1. Differentiate how application of the identified ethics principles to the health issue has resulted in population disparities.

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Congestive Heart Failure


Hello there, This paper is a continuation of other papers which I have included in the writing below. Thank you!!! I just want it to mesh well with what has already been written down below. Thanks again! :)

TOPIC: Congestive Heart Failure

Write a formal paper of 500-1,000 words that examines the previously addressed aspects of health policies, finance, global/ national prevention, and/or treatment initiatives related to the health issue by identifying applicable ethics principles.

1. Differentiate how application of the identified ethics principles to the health issue has resulted in population disparities.

2. Hypothesize how existing disparities might be eliminated using alternate ethics principles.

3. Critique whether the applicable ethics principles are consistent with the ANA`s Code of Ethics for Nurses.

Refer to "CLC Health Issue Analysis Overview."

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract, introduction, and conclusion are not required.

…..The previously addressed aspect are:

History of Congestive Heart Failure Health Issue

Congestive heart failure (CHF) is a major issue in the United States today. Currently more than 5 million people are living with a diagnosis of CHF, though the number of undiagnosed individuals may be higher. CHF is also the most common cause of hospitalization and unfortunately, the number of individuals with CHF continues to rise (Richardson, 2003). CHF is also a very costly illness. Blair, Lloyd-Williams, & Mair (2002) reported in 1991, the annual cost for CHF treatment is over $38 billion in the United States which is approximately 5% of the overall national health care expenditure. Besides the economic impact on patients and government, CHF affects many people in physiologic as well as psychosocial aspects that have negative impact on them which leads to decrease their quality of life. The purpose of this paper is to discuss the history of CHF in the context of determinants of health, initiatives to address it, indicators used to measure outcomes, and the current status of CHF. 

Determinants of Health and Socioeconomic Status

One major determinant of health in regards to CHF is socioeconomic status (SES). SES has a major effect on health outcomes in CHF patients. This is due to several reasons including environmental factors, personal behaviors, and patients’ access to health care. Populations with low SES are more likely to live in poorer living condition such as overcrowding, poor nutrition, or biohazards. About 20% of U.S. population resides in rural areas where primary health care are short in supply (Denisco & Barker, 2013). Also, they are usually have lower education levels which correlates with people making unhealthy choices such as smoking and the abuse of other substances, as well as health literacy issues and poor physical activity. Since they are from a low socioeconomic class, they are less likely to have paying jobs that offer insurance coverage resulting in less access to health care. Denisco & Barker (2013) concluded that “the uninsured tend to be poor, less educated, working in part-time jobs, and /or employed by small firms” (p.517). Hence, poor residents seek health care services less frequency than do more affluent residents. 

Blair et al., (2002) stated that “the prevalence of CHF and mortality from the disease are reportedly higher in those with a lower socioeconomic status” (p.169). Research has shown that the depravation of social and physical needs that is associated with people of a lower socioeconomic status yields an increased burden of CHF and with health disparities in regards to CHF outcomes and treatments. Research has demonstrated an increased rate of re-hospitalization in those with lower SES due to health care provider inequalities in deprived areas (Blair et al., 2002). Blair et al., (2002) described that few patients with CHF follow-up with cardiologists and those with low SES trend to being readmitted to the hospitals frequently. Furthermore, individuals with low incomes often have a reduced ability to cope with stress and illness which could influence patient behavior and contributes to increase the admission rates (Blair et al., 2002). Another health disparity with CHF is seen in the elderly population. Research has shown that treatment of CHF with angiotensin-converting enzyme (ACE) inhibitors is much lower in elderly patients with CHF than their younger counterparts (Blair et al., 2002). 

Past and Present Initiatives to Address the Health Issue

In the research article, Richardson (2003) concluded that interventions such as CHF management programs, especially those that include exercise, often offer a high level of benefit to individuals who are otherwise without social support and who suffer from depression. Patients with CHF often need the support of family and friends or caregivers to offer support and to facilitate their self-care. This study showed a reduced rate of re-hospitalization and a lower number of patients with CHF who needed to rely on long-term care (Richardson, 2003). Research recommended that patients with CHF should be referred to cardiac rehabilitation programs to improve psychological well-being and to provide emotional support (Richardson, 2003). While it is clear that this type of program is bound to meet with success, unfortunately few CHF patients are referred to them by their physicians. This may be associated with a lack of insurance coverage or a lack of knowledge about such programs (Richardson, 2003).

