HF-Taumarunui
Download
Report
Transcript HF-Taumarunui
The Waikato Integrated Heart
Failure Service (WIHFS)
Debbie Chappell
CNS Heart Failure
Taumarunui/Te Kuiti/Otorohanga/Te Awamutu
The Waikato Integrated Heart Failure Service Team
HF CNSs:
• Julie Jay, Eileen Gibbons, Karyn Haeata,Debbie Chappell,
Simona Inkrot, Catherine Callagher
Cardiologists:
• Mark Davis, Gerry Devlin, Raewyn Fisher
Sonographers
HF in Aotearoa/NZ
2 % Heart Failure prevalence in Western societies
HF Incidence is rising with an ageing population and the
improved treatment and survival of heart disease
Median survival of 3.5 years after initial HF admission in
NZ
One-year HF mortality rates after initial hospital admission
are between 25 and 35%
Maori patients admitted with HF are significantly younger
than NZ European: mean age 62 vs. 78 years
McMurray et al., 2012; Wasywich et al, 2010; Schaufelberger et al., 2004; Wall et al., 2012
Refresher A&P
Definition
Heart Failure is a clinical syndrome where the heart is unable to
pump blood at a rate required by the body, patients present with
some or all of the following features:
Symptoms typical of heart failure
(breathlessness at rest or on exercise, fatigue, tiredness, ankle swelling)
AND
Signs typical of heart failure
(tachycardia, tachypnoea, pulmonary rales, pleural effusion, raised jugular
venous pressure, peripheral oedema, hepatomegaly)
AND
Objective evidence of structural or functional abnormality of the heart at
rest
(cardiomegaly, third heart sound, cardiac murmurs, abnormality on the
echocardiogram, raised natriuetic peptide concentration)
Normal
HF-REF
HF-PEF
Some causes of heart failure
•
•
•
•
•
•
•
•
•
Coronary artery disease
Hypertension
Valvular heart disease
Cardiomyopathies
Endocrine disorders-thyrotoxicosis
Genetic conditions
Congenital heart disease
Inflammatory
Chronic arrhythmias
• Also think of co morbidities – diabetes, obesity, COPD
Pathophysiology
Compensatory mechanisms of acute heart failure
• Sympathetic nervous system activation
• Renin-angiotensin system activation
• LV remodelling
OUTCOME:
• Vasoconstriction – Increased HR, SV leads to increased CO
• Attempt to maintain cardiac output and vital organ perfusion –
heart, brain, kidneys
Maladaptation
• Compensatory mechanisms become “maladaptive”
in chronic heart failure
OUTCOME:
- Excessive vasoconstriction
- Increased afterload
- Excessive salt and water retention
- Electrolyte abnormalities
- Arrhythmias
Investigations
• Observations – TPR BP (lying/standing), weight, height BMI
• ECG – old and new changes
• Bloods – CBC, U&E, Cardiac enzymes, NT-pro BNP, LFT,
Cholesterol, TFT
• CXRay – old and new
• ECHO- normal EF >55%, moderate – severe HF<40%
Treatment Options – medical vs intervention
Pharmacological
- Diuretics
-ACEi
-Beta-blockers
-Other drugs
Non pharmacological
-fluid management
-nutrition
-physical activity
-smoking
-psychosocial support
-other factors
Case studies
• 75 year old female
• History incr SOBOE (getting
worse)
• Bilateral pitting oedema
• JVP +2, chest clear
•
•
•
•
History hypertension
Dip stick, LFT, U&E
NT pro BNP 400 pg/mL
Refer - ECHO normal LV,
elevated filling pressures, HFpEF
• Treatment options
•
•
•
•
49 year old male
Bilateral oedema, pants tight
Appetite depressed
JVP normal, ascites, ? pulsatile
liver
• Jaundiced
•
•
•
•
•
Dip stick (bilirubin)
LFT - abnormal
NT pro BNP – normal
Renal – normal
Check ? Hepatitis, alcohol, blood
transfusion
Aims of treatment / nursing role
• Improve symptoms – fluid restrict, daily weigh, medication
• Improve LV function – medication, medical intervention
• Improve exercise tolerance – moving, pacing themselves
• Improve patient education & self-management – HF booklet
• Decrease hospital admissions - improve survival
• End of life care
CNS led interventions for HF patients
Decreased hospitalisation, decreased number of
events, readmissions and days in hospital
Improved survival
Cost effective
Improved self-care behaviour
Stromberg et al., 2003; Phillips et al., 2005
Referral Criteria
Inclusion:
• Patients with possible heart failure and/or at high risk for heart failure in the community, e.g.
previous MI, family history of cardiomyopathy
• Patients readmitted for heart failure within 3 months
• Heart failure patients with significant co-morbidities affecting optimisation of treatment
• “Shared care” for end stage/palliative care
Exclusion:
• Lack of consent from patient
• Acute coronary syndrome
• Patients already under the care of a cardiologist, unless referred by this cardiologist
(inclusion criteria must be satisfied)
COMPONENTS OF WIHFS
• Specialist clinics (CNS and cardiologists), Home visits, Telephone care
– Patient and family/whanau education: heart failure knowledge and self-care
– Clinical monitoring
– Titration of heart failure medications in consultation with GP and/or cardiologist
• Professional education/CME for other health professionals and community teams
Thank you
Debbie Chappell – Taumarunui
Te Kuiti/Otorohanga/Te Awamutu
0212419452
07 8785192
Questions?