Congress Abstracts 2005

53

FROM HEART FAILURE TO HEART SUCCESS: IMPROVING OUTCOMES IN CANCER PATIENTS WITH HEART FAILURE THROUGH COLLABORATIVE PRACTICE. Anecita Fadol, RN, MSN, FNP, Daniel Lenihan, MD, Janet Taubert, RN, MSN, AOCN^®, Margaret Holm, RN, MHSA, FACHE, Stephanie Fulton, MSIS, and Marilou Sequitin, RN, BSN, M.D. Anderson Cancer Center, Houston, TX.

Although heart failure is a serious complication of chemotherapy, it no longer implies a “death sentence”. With appropriate management and pharmacological intervention, normal heart function can be restored. Management of heart failure in cancer patients requires complex therapeutic interventions and presents challenging issues not only to health care providers, but also to the patient and family. Oncology nurses should have an adequate understanding of heart failure management to be able to assist patients and their families to meet these challenges.

To improve the care of cancer patients with heart failure, a collaborative, multifaceted, interdisciplinary “Heart Success Program” was developed to provide cost effective quality care without compromising cancer therapy. The Theory of Planned Behavior is the theoretical basis for the Heart Success Program, with the assumption that a comprehensive approach will cause a behavioral change of better patient and provider adherence to standard heart failure therapy resulting in improved clinical patient outcomes.

Implementation of the Heart Success Program includes utilization of a heart failure clinical pathway, inpatient heart failure order set, and comprehensive patient and family education, using a heart success patient education booklet, heart failure videotapes, and a patient diary. An interdisciplinary clinical round is conducted weekly to provide a forum for discussion of identified patient’s problems and formulate solutions.

Quality improvement outcomes identified for the program include decreasing average hospital length of stay, decreasing hospital readmission over a one year period, improving quality of life, and improving provider compliance with evidence-based pharmacological therapy for heart failure as recommended by the American College of Cardiology/American Heart Association guidelines for heart failure management. A database has been created for measuring these outcomes.

There is abundant literature on the effectiveness of heart failure programs in improving clinical and patient outcomes in heart failure patients without cancer, however, there is a paucity of clinical evidence specific to cancer patients with heart failure. Oncology nurses should pursue nursing research efforts on nursing interventions and symptom management for this patient population and take an active role in changing heart failure to heart success.