Research has shown that another “intervention effective in managing CHF was the use of multidisciplinary health management programs” (National Committee of Quality Assurance (NCQA), n.d.). The NCQA developed a year-long health plan for adult CHF patients, and there were more than 500,000 members enrolled. After analyzing all data and reviewing published literature, the outcome committee identified barriers that affected patient health status. These included a lack of patient education and physician education, inadequate monitoring of symptoms, and a failure by providers to give feedback for CHF exacerbation patients (NCAQ, n.d.). 

In light of these barriers, it was determined that the best approach was the CHF Health Management Program. The program classified patients into high and low-risk groups. For high-risk patients, interactive interventions included enrollment in tele-monitoring program, weekly phone calls by nurses to track patient’s health status, physician contact if patient was decompensating, and post-discharge teaching such as treatment compliance, dietary restrictions, and medication schedule. On the other hand, for both high and low-risk patients, informational interventions included education on the importance of taking medications prescribed, management of nutrition, exercise, and emotional health, and weight monitoring. The researchers concluded that the implementation of these programs yielded a reduced number of recurrent hospitalizations and decreased the demand for CHF services. They also resulted in improving patients’ overall health, quality of life, and compliance with treatment regimens (NCAQ, n.d.).

Outcomes Indicators

The health plan monitored the impact of the program interventions with outcome measures, including admissions, inpatient days, emergency department visits, and the average days’ supply of medications including beta-blockers and ACE inhibitor per year (NCAQ, n.d.). After initiating the CHF Health Management Program, results demonstrated increasing physician and patient cooperation, decreasing admission rates significantly, and improving QOL in patients. It was reported that patients experienced a 31% improvement in total QOL at six months and 36% at 18 months compared with baseline (NCAQ, n.d.). Similarly, after revising the enrollment procedure, the rate of enrollment for the tele-monitoring intervention increased from 31% to 51% (NCAQ, n.d.). 

Moreover, patients’ compliance with ACE inhibitors and beta-blockers increased after receiving detailed education on the CHF program and nationally recognized CHF treatment. The characteristics of the plan that set it up for success were the careful identification of barriers such as education needs for patients, the need to notify physicians of decompensation and the successful design and implementation of appropriate interventions (NCAQ, n.d.). 

Another outcome indicator for CHF was implemented by the Centers for Medicare and Medicaid Services (CMS). In 2007 CMS began to provide public reports of 30-day mortality measures for CHF. This allowed an increased transparency of hospital care and provided useful information for patients who were seeking care and for hospitals in their efforts to deliver high quality care. This also had the effect of encouraging hospitals and health care systems to ensure adequate care and education of CHF patients and safe discharges in order to prevent readmission, because if patients are readmitted within 30 days the hospital does not receive compensation for their care (CMS, n.d.). 

Current Status of CHF

Despite significant advances in patient and healthcare provider education, and the development of CHF programs to assist individuals with improving health and quality of life, the prevalence of the patients diagnosed with CHF continues to increase in the United States. This is due to several factors, including the fact that people are living longer in America, and the risk of CHF increases with age. While it can be a good thing that people are living longer, the high rate of CHF and it’s costly treatments leave it as the most expensive health care remain a serious problem in the US today (Richardson, 2003). Thus, CHF remains a major public health issue and a significant cause of morbidity and mortality, and improved, cost-effective care is required (Crawford, T., Segars, L. W., & Rasu, R. S. 2013).

CLC Health Issue Analysis: Congestive Heart Failure Part 2

Scope and Depth of CHF

According to Galin, I., & Baran, D. A. (2003), Heart Failure (HF) is a common health issue that affects nearly five million people in the United States each year and out of these, 500,000 are newly diagnosed cases. This poses an immense impact on society and the health care system at large. The healthcare system spends approximately $500 million annually on heart failure medication alone. As healthcare professionals, we have an obligation to educate the general public and prevent progression of this disease, thus decreasing morbidity and mortality and optimizing the quality of life for patients. Heart failure affects 1.5 to 2% of the total population, and the prevalence increases to 6 to 10% for those over the age of 65 years. It is estimated that in the next 1-5 years, approximately 20 million people with clinically silent cardiac impairment will develop symptoms of HF. It is the leading cause of hospitalization in the US, with approximate those admitted being 65 years old and older (Galin, I., & Baran, D. A. 2003). It is also reported that about 1 in every 9 deaths in 2009, were as a result of HF and that about half of patients who developed HF died within 5 years of diagnosis. The disease is more common in certain areas of the US than others (Department of Health and Human Services n.d.)

