As defined by Heidenreich congestive heart failure occurs when, the

myocardium of the heart is unable to uphold a sufficient cardiac output to

meet the bodys metabolic needs. Heart failure can result from either
systolic or diastolic dysfunction (Trogdon JG, hav!ou "A, #utler J, $racup
, %&e'owit& ($, )in'elstein %A, et al. *+,,-
.hronic heart failure (.H)- is a chronic progressive condition where
the heart fails to meet the bodys metabolic demands. .H) is an
increasingly common and burdensome illness especially among older
people and is a ma!or cause of mortality, morbidity and poor /uality of life
worldwide (A0H1 *+,,-. The prevalence of .H) has been reported as
+.23 to *3 in the general population and between *.43 to over ,5A3
among those aged 678years (A0H1 *+,,9 Heidenreich et al. *+,,-. A large
proportion of health care resources increasingly go towards treating
cardiovascular diseases (.:$-, especially .H). (any of these costs are
attributed to hospitali&ation (#erry et al. *++,9-. )urthermore, effective self;
care has been critical in promoting optimal outcomes in .H) and reducing
mortality rates ($itewig et al. *+,+-.
0t is a well 'nown fact that chronic heart failure has become a
significant health problem in recent years (The Journals of Gerontology-.
1ith the increasing number of patients, the economic aspect of treatment
for these patients has become a ma!or burden on health care in many
countries. "ne of the reasons, why so many patients have progressed to
chronic failure is improvement in care of patients with acute myocardial
infarction (The American Heart Journal -. 0n the past any patient suffering
from myocardial infarction had a 8+ 3 chance of dying. 0n present, in
countries with developed cardiology services mortality reduced to a slim 8
3. All these patients surviving acute coronary event, gradually advance to
a stage of chronic heart failure (The <ancet-.
.H) can be categori&ed as forward or bac'ward ventricular failure.
#ac'ward failure is secondary to elevated systemic venous pressure, while
left ventricular failure is secondary to reduced forward flow into the aorta
and systemic circulation. )urthermore, heart failure can be subdivided into
systolic and diastolic dysfunction. =ystolic dysfunction is characteri&ed by a
dilated left ventricle with impaired contractility, while diastolic dysfunction
occurs in a normal or intact left ventricle with impaired ability to rela> and
receive as well as e!ect blood ($itewig et al. *+,+-.
As stated in (rum, Henry9 Teerlin', John ? in their article The
<ancet-, @the clinical manifestations of heart failure occur secondary to
elevated filing pressure and tissue hyperfusion .linical manifestations of
congestive heart failure can be bro'en down into the systems in which they
affect the respiratory, cardiovascular, gastrointestinal systems and show
effects in both cerebral and psychosocial. .linical manifestations in
respiratory are, dyspnoea, orthopnea, a persistent cough, crac'les in the
lungs. The cardiovascular system is affected by, the onset of angina,
tachycardia, increase of systolic blood pressure and an increase in systolic
blood pressure. Gastrointestinal clinical manifestations include that of,
enlargement of the right upper /uadrant of the abdomen, nausea and
vomiting, pain in the epigastric region, anore>ia and bloating. .onfusion
and restlessness can be seen as manifestations of cerebral, and an>iety is
associated with manifestations to psychosocial. Generalised manifestations
include oedema9 either pitting or peripheral, weight gain and fatigue,
(Heidenreich AA, Trogdon JG, hav!ou "A, #utler J, $racup , %&e'owit&
($, )in'elstein %A, et al-, (#erry ., (urdoch $?, (c(urray JJ: *++,-,
(The Journals of Gerontology-.
#uetow et al. reported that recogni&ing .H) symptoms, especially
atypical symptoms such as di&&iness, fatigue, sleepiness, cognitive decline
and loss of consciousness, was difficult for patients with .H). Aatients
found it difficult to interpret or respond to comple> symptoms, especially in
combination (Granger et al. *++B-. Horowit& et al. reported that patients
found difficulty either in recogni&ing or responding to symptoms in an
e>acerbation. )urthermore, suffering from such symptoms reduced the
ability of patients to engage in efficacious self;care (Granger et al. *++B-.
%ven patients who had sufficient 'nowledge about H) and self;care
fre/uently were unable to manage e>acerbations of H) symptoms
(Horowit& et al. *++29?iegel et al. *++5-. Also, functional limitation and
dependency lin'ed to .H) have been reported as serious barriers to self;
care in patients with advanced H) (classes 000 and 0:- by three studies
(Granger et al. *++B-.
The lac' of 'nowledge of .H) patients, especially regarding diet and
salt restriction, and misconceptions about .H) and its symptoms leading to
failure of understanding of the relationship between disease and
symptoms, (?iegel C Horowit& et al. *++2-. Aatients identified health
awareness and understanding the conse/uences of ignoring the treatment
plan and indicators of a worsening condition as facilitator stimulating care
for them. ?egarding duration of .H), only one study reported that patients
with long; standing .H) fared better than those recently diagnosed (?iegel
et al. *++7-,-. Dsing a disavowal coping strategy helped patients to affirm
their physical health (#uetow et al.*++,-. However, using avoidance and
denial reduced the capability of patients to care for themselves (#uetow et
al. *++,9 Also, depression (?iegel et al. *++7-, an>iety and hopelessness
were found to be negative factors for self;care maintenance of individuals
suffering from .H), while positive belief in the future could serve as a
catalyst (Granger et al. *++B-.
.ultural beliefs and personal values might lead to a misguided
conception of .H), difficulty with adherence to a healthy diet, preventing
help;see'ing, non;adherence to recommendations and health messages
(Horowit& et al. *++2-. "n the other hand, cultural beliefs and personal
values may support individuals with .H) (Granger et al. *++B-.
0n recogni&ing and managing their symptoms, patients with .H)
faced many difficulties and problems. )irst, confusing symptoms of .H)
and cognitive impairment, especially in elderly patients, may reduce
individualsE mental ability to recogni&e their symptoms (#erry et al. *++,-.
=econd, illness severity may limit the capacity of a patient to manage
symptoms. Third, symptoms might be attributed to other health problems
and patients became confused in see'ing to distinguish the reason and
origin of their symptoms. 0n such situations, patients failed to ta'e the
correct action. As an e>ample patients with .H) suffering, from arthritis
might became confused about whether their swollen an'les are due to
heart failure or arthritis (?iegel et al.*++B-.
As the number of .H) cases continues to rise with the rate of ,+3
after one year. =tudies show that about half of those with congestive heart
failure die within five years after their diagnosis (Granger et al. *++B-.
These statistics vary widely9 a patientEs e>act diagnosis and response to
therapy play a large role in patient survival. Any /uestions about diagnoses
and therapy should be discussed with the treating physician. Advances in
research are providing more options and improving outcomes for people
with congestive heart failure (Horowit& et al. *++2-.
Reference:
A0H1 (*+,,- .ardiovascular diseaseF australian facts *+,,
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heart failure. %ur J Heart )ail 4(4-F*G4;*B,

$itewig J#, #lo' H, Havers J, van :eenendaal H (*+,+- %ffectiveness
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