Heart Failure

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Heart Failure

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• Marie Morrison
• BHF Heart Failure Nurse Specialist
• Carlisle and District PCT

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Order Of Session (1)

• Introduction
• Video (5 minutes) The Failing Heart
• Heart Failure The Facts and Management
• Questions and Feedback

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• BHF Heart Failure Nurse

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Definition of Heart Failure (2)

• A syndrome in which cardiac dysfunction is
  associated with reduced exercise tolerance, a
  high incidence of ventricular arrhythmias and
  shortened life expectancy (Jay Cohn 1988)

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• A condition in which the heart fails to
  discharge its contents adequately
• (Thomas Lewis
  1933)

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Heart Failure - The Facts (3)

• Main causes CHD and Hypertension
• Affects approx. 1-2 of population
• 10 in population over 80 years of age
• Increasing incidence
• Poor prognosis
• Poor quality of life
• Depressive illness affects 1/3rd of pts

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Heart Failure - The Facts Cont.

• Sub-optimally treated
• 1.2 health care budget (400m annually)
• 70 due to hospitalisation
• Accounts for 5 of medical admissions
• 30 patients admitted to hospital will be
  re-admitted within 1 year
• 54 of hospital re-admissions preventable

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The Future For HF (4)

• HF will increase by 9 during 2005
• By 2020 prevalence will be estimated at an
  increase of 48
• Increase in GP visits by 8 during 2005 and 56
  in longer term.
• Hospital admissions are likely to increase by 68
  by 2020

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Aims of Chapter 6 of NSF (CHD)
(5)

• To help people with HF to live longer and
  achieve a better quality of life
• To help people with unresponsive HF and other
  malignant presentations of CHD receive
  appropriate palliative care support
• (Paragraph 3, NSF for CHD)

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(6)

• Why is Heart Failure difficult to manage?

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Life Trajectory of a Heart Failure Patient
(7)
decompensation
Death
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(8)

• WHY HAVE A HEART FAILURE NURSE
• TEAM?

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Needs Of A Heart Failure Patient
(9)
Diagnosis

• Pharmacological
• Many different drugs
• Complex drug regimes
• Starting/stopping drugs
• Little or no understanding
• of medications
• Side effects/interactions
• Compliance
• Biochemistry observation
• Immunisations

• Other Issues
• Occupational/financial
• Stress on relationships
• Psychological issues
• Support/counselling
• Contraception
• Other health problems
• Social isolation
• Hobbies
• Ongoing care
• Palliative therapy

• Non-Pharmacological
• Implications of condition
• Symptom awareness
• Self-management
• Contacting professionals
• Changes to lifestyle
• Diet/fluid intake
• Self-monitoring -weights
• Exercise
• Energy conservation
• Alcohol/smoking

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(10)

• What Can The Nurse Team DO?

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Nursing Assessment (11)

• CHF monitoring - PRIMIS template
• Etiology co-morbidity's
• Signs and symptoms - NYHA grading
• Observations
• Investigations
• Pharmacological
• Non-pharmacological

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Clinical Examination (12)

• HR, BP, Respiration's
• Raised JVP
• Heart sounds/murmurs/displaced apex
• Auscillation of chest - crackles/effusions
• Peripheral oedema
• Ascites
• Hepatomegaly/Jaundice

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Nursing Investigations (13)

• Bloods U Es, TFTs, LFTs, FBC
• ECG if not performed in last year
• Echocardiogram recorded (normal/abnormal)

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Educational Issues (14)

• Drug compliance - avoidance of specific drugs
• Diet
• General healthy balanced diet
• Low salt diet
• Obesity/Cachexia (protocol for dietician)
• Awareness of Fluid intake
• 1.5-2 litres in NYHA III-IV
• Daily Weights
• After the toilet and prior to breakfast

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Educational Issues (15)

• Alcohol
• 1-2 units/day for females
• 2-3 units/day for males
• Abstinence in alcohol related DCM
• Smoking
• Consideration to be given prognosis Vs Q of Life
• Exercise
• Regular/light exercise beneficial in increasing Q
  of Life, circulation and psychological wellbeing

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Educational Issues (16)

• Vaccinations
• Annual Flu vaccinations
• Pneumococcal vaccination
• Recognition of worsening symptoms
• Travel/Holidays
• Management of diuretics
• DVT prophylaxis
• Rest/exercise, Luggage, insurance etc

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Empowerment

• Give support and advice to enable patients to
  manage their own condition

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• Other issues
• Diarrhoea and/or vomiting
• Atrial fibrillation
• Gout
• Depression
• Contraception
• Erectile dysfunction
• Diabetics

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Help Co-Ordinate.. (17)
Heart Failure Patient
Cardiologist/ Care of Elderly Physicians
General Practitioner
Heart Failure Nurse
Community Nurses
Ward Nurses
Day/community Hospitals
Dietician
Cardiac Rehab
Social Workers
Pharmacists
Occupational Therapist
Physiotherapists
Religion
Palliative Care Team
Mental Health Teams
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(18)

• Give time to discuss end of life issues

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So what's it all about? (19)

• Helping to share the load !!

Patient Carer
NSF GMS N.I.C.E
Colleagues !!
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To Summarise.. (20)

• ? incidence and prevalence of HF
• Poor quality of life
• Poor prognosis
• Financial burden on NHS
• Strain on PC and SC
• Evidence that care can be enhanced
• Efficient use of evidence based Nurse Led Service
• Research continuous in HF management

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Heart Failure Team (Wigton)

• Nick Beal Team Leader (BHF)
• Marie Morrison (BHF)
• Debbie Purdue PCT CIC HF Clinics
• Carlisle/Eden Valley
• Alison True PCT (PCT)
• Catherine Douglas (BHF) Workington/Whitehaven

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• Questions..
• Feedback..
• Referals

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