Rough Draft Quantitative Research Critique and Ethical Considerations

Rough Draft Quantitative Research Critique and Ethical Considerations

Introduction to Nursing Research NRS – 433V – 0502

Background of Study

Individuals who are admitted the hospital for Congestive Heart failure (CHF) are at higher risk for readmission to the hospital, with a 30-day readmission rate. CHF is a chronic disease described as the incapability of the cardiac muscle to pump a satisfactory amount of blood to attain the demand of the various organ systems (AHA, 2015). The American Heart Association has indicated that more than 650,000 new cases of CHF are diagnosed yearly and is increasing with age, intensifying from roughly about 20:1000 people 65 – 69 years of age to > 80:1000 people amongst those > 85 years of age. Roughly speaking there are about 5.1 million peoples in the United States have clinically observable CHF, and the prevalence continues to rise. CHF is the primary diagnosis in more than 1 million hospitalizations annually (Yancy, et al., 2013).

A recognized public health concern in high-income countries (IHC) exemplifying a considerable problem for patients and health-care systems is CHF. CHF is projected to be a chief health issue of the public in low and middle-class income countries (LMICs). In the United States 20% – 30% of patient that who live to be released from the hospital will probably have a rehospitalization in 30 days, at the same time a 5-year mortality rate ranges between 40% – 65% amongst United States, United Kingdom, Netherlands, and Sweden (Rahimi, et al., 2014).

Most of hospitalization are from the lack of self-care help, medication managing, and following a nutritional regimen. Patient-level obstacles to self-care include regimen difficulty, adverse effects to medication, and insufficient knowledge, tools and support (Holden, et al., 2015). CHF is predicted to develop as a chief health matter in low-and middle-income countries with changes of demographics and the epidemiological shift to non-communicable diseases (Rahimi, et al., 2014).

The objective of the study was to determine and analyze the load of CHF in LMICs globally, gathering facts on over 231,000 incidents from 30 countries, with submissions from all over the world (Rahimi, et al., 2014, p 4). It was found that CHF was previously a main problem to residents and health facilities in LMICs, where it generated a mean of up to 2% of hospitalizations, involving more men than women. Information about CHFs burden in LMICs is scant, which was review for both distributed and undistributed evidence on the appearance, effects, managing and results of CHF (Rahimi, et al., 2014). The purpose of the study was to analysis a wide-range of articles, each with different purposes and strategies, to portray a wide-ranging synopsis of CHF in LMICs.

The study made a comprehensible difference between etiology and co-morbidities, which were adjustable, and various reasons were frequently recognized to specific cases of CHF. Non-communicable diseases from all LMICs included ischemic heart disease (IHD) and hypertension (HTN), as the primary bases of CHF. IHD is the universal cause of CHF in all areas. In the United States HTN and IHD are accountable for a proportion of verified cases, at 30% and 33% respectively (Rahimi, et al., 2014). The average age was 63 for HIC, being 10-years younger than in the LMICs. The average age of peoples from lower income, low-middle-income, and upper-middle-income countries, from previously being 50-years to 60-years and 70-years, respectively. Consequently, the age in upper-middle-income countries appeared near to those in HICs (Rahimi, et al., 2014),

Among all reports, the treatment of CHF differs significantly between areas sections and within regions. An additional issue connected to the therapy management of CHF is that in most researches, minorities were lessened, making the current recommendations less valid to minorities (Nasif & Alahmad, 2011). The most commonly prescribes treatment is loop diuretics, prescribed for 70% of individuals in LMICs globally. Angiotensin-converting enzyme inhibitors (ACEIs) are consumed by individuals in about 60% of cases, beta-blockers in roughly 30% and mineralocorticoid receptor antagonists in about 30% cases on average (Rahimi, et al., 2014).

A statistically noteworthy outcome was noticed during the time of the study noting HTN as a root cause of CHF, which rose by almost 3% per year between 1990 and the late 2000s. (Rahimi, et al., 2014). No indication was noted to imply that the studies time-frame had a considerable effect on the other causes of CHF. The rates utilized for medical managements of CHF did not have any notably changes over the course of time, except for beta-blockers, which presented a surge of 3% per year. Inpatient death rate deteriorated to about 0.30% per year between 1990 and 2010 (Rahimi, et al., 2014). Patient admitted to the hospital with CHF was hospitalized for 10 days. The average length that patients stayed in the hospital ranged from 3 days to 23 days. This data was obtained from 23 studies that reported these measures.

Method of Study

The study used quantitative research methods. The systematic review was planned and accepted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of Medline, Embase, Global Health Database, and World Health Organization (WHO) regional databases for articles published between January 1995 and March 2014. Related studies from LMICs on the epidemiology, diagnosis, management, and outcomes of CHF were incorporated (Browne, Macdonald, & May, 2014).

There was a total of 42 articles that offered pertinent material on hospitalized patient in an acute care setting (25 LMICs; 233,000 patients) and 11 findings on the managing of CHF in physicians ‘office or outpatient clinics (14 LMICs; 5,360 patients). According to Rahimi and Callender, overall, IHD was the main described reason of CHF in all areas except African and the United States, where HTN was largest reason (Rahimi, et al., 2014).

