Research Proposal:  Part 1
	According to the U.S. Department of Health & Human Services (2010) heart failure (HF) patients have a 30-day national re-admission rate of 24.7%.  The 30-day re-admission rate for heart failure patients at Carle Foundation Hospital in Champaign, Illinois is 24.2%.  (U.S. Department of Health & Human Services website, 2010).  Although Carle’s 30-day re-admission rate is slightly lower than the national average, the problem is that there is significant room for improvement in both 30-day re-admission rates for patients with HF .  The research question is what interventions can the hospital implement to improve their 30-day re-admission rates for HF patients.   
	To reduce the rates of re-admission for HF patients Carle should implement two interventions that can be conducted by the nursing staff.  First, the nursing staff should conduct a six-minute walk for each HF patient upon discharge to determine the likelihood of re-admission within 30 days.  Second, the hospital should implement a HF telemanagement program to follow-up on patients recently discharged.  Once implemented the interventions should contain a control group so the effectiveness of the intervention can be measured.  
	The topic of reducing HF readmission rates in the inpatient cardiac unit at Carle Foundation Hospital is significant to nursing because research suggests that these rates can be greatly reduced by implementing efficient interventions that are conducted by the nursing staff.  The nursing staff can use the six-minute walk and the telemanagement program to not only decrease re-admission rates but also help each patient to have a better outcome after their hospital stay.  The purpose of this paper is to propose an intervention to decrease 30-day hospital re-admission rates for HF patients, discuss the background of CVD, and to provide a review of the literature related to interventions to reduce HF re-admission rates. 
	Background
Re-admission rates and causes
	Heart failure has a high rate of re-admissions within 30 days of discharge.  The national 30-day re-admission rate for patients with heart failure is 24.7 %.  Carle Foundation hospital has a slightly lower re-admission rate of 24.2%.  (U.S. Department of Health & Human Services, 2010).  There are several possibilities why these rates are so high.  Hospitals may discharge patients too soon, before they have fully recovered and are physically prepared to go home.  Also, patients may not be receiving adequate teaching and self-care instructions to take care of themselves and their illness before leaving the hospital.  (Wheeler & Waterhouse, 2006).
National demographics
	Cardiovascular disease (CVD) is one of the most prevalent diseases affecting our population today.  According to the American Heart Association (2010) an estimated 81,100,000 people in the U.S. had one or more forms of CVD in 2006 and the Cardiovascular Disease Foundation (2009) reports that every one in three Americans is affected with at least one form of CVD.  The most common form of CVD in 2006 was high blood pressure, which affected 73,600,000 Americans.  Coronary heart disease was the second most common with 17,600,000 cases.  Myocardial infarction accounted for 8,500,000 while angina pectoris affected 10,200,000 people.  There were 6,400,000 stroke patients and 5,800,000 Americans with heart failure.  (American Heart Association website, 2010).  
Pathophysiology of cardiovascular disease
	Hypertension (HTN) is defined as a blood pressure 140/90 mm Hg or higher on repeated measurements.  Increased sodium intake, decreased activity, psychosocial stress, and obesity are the most common environmental risk factors for HTN.  (McCance & Huether, 2010).  The highest prevalence of HTN occurs in the African American population.  An increase in cardiac output or an increase in peripheral resistance, or both can lead to hypertension.  Situations that may be responsible for increasing blood pressure are when sympathetic nervous system activity is increased due to autonomic nervous system dysfunction, when the absorption, elimination, or distribution of electrolytes is altered, an increase in the renin-angiotensin-aldosterone system, or when vasodilation of vessels decrease.  (Smeltzer et.al., 2010).
	Continuous elevated blood pressure can result in increased stiffness of vessel walls, which could possibly lead to vessel wall injury and inflammation.  The inflammation process can potentially lead to the enhanced production of atherosclerotic plaques.  Long-term HTN also causes the work load for the left ventricle to increase.  Over time the increased work load can cause myocardial hypertrophy which can lead to HF.  (Smeltzer et al., 2010).
	Coronary heart disease (CHD) is a condition that results from a process called atherosclerosis, in which vessels narrow as a result of lipid plaque build up on the vessel walls.  Many risk factors such as obesity, cigarette smoking, hypertension, elevated cholesterol level, and family history can contribute to the development of CHD.  If proper management of CHD is not taken, it can cause a myocardial infarction or stroke.  (McCance & Huether, 2010).
	A myocardial infarction (MI) is permanent destruction of the heart muscle caused by ischemia when the oxygen demand of the heart exceeds the supply available. When an MI occurs, the heart muscle is not getting enough oxygen from the blood supply and tissue death results.  Increased oxygen demand with insufficient supply can occur when the heart is under stress from things like tachycardia, exercise, and hypertension.  Atherosclerosis of the coronary vessels decreases the blood flow to the heart leading to a decrease in oxygen supply and contributing to a MI.  (McCance & Huether, 2010).
	Angina pectoris is chest pain caused by lactic acid buildup or overstretching of the ischemic heart that irritates the myocardial nerve fibers.  The pain is typically experienced in the substernal chest with discomfort ranging from a sensation of pressure to moderate or severe pain.  The chest pain can also cause symptoms of pallor, diaphoresis, and dyspnea in the patient.  In stable angina, predictable and recurrent chest pain, the gradual narrowing and hardening of vessel walls disables their ability to dilate in response to increase demand of oxygen.  When the coronary vessels are unable to dilate in response to the heart’s demand for increased oxygen during physical activity and emotional stress angina pectoris can occur.  (McCance & Huether, 2010).  

	

http://www.americanheart.org/presenter.jhtml?identifier=4478 American Heart Association  2010

http://www.cvdf.org/  Cardiovascular Disease Foundation 2009