Living Well with Heart Failure.
by Rhonda Veenhuis
I’d be in the hospital several days … out a week … then back,” said Beverly Cannon, 64, an Illinois resident. “It was a revolving door.”
Cannon, who has congestive heart failure, believed she was complying with everything her doctors asked. Being hospitalized repeatedly was frustrating and scary.
Her primary care physician and cardiologist recommended she seek help from the Heart Failure Center at Missouri Baptist so she could learn more about controlling her symptoms.
As Cannon was being discharged from her last hospitalization, Valerie Emery, adult nurse practitioner, visited her to explain how the program worked. Emery leads the nursing and educator team at the Heart Failure Center, which opened last April.
“We teach and encourage patients to monitor their symptoms, and help them understand how they can control their lives again. We then become their partner, talking with them once or twice a week.”
Allan Bierman, 83, experienced a situation similar to Cannon’s. He, too, had been hospitalized, four times within a two-month period for CHF.
“The Center has definitely helped my mental attitude and that is very important since it affects everything,” said Bierman. “They have gone overboard to help me. I feel a lot better.”
Importantly, he also has managed his physical symptoms and so far avoided further hospital stays.
What is Congestive Heart Failure?
Congestive heart failure (CHF) affects about six million Americans and is the leading cause of hospitalization in people over age 65.
CHF occurs when a patient’s heart muscle weakens and does not pump blood well. It can result from a variety of conditions, including coronary artery disease, A-fib, high blood pressure, diabetes or obesity.
When the heart’s pumping power weakens, it affects the kidneys, causing the body to retain water and salt. Fluids build up in your arms, legs, feet and lungs. The body becomes swollen or ‘congested,’ hence, the term congestive heart failure.
Treatments and lifestyle changes, such as exercising, reducing salt intake, managing stress and weight, can improve the symptoms and help patients live better and sometimes longer.
Why a Heart Failure Center?
David Sewall, MD, medical director of the Center said, “We teach patients with CHF how to manage their disease. The more patients learn about their disease, its physiology and the impact of their lifestyle choices, including diet, activity and medications, the better they are equipped to keep it in check.”
The Center partners with each patient’s primary care physician, and coordinates their care with a team of health care professionals including pharmacists, dietitians, cardiac rehab therapists, cardiologists and pulmonologists.
“We focus solely on the CHF piece of their care, and rigorously apply evidence-based medical guidelines for optimal care and quality of life,” he added.
Dr. Sewall directs the Center’s clinical activities and is a resource for staff when a patient’s physician is not available (the Center’s patients do not become his patients).
“Another goal is to identify individuals who are not responding to traditional therapy and facilitate advanced care when needed,” he said. “If we can recognize a need early on when a patient still has options, we can send them to Barnes/Washington University for a potential transplant or left ventricular assist device, procedures we don’t perform here.”
Uncovering Reasons Behind Symptoms.
CHF patients often have no energy, can be short of breath, don’t sleep well and just don’t feel well. Research shows they often don’t realize how their lifestyle choices worsen their condition.
For Cannon, this was the case. After a series of probing questions, Emery helped Cannon pin down a key cause of her symptoms. She was experiencing problems breathing, and had fluid retention in her feet and legs, heart and lungs.
Often, Cannon would eat at a restaurant generally perceived as having ‘healthy food.’
“For me, eating out was better than cooking, plus it was a social thing as I’d see my friends,” she said.
Emery helped her identify the sodium content in the restaurant’s food. Cannon was totally surprised. Most meals were high in sodium, and one item alone often contained her daily sodium allotment.
Cannon has eliminated those foods. The Center, in consultation with her cardiologist and pulmonologist, could then adjust her diuretics and blood pressure medicines. Cannon also saw a dietitian at Missouri Baptist for nutrition counseling.
“Old habits are hard to break,” said Emery. “But CHF is serious. Working as a team, we help patients identify what works best for them. Like most diseases, the earlier the intervention, the better the outcome. Appropriate medical therapy can delay progression of CHF symptoms.”
CHF, a relatively common disorder, is misperceived as a condition of the elderly. But, it strikes younger people, too. The Center treats patients in their late-20s to 95. Often, younger patients have an enlarged heart or muscle disease, which interrupts normal heart function.
Bierman, a retired wholesale candy distributor, was fit and active most of his life. He played football, baseball, and handball and lifted weights. While his father died from a heart attack at age 31, his mother lived to 92.
Like his father, Bierman had both a heart attack and bypass surgery. He later had a defibrillator/pacemaker placed, and now struggles with CHF, too.
“The Heart Failure Center has given me physical, mental and spiritual guidance,” said Bierman. “I used to be physically strong and now suddenly I’m not so strong. It’s difficult to deal with.”
“I definitely watch my sodium and have lost 15 pounds in the past 90 days since starting to work with the Center. I trust them explicitly.”
Cannon, who retired from being an occupational therapist due to lupus, which contributed to her CHF, has many reasons to get healthier, including seven grandchildren.
“If I had not been going to the Center, I’d be back in the hospital,” she said. “They helped educate me. I absolutely love them. They watch over me. The concern they have for me also makes me more diligent! They reinforce the things I need to do.”
As Dr. Sewall explained, “At the Center, patients have access to healthcare professionals who know about them and their condition. Our goal is to improve a patient’s self-management and co-management of their chronic disease and to keep them from needing the ER or hospital.”
Why Consider a Heart Failure Center.
People who benefit from a CHF program often have had multiple hospital admissions. The lucky ones are referred early on, so they can slow the disease while still healthy.
Each patient receives a personalized treatment program that often includes:
- teaching about CHF, its symptoms and danger signs
- explaining the drugs used to treat CHF, how they work and when to take them
- talking with patients by telephone a couple of times a week to discuss their symptoms
- teaching self-monitoring of weight, sodium intake, swelling and other symptoms
- practicing exercises so they can
- reduce swelling
- helping with medication management.
“Although we’re called the Heart Failure Center, we think of ourselves as the Heart Success Center for our patients,” said Emery.
David Sewall, MD, is board-certified in cardiovascular disease and interventional cardiology, on staff at Missouri Baptist, and a member of the BJC Medical Group. He received his medical degree from Boston University School of Medicine and completed his internship, residency and a fellowship in Cardiology at Washington University School of Medicine.
Valerie Emery, RN, ANP, has worked with cardiac patients with special interest in heart failure for 20-plus years. She received her BSN from Central Missouri State University and her MSN from Barnes School of Nursing. She is a member of the BJC Medical Group.