Heart failure is a scary diagnosis for a person to hear. A significant issue for the health care of Canadians.
Heart failure is on the rise in Canada and across the world. According to the Canadian Cardiovascular Society, between 1996 to 2050, there will be a three-fold rise in patients hospitalized with heart failure. Currently 9.5 out of 100 hospital deaths in patients older than 65 years are attributed to heart failure. This percentage increases to 12.5 for patients over 75 years.
The Canadian Cardiovascular Society defines heart failure as “a complex syndrome in which abnormal heart function results in, or increases risk of, clinical symptoms and signs of low cardiac output and/or pulmonary or systemic congestion.” Essentially, for the patient, this means poor quality of life, decreased activity tolerance and increased mortality.
For patients admitted with heart failure, 23 per cent are newly diagnosed, two per cent are admitted with end-stage heart failure, and 75 per cent with worsening chronic heart failure. Sobering statistics.
Joseph Brant Memorial Hospital recognized this trend and, in July 2002, established a full time Heart Function Clinic with a full time nurse clinician. A dietitian is available part time and a pharmacist when needed. Staff works closely with the the patient’s own cardiologist or internist to provide optimum care.
As the nurse working in the clinic, Deb Weber RN, meets with patients individually, and encourages them to bring family members or caregivers to the appointments. She assesses patients for symptoms, activity tolerance, psycho-social issues and provides education about disease process and lifestyle modification. If caregivers attend, Deb assesses coping skills and caregiver burden.
Deb makes personalized plans with patients for self-monitoring that include their early signs of decompensation and what to do, their levels of sodium and fluid intake, monitoring and logging daily weights. She gives direction about altering their diuretic dose, and consideration of smoking cessation and weight loss as appropriate.
Each appointment includes a physical assessment with weight, lung sounds, heart sounds, and presence of edema, blood pressure sitting and standing, as well as close monitoring of creatinine and potassium levels. If this assessment demonstrates that the patient is decompensating, a quick call to the patient’s cardiologist or internist may result in a short stay on the stretchers in the Fast Track area as Deb administers a dose of intravenous diuretics and observes how the patient responds. Instructions may also include “fine tuning” of other cardiac medications.In between visits, Deb encourages patients and their caregivers to call the clinic with any questions or concerns. For more urgent (but non-emergent) issues, they may page Deb.
The clinic also has monthly meetings shared by the nurse clinician and the dietitian. These are opportunities for patients and families to learn (the December meeting for example is devoted to a “pot luck” featuring low sodium foods, while at other meetings, patients prepare healthy heart meals and exchange ideas and recipes) and share their experiences about living with heart failure.
How has the Heart Function Clinic benefited patients and their families?
Patients and their caregivers say the support they receive in the Heart Function Clinic is an enormous relief. The fact that they can call or page the clinic with questions or concerns is like a “security blanket” and in fact lessened the need to call.
Patients who do call and are decompensating are often seen the same day or within 24 hours if needed. At times, the clinic gives direction over the telephone, and follow up with a phone call within 24 Ð 48 hours to assess how effective their advice has been. In most cases, they are able to avert a hospital admission.
The clinic’s practice to tailor education to the needs of their patients, over time in follow up visits, increases patients’ confidence in their health status and their ability to continue to manage their disease.
The clinic has found that patients who are followed closely and systematically, especially patients who are somewhat atypical in their presentation, have been successfully treated before they have fully decompensated.
Patients who reach end-stage have also benefited. With community supports, some have been able to remain at home longer.