICO(T) research question is: In patients with acute heart failure (AHF) who experience diuretic resistance (P), how does the use of evidence-based fluid management interventions (I) compared to standard diuretic therapy (C) affect fluid retention and patient outcomes (O) over 12 weeks (T)?

The research question aligns with the PICO(T) framework as shown below:

Component	Description
P (Population)	Patients diagnosed with acute heart failure exhibiting diuretic resistance
I (Intervention)	Evidence-based fluid management strategies tailored to individual clinical needs
C (Comparison)	Standard diuretic therapy routinely used in conventional care
O (Outcome)	Reduction in fluid retention and improvements in patient outcomes
T (Time)	12-week evaluation period to assess intervention efficacy

This question enables researchers and clinicians to systematically assess how newer, individualized fluid management techniques compare to traditional therapies in managing AHF complicated by diuretic resistance.

Literature Search

To gather relevant data, a comprehensive literature search was conducted across reputable academic databases including PubMed, CINAHL, the Cochrane Library, and Google Scholar. Search terms included “acute heart failure,” “fluid overload management,” “diuretic resistance,” “standard diuretic therapy,” and “evidence-based fluid therapy.” Boolean operators like AND and OR were applied to refine search accuracy. The selection criteria focused on studies comparing conventional diuretic treatments with advanced fluid management methods in patients resistant to diuretics.

The CRAAP test—assessing Currency, Relevance, Authority, Accuracy, and Purpose—was employed to validate source credibility. Peer-reviewed journals and articles published within the last five years were prioritized to ensure inclusion of current evidence. Authoritative sources, such as those from the American Heart Association (AHA), were favored for their clinical reliability (AHA, 2021). Search parameters were restricted to full-text, English-language articles involving adult AHF patients. By progressively narrowing the scope using specific keywords like “evidence-based fluid regulation,” the most applicable and high-quality studies were identified to address the research question effectively.

Relevant Articles

Multiple reputable sources were reviewed to understand fluid therapy’s role in managing AHF among diuretic-resistant individuals. A systematic review by Rahman et al. (2020) explored mechanical fluid removal techniques such as peritoneal dialysis and paracentesis. These interventions showed promise for improving fluid balance in AHF patients. The study’s credibility stemmed from its publication in a peer-reviewed cardiology journal.

Another significant source was Wobbe et al.’s (2020) meta-analysis, which investigated ultrafiltration (UF) as a therapeutic option. Findings revealed UF to be superior to conventional diuretic therapy in promoting weight loss, fluid reduction, and decreased rehospitalizations. The randomized controlled trials included in this review supported its applicability to clinical practice.

Guidelines issued by the European Society of Cardiology (ESC, 2021) were also considered. These offered standardized recommendations for sodium and fluid management in AHF, lending critical clinical insight. Lastly, a systematic review by Stachteas et al. (2024) examined the use of Sodium-Glucose Co-Transporter-2 (SGLT-2) inhibitors as a solution for diuretic resistance. The study evaluated their efficacy in managing fluid status, symptom improvement, and safety profiles in AHF patients. Collectively, these sources provide a comprehensive understanding of innovative fluid management strategies.

Analyzing Evidence

Evidence from the reviewed literature supports the clinical advantages of fluid regulation strategies over conventional diuretic therapy in cases of diuretic resistance. Rahman et al. (2020) highlighted that rigid fluid restriction could contribute to adverse effects like dehydration, poor nutrition, and worsened quality of life. They advocated for individualized fluid removal methods such as paracentesis. Wobbe et al. (2020) demonstrated that ultrafiltration therapy facilitated more efficient fluid clearance and reduced the likelihood of readmission. ESC (2021) guidelines endorsed personalized fluid and sodium management to optimize outcomes in AHF patients. Stachteas et al. (2024) assessed the role of SGLT-2 inhibitors in improving fluid control, reinforcing their use as a novel pharmacologic intervention for patients unresponsive to diuretics. Together, these studies underscore the clinical value of personalized, evidence-based strategies and assume the availability of training and infrastructure necessary for their implementation across healthcare settings.

Conclusion

The cumulative evidence underscores the clinical superiority of evidence-based fluid management techniques over traditional diuretic therapies in treating AHF patients with diuretic resistance. Interventions such as ultrafiltration, mechanical fluid extraction, and pharmacologic options like SGLT-2 inhibitors offer improved patient outcomes, reduced hospital admissions, and enhanced quality of life. These findings align with existing clinical guidelines advocating for personalized care approaches. Ensuring that healthcare providers are adequately trained and equipped to implement these interventions is critical to optimizing outcomes and alleviating the burden of acute heart failure.

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References

AHA. (2021). Heart failure. https://www.heart.org/en/health-topics/heart-failure

ESC. (2021, August 25). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure

Heidenreich, P. A., Fonarow, G. C., Opsha, Y., Sandhu, A. T., Sweitzer, N. K., & Warraich, H. J. (2022). Economic issues in heart failure in the United States. Journal of Cardiac Failure, 0(0), 453–466. https://doi.org/10.1016/j.cardfail.2021.12.017

Capella 4025 Assessment 3

Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/ethnic and gender disparities in heart failure with reduced ejection fraction. Current Heart Failure Reports, 18(2), 41–51. https://doi.org/10.1007/s11897-021-00502-5

Rahman, R., Paz, P., Elmassry, M., Mantilla, B., Dobbe, L., Shurmur, S., & Nugent, K. (2020). Diuretic resistance in heart failure. Cardiology in Review, Publish Ahead of Print(2), 73–81. https://doi.org/10.1097/crd.0000000000000310

Savarese, G., Becher, P. M., Lund, L. H., Seferovic, P., Rosano, G. M. C., & Coats, A. J. S. (2022). Global burden of heart failure: A comprehensive and updated review of epidemiology. Cardiovascular Research, 118(17). https://doi.org/10.1093/cvr/cvac013

Stachteas, T., Nasoufidou, S., Patoulias, D., Karakasis, S., Karagiannidis, E., Mourtzos, I., & Samaras, A. (2024). The role of sodium-glucose co-transporter-2 inhibitors on diuretic resistance in heart failure. International Journal of Molecular Sciences, 25(6), 3122. https://doi.org/10.3390/ijms25063122

Capella 4025 Assessment 3

Wobbe, B., Wagner, J., Szabó, A., Rostás, I., Farkas, N., Garami, A., Balaskó, M., Hartmann, P., Solymár, M., Tenk, A., Ottóffy, G., Nagy, A., Habon, T., Hegyi, P., & Czopf, L. (2020). Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: A meta-analysis. Heart Failure Reviews, 26(3), 577–585. https://doi.org/10.1007/s10741-020-10057-7