Globally, the increasing prevalence of CHF is progressively becoming a major cause of morbidity and mortality. This is becoming major public health concern, and CHF being a part of the group of cardiovascular diseases, has become one of the world’s leading cause of death (Hsu, P., Parker, J., Egger, C., Autschbach, R., Schmitz-Rode, T., & Steinseifer, U. 2012). 

Countries that are faring better or worse than others

In developed countries, CHF is a well-acknowledged public health problem and places a significant burden on patients as well as the healthcare system in general. However, this type of data is either unavailable or scant in developing countries (Callender, T., Woodward, M., Roth, G., Farzadfar, F., Lemarie, J., Gicquel, S., & ... Rahimi, K. 2014). CHF is one of the leading causes of hospitalization world-wide. In Germany, disease management programs have been implemented in order to standardize care for chronic ailments like CHF. They have also adopted a method of fixed payments to hospitals so that to discourage hospitals from over treatment. In is real, insurance coverages mandatory for all its citizens, therefore visiting healthcare facilities does not pose as a problem

How the United States ranks on CHF in relation to other countries

The United States has one of the most expensive health care system in the world, and yet the one of the best quality of healthcare provider. CHF ranks as one of the leading causes of hospitalization in the US as well as the rest of the developed world. In a report by The Commonwealth Fund (2015), a group of 11 nations, namely Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States were studied, and the US ranked last. This data was obtained from surveys by patients and physicians based on healthcare experiences encountered and their rating (The commonwealth fund 2015). Lack of universal health insurance coverage is the most notable way that the US differs from other developed countries. The US ranked last on matters related to measures of quality of care, health outcomes, and efficiency. Despite advanced level of technology in the US, physicians still reported having difficulty receiving information in a timely manner, coordinating care, and hassling with administration.

Even though developing countries represent 84% of the world’s population, they are only responsible for 11% of its health spending. At the same time, these countries account for 93% of worldwide burden of disease. Compared to developed regions of the world, people living in developing regions often have to rely on limited government services that are of questionable quality as compared to those of the developed Worlds.

Efforts of the World Health Organization and other agencies on CHF

Hypertension (HTN), or high blood pressure increases the risk of developing CHF. Other risks also include CHF, myocardial infarction, kidney failure, strokes. HTN is one of those diseases that can be easily detected and is both preventable and treatable. According to WHO, CHF falls under a group of disorders of the heart known as cardiovascular diseases (CVDs). It estimates that by the year 2030, approximately 23.6 million people will die from CDVs mainly HF and stroke. WHO recommends eating a healthy balanced diet that is crucial for a healthy heart and circulatory system. Accompanied with regular physical exercise, approximately 30 minutes daily, (60 minutes on most days in order to maintain a healthy weight), would maintain cardiovascular fitness.

According to Blum’s Model of Health Determinants, there are four main factors that are connected to the leading cause of premature mortality in the United States: Environment, Lifestyle, Heredity, and Medical care. Having access to healthcare can drastically reduce ones chance to premature death. Public health measures, control and use surveillance to ensure satisfaction of the public health service (Barker, A. M., & DeNisco, S. M. 2013). 

Existing Disparities

In the United States, there is a form of universal catastrophic health insurance for the uninsured which warrants that every citizen or legal resident has access to basic health care. On the other hand, the uninsured generally have to relinquish health care at a basic level Barker, A. M., & DeNisco, S. M. 2013). Insurance still remains one of the leading reasons why patients do not seek health care within a sensible time frame. Insurance remains an employer based financing system which is one reason why some citizens have been without health insurance coverage. A great way to access healthcare would be the removal of financial hurdles, i.e. insurance, so that people can have a healthcare provider whom they can relate to without thinking of how much it would cost. In the United States, there is a form of universal catastrophic health insurance for the uninsured which warrants that every citizen or legal resident has access to basic health care. On the other hand, the uninsured generally have to relinquish health care at a basic level Barker, A. M., & DeNisco, S. M. 2013). 

Insurance in the United States has an employer based financing system which is one reason why some citizens have been without health insurance coverage. A great way to access healthcare would be the removal of financial hurdles, i.e. insurance, so that people can have a healthcare provider whom they can relate to without thinking of how much it would cost.

According to WHO, the 4 out of 5 people from developing countries died from HF related causes, and contrary to popular belief that men are usually more prone to HF disease, both men and women were nearly equally affected (WHO 2015). However, hospital admissions for CHF in the US from 1979 to 2000, have been steadily higher in women than in men (Alaeddini, J., Wood, M. A., Amin, M. S., & Ellenbogen, K. A. 2008). Research studies carried by the same author also revealed that women, have a higher ratio of hospital admissions for CHF, than their counterparts even though they present a lower prevalence rate. Their mortality rate is also higher. Unfortunately the use of cardiac resynchronization therapy (CRT) on women was significantly low. Further research was needed in order to follow up on this disparity.

