Reducing Heart Failure Hospitalization

Clinic works to decrease re-admissions, improve quality of life for patientsPaula Bryant, MS, ARNP, monitors the health of heart failure patients at the new CVM Heart Failure Clinic, a collaboration of area cardiologists and the Genesis Heart Institute

Simply missing a dose of medication, drinking too many fluids, or going overboard on salt intake can land a patient with heart failure in the hospital or the Emergency Room.

It's a leading reason for hospitalization for people 65 and older. Indeed, nearly 25 percent of the people on Medicare who are hospitalized for heart failure are back in the hospital within a month, says a study published online Nov. 10 in "Circulation: Heart Failure."

To help prevent the revolving door of hospitalization for heart failure patients, area cardiologists in collaboration with the Genesis Heart Institute, recently opened an outpatient heart failure clinic to give these patients more frequent monitoring.

"Managing heart failure patients is one of the greater challenges in cardiology and one that is putting a larger and larger burden on our health care system," says cardiologist Randolph Lewis, M.D., who is medical director of the Cardiovascular Medicine Heart Failure Clinic. "Hospitalization rates for patients with heart failure have increased dramatically over the past three decades, especially among women."

Heart failure, which is the progressive loss of the heart's ability to pump blood, affects an estimated 5.7 million people in the United States, with 670,000 new cases diagnosed every year, says the American Heart Association. The trend is likely to get worse as the U.S. population continues to age.

"With this outpatient clinic, we hope to improve coordination between the hospital, physicians and our heart failure patients," Dr. Lewis says. "With closer monitoring, we can better ensure our patients are receiving important therapies at the right doses and know how to manage their condition so they aren't going in and out of the hospital."

A new clinic

Leading the clinic is cardiovascular nurse practitioner Paula Bryant, MS., ARNP, who provides compassion, positive reinforcement, and follow-up to patients with heart failure. The clinic is located on the third floor of the Genesis Heart Institute, 1236 E. Rusholme St.

Through routine office visits and phone calls, she keeps an eye out for any red flags that signal a patient's condition is deteriorating. Her goal is to catch changes in health status early -- before a patient ends up back in the Emergency Room or the hospital.

Bryant enjoys working with heart failure patients, most of whom are elderly.

"Their quality of life is greatly impacted with this diagnosis," Bryant says. "This condition has emotional, social and physical components that must all be recognized and addressed. The majority of these patients want to do the best they can with their condition, without feeling like they're a burden to their family. They need the extra attention and frequent reinforcement."

The clinic will help reduce re-admissions for heart failure, which not only puts patients at greater risk but also drives up the cost of health care, says Craig Sommers, Executive Director of the Genesis Heart Institute.

 "What is unique about our program is that Paula helps to bridge the gap in patient care between inpatient and outpatient visits," Sommers says. "This is very important because the five-year survival rate for heart failure patients is low."

The outlook for an individual patient depends on the patient's age, severity of heart failure, overall health and a number of factors. He points to statistics from the National Heart, Lung and Blood Institute's Framingham Heart Study of generations of heart patients:

  • Eighty percent of men and 70 percent of women under age 65 who have heart failure will die within eight years.
  • After heart failure is diagnosed, survival is poorer in men than in women but less than 15 percent of women survive more than 8-12 years. The one-year mortality rate is high, with 1 in 5 dying.
  • In people diagnosed with heart failure, sudden cardiac death occurs at 6-9 times the rate of the general population.

Improving quality of life

Often, heart failure patients can significantly improve their quality of life -- and stay out of the hospital -- if they comply with their medications, fluid and sodium management and are aware of warning symptoms to report, Bryant says.

"Many of them are on 10-12 different medications," Bryant says. "They have to follow a very low-salt diet and have fluid restrictions. With their advancing age, they usually have other co-morbidities or illnesses, such as diabetes, hypertension, coronary artery disease, chronic lung disease or chronic kidney disease. You're trying to keep all of these conditions stable, and any little change can trigger several of the problems at once."

Too much salt over the weekend, a new prescription, a case of the flu or simply missing a dose of medication can cause a health concern. Sometimes confusion over medication dosages or an inability to pay for the many medicines also can get patients off track, she adds.

In patients with heart failure, the inability of the heart to effectively pump and deliver blood throughout the body exists. As a result, an excess of fluid tends to accumulate in the body's tissues and causes swelling in the lower extremities and congestion in the lungs and abdomen.

"Many of my patients are women and most of them to a certain degree are caregivers," she says. "They're trying to take care of a spouse, too, so that puts a real toll on their health. We try to instill in our patients that we need to be alerted to every subtle change -- another illness, weight gain, a change in breathing or a change in activity tolerance. They need to weigh themselves daily, watch for shortness of breath or lower-extremity swelling. We encourage them to ask questions if they are unclear about something."

In most cases, heart failure is a chronic condition. It can be better managed, however, with medications and healthy changes in habits, such as diet, exercise and smoking cessation.

"The primary treatment goal for these patients is quality of life," Bryant says. "Through a team approach between patients and health care professionals, we hope each patient can achieve a satisfactory quality of life."

                                                      Symptoms of heart failure

 

  • Persistent coughing or wheezing
  • Feeling tired and weak
  • Feeling of suffocation
  • Unusual swelling in the lower legs and ankles
  • Sudden weight gain from fluid retention (2 or more pounds overnight)
  • Shortness of breath during normal activities
  • Increased heart rate
  • Poor appetite