With the global increase in heart failure, the management of this condition (medically termed congestive cardiac failure or simply cardiac failure) has changed considerably over the past few decades.
Being a chronic, progressive disease characterized by frequent hospital admissions and ultimately high mortality rates, heart failure, because of its high consumption of medical resources, is today the most costly cardiovascular illness in the United States.
Whereas in the past the very term "heart failure" implied that the heart had failed and that there was precious little doctors could do for the patient, today we know that if managed properly a patient with heart failure can enjoy good quality life and survival.
With improved treatment of medical conditions like high blood pressure and heart attacks, more people are surviving with sub-optimally functioning hearts into what used to be called old age. The only drawback is that their hearts then fail to function as effectively as they did in earlier years.
The main emphasis in managing the condition today lies in
- preventing healthy patients progressing to heart failure
- preventing heart function getting worse in those who already have the condition
- decreasing heart failure patients' morbidity (symptoms) and the need for hospitalization
Modern Management of Heart Failure
Like most long term diseases (for example, diabetes and arthritis), heart failure requires an integrated approach by various health care providers - primary care physicians (general practitioners), heart specialists (cardiologists), nurses, pharmacists and dietitians. Even psychologists, physiotherapists and occupational therapists can play significant roles in looking after these patients.
Studies have showed that integrated management programmes for heart failure patients have improved their quality of life and reduced admissions to hospital.
Role of GP
Primary care physicians (GPs) have a vital role in detecting the condition early - and also in identifying and managing the main risk factors that will progress to heart disease and heart failure. With the improved survival of these patients, management of heart failure in the community rather than in hospital has become the norm.
Ideally, follow up in the form of ongoing care should be by the GP (who sees the patient regularly) in collaboration with a cardiologist (who reviews the patient from time to time). Both GPs and specialists have unique skills, and complement each other's roles.
Role of Nurse
Evidence has accumulated that regular review - even regular telephone review -by specially trained nurses results in significant improvement in outcomes. Nurses can advise and counsel patients, support and educate carers, ensure compliance with medications and other lifestyle measures and detect the need for further assessment by medical colleagues.
Role of Pharmacist and Other Health Care Providers
A dedicated pharmacist can play an important role in ensuring the patient receives appropriate medications - and also in educating the patient about adherence and monitoring for adverse effects of drugs.
Patients with heart failure can suffer from depression - which compromises compliance with medications and self care. Counsellors and psychologists can be helpful in dealing with such problems.
Physiotherapists (to help with exercise and muscle strengthening) and occupational therapists (who can advise about making it easy for patients to perform their activities of daily living) are other health care providers who can form part of a management team
Barriers to Treatment of Heart Failure
Despite all the medical advances of the past few decades, many patients even today remain sub-optimally treated. This is a pity because if people's misconceptions can be corrected and an effective multidisciplinary approach adopted, patients with heart failure will have improved outcomes, less stays in hospital and a better quality of life.
And less health care dollars will be required to look after them - which will make all those who are interested in health care reform happy!
References:
1. Grady KT, Dracup K, Kennedy G. Team management of patients with heart failure. Circulation 2002
2. Krum H, Liew D. Recent advances in maanagement of heart failure. Australian Family Physician 2003
Sanjiva Wijesinha - Dr. Sanjiva Wijesinha, Associate Professor at Monash University medical school, writes on health, travel and medical topics.