Another research study carried out in Quebec, Canada by Sheppard, R., Behlouli, H., Richard, H., & Pilote, L. (2005), found that women were less likely to be admitted to a hospital by cardiologists, had fewer noninvasive assessments, and had fewer revascularization procedures. Despite all these disparities, both men and women had similar readmission and survival rates. Female patients tended to be much older than the males, probably the reason why men had more invasive procedures than women.


Alaeddini, J., Wood, M. A., Amin, M. S., & Ellenbogen, K. A. (2008). Gender Disparity in the Use of Cardiac Resynchronization Therapy in the United States. Pacing & Clinical Electrophysiology, 31(4), 468-472.

Barker, A. M., & DeNisco, S. M. (2013). Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed.). Boston: Jones & Bartlett.

Callender, T., Woodward, M., Roth, G., Farzadfar, F., Lemarie, J., Gicquel, S., & ... Rahimi, K. (2014). Heart failure care in low- and middle-income countries: a systematic review and meta-analysis. Plos Medicine, 11(8), e1001699. doi:10.1371/journal.pmed.1001699

Department of Health and Human Services (n.d.). Heart Failure Fact Sheet. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

Galin, I., & Baran, D. A. (2003). Congestive Heart Failure: Guidelines for the Primary Care Physician. Mount Sinai Journal Of Medicine, 70(4), 251-264.

Health Topics: Anemia (2015). World Health Organization. Retrieved from http://www.who.int/topics/anaemia/en/

Hsu, P., Parker, J., Egger, C., Autschbach, R., Schmitz-Rode, T., & Steinseifer, U. (2012). Mechanical Circulatory Support for Right Heart Failure: Current Technology and Future Outlook. Artificial Organs, 36(4), 332-347. doi:10.1111/j.1525-1594.2011.01366.x

Sheppard, R., Behlouli, H., Richard, H., & Pilote, L. (2005). Heart failure: Effect of gender on treatment, resource utilization, and outcomes in congestive heart failure in Quebec, Canada. 

The American Journal of Cardiology, 95955-959. doi:10.1016/j.amjcard.2004.12.033

World Helath Organization (2015).Cardiovascular disease: controlling High Blood Pressure. Retrived from http://www.who.int/cardiovascular_diseases/en/

The commonwealth fund (2015). Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. Retrieved from http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Blair, A. S., Lloyd-Williams, F., & Mair, F. S. (2002). What do we know about socioeconomic status and congestive heart failure? A review of the literature. The Journal Of Family Practice, 51(2), 169.

Centers for Medicare & Medicaid Services. (n.d.). Outcome measures. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/OutcomeMeasures.html

Crawford, T., Segars, L. W., & Rasu, R. S. (2013). Original Research: Prescribing trends for management of congestive heart failure from 2002 to 2004. Research In Social And Administrative Pharmacy, 9482-489. doi:10.1016/j.sapharm.2009.06.004

Denisco, S. M., & Barker, A. M. (2013). Advanced practice nursing: Evolving roles for the transformation of the profession. (2¬¬nd ed.). Burlington, MA: Jones & Bartlett Learning.

National Committee for Quality Assurance. (n.d.). Improving member outcomes with a congestive heart failure health management program. Retrieved from http://www.ncqa.org/PublicationsProducts/OtherProducts/QualityProfiles/FocusonCardiovascularDisease/ImprovingMemberOutcomes.aspx

Richardson, L. G. (2003). Psychosocial issues in patients with congestive heart failure. Progress in Cardiovascular Nursing, 18(1), 19-27. doi: 10.1111/j.0889-7204.2003.00835.x


Congestive Heart Failure Name Institution Date Congestive Heart Failure For patients with congestive heart failure (CHF), psychological issues are some of the important aspects that need to be addressed. Patients suffering from CHF experience depression as they lack the necessary support required, increasing morbidity. High levels of social support reduce the impact of mortality. One of the ethics principles of health includes acting in the best interest of the patient, which means preventing harm when delivering health care services. Harm can be prevented by removing pain and suffering. It is important to consider if the proposed treatment will promote good health for patients (Richardson, 2003). Certain interventions like CHF management programs that incorporated exercise, offers a lot of benefits to individuals without social support, reducing the levels of depression. Establishment of cardiac rehabilitation programs has improved psychological well-b


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