Vantaggi di una mobilizzazione precoce del paziente affetto da scompenso cardiaco"

Introduction: Acute heart failure is defined by a rapid or gradual onset of symptoms and/or signs of heart failure (HF) that prompt the patient to urgently seek medical attention, resulting in an unplanned hospitalization or emergency room visit. Acute heart failure is a heterogeneous clinical syndrome and is the leading cause of unplanned hospitalization in people over 65 years of age. Patients with heart failure may have distinct clinical manifestations based on clinical history, pre-existing heart disease, and the pattern of intravascular congestion. A comprehensive assessment of clinical, echocardiographic, and laboratory data should aid in clinical decision-making and treatment. In some cases, a more accurate assessment of the patient's hemodynamics via a pulmonary artery catheter may be necessary to undertake and guide the escalation and de-escalation of therapy, especially when clinical, echocardiographic, and laboratory data are inconclusive or in the presence of right ventricular dysfunction. Heart failure is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated levels of natriuretic peptides and/or objective evidence of pulmonary or systemic congestion. The patient hospitalized for heart failure requires care from a multidisciplinary team of healthcare professionals, within which professional nurses play a central role. Rehabilitation of the patient with heart failure is defined through the implementation of a multidisciplinary program that includes mobilization, mitigation of risk factors through the adoption of healthy lifestyles and adequate nutritional plans, constant monitoring by the designated nursing staff, and ongoing evaluation of the individual's psychosocial well-being through careful monitoring of their conditions. Objective: The aim of this research is to describe nursing approaches useful for the mobilization of patients with acute heart failure and report the outcomes of effective nursing interventions related to measures of improvement in the patient's autonomy management and other outcomes such as quality of life, physical function, and anxiety. This paper intends to analyze the mobilization protocols for patients with acute heart failure and their effectiveness, identifying the crucial role played by the designated nursing staff. Method: A bibliographic search of the literature was conducted up to January 2024 through the consultation of databases such as PubMed, CINAHL, PsycInfo, Cochrane. The acquired articles were subject to review. The search was conducted without time limits for the publication date and filters. Limits were set for language (Italian and English), age (adults with osteoarthritis and non-oncological chronic pain), study type (RCTs, observational and cross-sectional studies), and studies concerning only the subject pathology (not general pain, no comorbidities). Pediatric, oncological, veterinary, military, pre and post-surgical, psychological, and physiotherapeutic studies, and study types that do not meet the inclusion criteria were excluded. All relevant articles were archived and managed with the Medeley software platform. Comprehensive evaluation and selection were carried out using the Joanna Briggs Institute Critical Appraisal Tools checklists. Results: The progressive mobilization program in patients with acute heart failure is associated with a reduction in hospital stay and an improvement in clinical outcomes. Conclusions: Nurses play a fundamental role in managing the pathology, especially in the context of non-pharmacological therapies and patient education aspects. Nevertheless, further trials and studies of better methodological quality could be useful to obtain more scientifically and statistically relevant results.

Introduzione: L'insufficienza cardiaca acuta è una sindrome caratterizzata da un rapido o graduale peggioramento dei sintomi di insufficienza cardiaca, spesso portando a ricoveri non pianificati. È la principale causa di ospedalizzazione per persone sopra i 65 anni. La gestione richiede una valutazione completa dei dati clinici, ecocardiografici e di laboratorio, e talvolta un catetere arterioso polmonare per guidare la terapia. Obiettivo: Descrivere gli approcci infermieristici per la mobilizzazione dei pazienti con insufficienza cardiaca acuta e valutare l'efficacia di questi interventi sul miglioramento dell'autonomia, qualità di vita, funzionalità fisica e ansia. Metodo: Ricerca bibliografica fino a gennaio 2024 su database come PubMed, CINAHL, PsycInfo, Cochrane. Inclusi studi RCT, osservazionali e trasversali in italiano e inglese, esclusi studi pediatrici, oncologici, veterinari, militari, pre e post-chirurgici e di competenza psicologica e fisioterapica. Gli articoli pertinenti sono stati valutati con le check list Joanna Briggs Institute Critical Appraisal Tools. Risultati: La mobilizzazione progressiva dei pazienti con scompenso cardiaco acuto riduce la degenza ospedaliera e migliora gli outcome clinici. Conclusioni: Gli infermieri svolgono un ruolo cruciale nella gestione della patologia, specialmente nelle terapie non farmacologiche e nell'educazione del paziente. Ulteriori studi di alta qualità potrebbero fornire risultati più rilevanti.