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This week you will submit the Literature Review section of your proposal. Each week you have been adding to your growing body of evidence to support your problem and proposed innovation to address the problem. The review of literature is a critical, analytical summary and synthesis of the current knowledge of your research topic. Thus it should compare and relate different theories, findings, etc., rather than just summarize them individually.

The following resources will help guide you 


Guidelines for writing a literature review

The Writing Center at UNC-Chapel Hill

Writing the Literature Review: Step-by-Step Tutorial for Graduate Students

Writing the Literature Review (Part Two): Step-by-Step Tutorial for Graduate Students



Heat Failure and Readmission Rates

Student’s Name kenya leyva


As a future family nurse practitioner, some adaptations have to be made to effect change in healthcare. Moreover, an advanced practice nurse with a doctorate or master’s complies with the AACN (American Association of Colleges of Nursing research to promote public health through discovery and propagation of knowledge effectively. The area of concern in this study researched and proven in this study is the existence of Heart Failure. About 5.7 million Americans suffer from heart failure, which is directly linked to considerable health care costs and deaths. Research shows that congestive heart failure is one the highest and, in most cases, the leading cause of hospital readmission. Unintended hospital admissions add extra costs to patients, and Hearth failure (HF) is a significant cause. Further research shows that HF patients who are readmitted have a fragmentation of care, such as failure to adhere to a medication when they are discharged from the hospital. Besides, socioeconomic aspects, such as ethnic background, race, and marital status, impact differently on heart failure and rehospitalization. Although medical practitioners may be the cause of readmissions due to incompetence, HF patients are prone to readmissions due to disconnection to medications; thus, proper measures should be implemented.

Congestive heart failure is a condition where there is insufficient blood filling capability pumped by ventricles, which results in leads to low discharge volume unable to sustain body metabolisms. The library search strategies included visiting the South University online library. The program selected was the school of nursing. In the catalog, the keywords (heart failure and readmission) were used to generate searches. The journals with the recent studies were used for research.

Heart failure is the top reason for readmissions among Medicare recipients. According to Damiani et al. (2015), cardiovascular diseases are not only leading in hospital readmissions but also in disability. The research involved was carried out through hand searching and electronic database. The study population included the most common causes of the issue: HF and AMI (Acute Myocardial Infarction). Out of the eleven articles used in the review, the researchers found that socioeconomic factors have an impact on HF patients’ readmission. 63.6% of short-term outcomes indicated that marital status, race, and ethnicity influenced the data (Gupta et al., 2018). Also, the study was carried out for older adults aged 65 years.

The patients incur the cost of managing heart failure in hospitals, and readmissions have caused substantial expenses nationally. For instance, admitted patients in the United States constitute about 6.5 million hospital days, which amounts to a healthcare expenditure of $37.2 billion (Okunji et al., 2017). Thus, prolonged length of stay in hospitals is directly proportional to health care costs.

Many causes for an extended length of stay in health facilities rage from the quality of care and the patient’s response to treatment. A nurse or a doctor may incompetently treat a patient or administer the wrong medication, which may cause the health deterioration of a patient. In a study conducted by Ruppar et al. (2016), it was reviewed that patients developed adverse outcomes due to a lack of adherence to HF medications. They took the reported data and calculated readmission and mortality rates. Their research showed that medication adherence interventions have positive impacts on patients. For instance, they reduced mortality risks for patients with Heart Failure. The researchers also discovered that it decreased the chances of readmission.

Solving the rehospitalization issues involving acute myocardial infarction, heart failure, and pneumonia is the responsibility of bodies such as HRRP. The Hospital Readmissions Reduction Program was established under the 2010’s Patient Protection and Affordable Care Act. This body reported hospitals with high-risk readmission rates and penalized those with uncontrolled readmissions (Gupta et al., 2018). Since 2012, HF readmissions is the leading cause of penalties by the HRRP.

Financial penalties targeted hospitals to improve their care quality and minimize readmissions. Nevertheless, 30-day readmission has the potential to delay medical care for patients who were discharged in less than a month. As a result, it can yield adverse impacts on patient outcomes. This approach of solving the research problem can only indicate the effects of improving healthcare, but it does not guarantee the low numbers as a general improvement in care quality; it may occur due to the deliberate failure of hospitals to accept back HF patients. Such victims may be redirected to other facilities to receive

To conclude, Heart Failure patients are likely to be readmitted in a hospital after being discharged. For adults, race/ethnicity, and other socioeconomic factors contributed to the rate of the second hospitalization. Other studies show that heart failure is associated with high disabilities and deaths. Care transition programs and hospital-based quality initiatives can be used to enhance coordination in this population. Besides, most patients are readmitted due to improper medication after leaving a health facility. Thus, interventions can be made to ensure HF patients observe medical guidelines. Research shows that these interventions reduce readmission and mortality rates. As a family nurse practitioner, it is vital to ensure that patients adhere to self-care programs. These approaches can help the patients prevent deaths and unnecessary costs of rehospitalization.


Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar‐Jacob, J. M. (2016). Medication adherence interventions improve heart failure mortality and readmission rates: systematic review and meta‐analysis of controlled trials—Journal of the American Heart Association5(6), e002606.

Damiani, G., Salvatori, E., Silvestrini, G., Ivanova, I., Bojovic, L., Iodice, L., & Ricciardi, W. (2015). Influence of socioeconomic factors on hospital readmissions for heart failure and acute myocardial infarction in patients 65 years and older: evidence from a systematic review. Clinical interventions in aging10, 237.

Okunji, P., JS, N., NM, E., SG, K., TV, F., & TO, O. (2017). Descriptive Characteristics of Patients Hospitalized with Congestive Heart Failure: A Brief Summary. International Journal Of Nursing & Clinical Practices4(1). DOI: 10.15344/2394-4978/2017/249

Gupta, A., Allen, L. A., Bhatt, D. L., Cox, M., DeVore, A. D., Heidenreich, P. A., … & Fonarow, G. C. (2018). Association of the hospital readmissions reduction program implementation with readmission and mortality outcomes in heart failure. JAMA cardiology3(1), 44-53.