Studies that were included or qualified to be included had to convey information on CHF residents from LMICs as outlined by the World Bank. Case findings should have a minimum of 100 reviewed cases which included pertinent material on demographic, characteristics, prevalence, case mortality, underlying etiology, or managing of patient with CHF. Studies that only encompassed data on complication of acute myocardial infarction or studies that did not contained information on cardiomyopathy or CHF as a problem of acute were rejected, as were articles that did not contain an illustrative sample of individuals from the background that was chose for CHF were omitted (Rahimi, et al., 2014).

This study took place over a 20-year span and the studies used ranged from January 1, 1995 to March 30, 2014. The study included individuals from three groups: those newly diagnosed with CHF, those with acute decompensated chronic heart failure and those with stable chronic heart failure seen in the clinic in an outpatient setting which developed from an assorted group of studies were set out with different study purposes. Transformations amongst healthcare organizations means that descriptions of peoples seen in countless situations might be different among other countries, while observance to gold-standard managing may be more common amid individuals with stable CHF seen in outpatient locations employed with cardiologists than among those with acute CHF that are being managed by internal medicine physician in hospitals (Rahimi, et al., 2014).

Another constraint to the study is that facts are derived from reports directed towards the urban tertiary centers, which possibly does not reveal the extensive depiction of CHF in other acute care setting or in the community. The large number of journals that were used, data taken from some regions and for some results were inadequate, especially in countries where there was not much information obtainable, these effects may not be philosophical of the people and should as a result be taken only as an ideal to the factual prevalence, causes, and management of CHF (Rahimi, et al., 2014).

Results of the study

The results of the study are mostly reliable with outlines of risk factors reported by Khatibzadeh and colleagues in their most recent evaluation of the universal risk factors for CHF, as well as those of the Global Burden of Disease Study (Lozano, Naghavi, Foreman, Lim, & Shibuya, 2012). It is noted that avoidable non-communicable illnesses, IHD and HTN, are accountable for the greatest number of the cases globally. The viewed changes in age among the republics connected clearly with the modifications in human development index (HDI). Significant inter-regional difference is existing in the reasons attributed to separate cases of CHF (Lemay, Li, Benzaquen, Khoury, & Azad, 2016). CHF has a pattern of signs and symptoms, with other characteristics existing for additional investigation. Taking into consideration that many etiological footings are frequently possible co-morbidities, separating one from the other is burdened with encounters, predominantly in low-resource environments without option to a wide range of explanatory tools. Although 80% of studies from the United States, reporting etiologies for CHF verified the usage of added analytical tools (Rahimi, et al., 2014).

The 30 studies from which managing data were accessible, few of them conveyed the left ventricular ejection fraction (LVEF) of patients. It is not conceivable to make clear-cut assumptions about the commitment to the evidence-based practices (EBP) universal, but it is apparent that managing deviates substantially between areas and continues to be optimized on average (Rahimi, et al., 2014). Existing strategies emphasis the significance of ACEIs, beta-blockers, and mineralocorticoid receptor antagonists in the medication managing of CHF with reduced LVEF, with loop or thiazide diuretics given for symptom alleviation (American, 2015).

Ethnical Consideration

The study was approved by Protocol SI and used PRISMA. Patients information was obtained from researched studies and additional information was obtained from unpublished articles. There were no ethical considerations regarding the treatment or lack of. The patients in the study were typical of hospitalized patients with CHF.


This review demonstrations that CHF has place a substantial drain on healthcare systems in LMICs, and involves a widespread population summary of individuals in many nations. Non-communicable disease is the leading causes of CHF across LMICs. It has been acknowledged as high in hospitalized death and wide disparity and important suboptimal use of medication therapies. Further residents’ findings, with pure case and result explanations are needed for a further precise assessment of CHF in LMICs (Rahimi, et al., 2014).


American, H. A. (2015). What is Heart Failure. American Heart Association.

Holden, R. J., Schubert, C. C., Eiland, E. C., Storrow, A. B., Miller, K. F., & Collins, S. P. (2015). Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach. Annals of Emergency Medicine, 66, 1 – 12.

Lozano, R., Naghavi, M., Foreman, K., Lim, S., & Shibuya, K. (2012). Global and regional mortality from 235 causes of death from 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2100.

Nasif, M., & Alahmad, A. (2011). Congestive Heart Failure and Public Health. American College of Cardiology, 9.

Rahimi, K., Callender, T., Woodward, M., Shaikh, M., Shrivastava, R., Xin, D., . . . Patel, A. (2014). Heart Failure Care in Low- and Middle-Income Countries A Systematic Review and Meta-Analysis. Public Library of Science, 11(8), 2.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., & Fonarow, G. C. (2013). 2013 ACCF/AHA Guideline for the Management of Heart Failure. American College of Cardiology Foundation, e248.