Heart failure is the number one admitting diagnosis for patients 65 and over. Every year, Floyd Memorial has over 300 admissions due to the condition. Once a patient is discharged from the hospital, managing heart failure can be difficult, requiring constant vigilance and careful compliance with physician instructions. To meet the special needs of patients who are coping with the disease, the Floyd Memorial Heart and Vascular Center has opened a Heart Failure Outpatient Clinic.
According to Marla Estes, advanced registered nurse practitioner at the Heart and Vascular Center, “The primary issue is that over 21 percent of heart failure patients have to be readmitted to the hospital with the same condition due to a lack of follow-up treatment, lifestyle changes and education. This new clinic is designed to provide the missing link that will help patients improve their quality of life and help prevent the recurrence of heart failure symptoms.”
Floyd Memorial already has an inpatient program in place to help heart failure patients. According to Kelly Hanifen, RN, cardiac rehab supervisor, “Every patient with heart failure is visited by a nurse who goes over a booklet of information with the patient and family. The nurse teaches them how to follow a low sodium diet, what symptoms to watch for, and to weigh themselves every day. By weighing themselves daily, they will notice fluid retention early, and can get help before symptoms spiral out of control and require hospital care. If they can’t afford a scale, we can give them one through a grant from the Floyd Memorial Auxiliary. We also call them on a weekly basis to reinforce the education, and check to see if they are having problems. Still, because compliance can be so difficult, we saw the need to take that next step, to have patients work directly with a nurse practitioner in a clinical setting. That’s what the new Heart Failure Outpatient Clinic offers.”
Goals of the new clinic are:
- To improve the patient’s quality of life
- To decrease the number of readmissions for heart failure
- To decrease the length of stay when a patient does need to be readmitted (Readmissions cannot be avoided entirely because heart failure is a progressive disease.)
One-on-one attention from a certified nurse practitioner
In the new clinic, patients will get the one-on-one attention of a certified nurse practitioner. As Estes explained, “The initial visit will include a history and evaluation so that we can learn what that individual needs and set up a schedule for follow-up visits. We will discuss their medications to make sure they are taking them properly. If they’re having trouble affording their medication, we can get a social worker involved. Many drug companies offer drugs at a loUndwer cost as long as the patient qualifies. The social worker will help with the application process.” Estes added, “During their visit, we can help them with their low sodium diet and be more specific with our education, actually showing them how to count milligrams, read labels and choose the best foods. Having the clinic associated with the hospital is a great benefit as well; in that we have access to all the experts they may need, such as a dietitian, chaplain, social worker or therapist. We have a whole team of professionals who can care for them.”
“Our primary goal,” said Estes, “is to improve the quality of life for people with heart failure. Their activity level, emotional and psychological well-being, and their 6 patient focused New Heart Failure Outpatient Clinic Helps Improve Patients’ Quality of Life, Prevent Readmissions “The new heart failure clinic is another significant sector of cardiovascular disease management that means so much to our community. It is a very important part of providing a state-of-the-art continuum of care.” Mark Bickers, MD Cardiologist Premier Cardiology, LLC 7 families are all affected by the disease. We believe they can benefit greatly from closer supervision, one-on-one visits with a nurse practitioner, access to a team of experts and ongoing education.”
Understanding heart failure
Heart failure is an extremely prevalent condition characterized by a progressive loss of the heart’s ability to pump blood. Mark Bickers, MD, a cardiologist with Premier Cardiology, LLC, explained what the disease involves, and how its incidence is on the rise. “The left ventricle is the heart’s main pumping chamber. Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the function of the left ventricle to fill with or eject blood,” said Dr. Bickers. “Because the pumping mechanism is impaired, blood doesn’t flow as efficiently through the body. Fluid can back up and pool in the lungs, legs and feet.” Symptoms of heart failure include shortness of breath and swelling of the legs and feet. As the disease progresses, these symptoms can severely impact the patient’s quality of life, to the point that the ability to perform tasks as simple as walking across the room becomes limited. During an episode of acute heart failure, the heart’s inability to circulate blood adequately throughout the body worsens to the point that hospitalization may be necessary to stabilize the patient’s condition.
According to Dr. Bickers, “Heart failure tends to be age related, and will increase dramatically as baby boomers grow older. For example, only one to two percent of the population between the ages of 45 and 55 have heart failure, but up to ten percent of the population over 75 has it. Approximately 80 percent of cases occur in patients 65 and older.” Statistics show that the incidence of the disease is increasing rapidly. “In 1979, fewer than 377,000 hospital admissions were for heart failure,” said Dr. Bickers. “By 2005, the number had risen to a million.” “At Floyd Memorial,” he added, “we see over 300 heart failure patients each year. We believe we can reduce the level of disability and improve the quality of life for those patients if we are more aggressive in preventing the recurrence and slowing the progression of the disease. The new heart failure clinic is a major step toward reaching those goals.”