Transcript Congestive Heart Failure Patient Advocate

Congestive Heart Failure
Patient Advocate
Joe R. Anderson, PharmD, PhC, BCPS
Associate Professor Pharmacy Practice and
Internal Medicine
University of New Mexico College of Pharmacy and
School of Medicine
Living with Heart Failure
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Symptoms
– Shortness of breath, fatigue, lack of
energy, swelling, bloating, decreased
appetite, difficulty sleeping
– Symptom burden effects quality of life
and ability to function (Eur J Cardiovasc Nurs
2005;4:198-206)
– Depression, anxiety, confusion
(Eur J Cardiovasc Nurs 2005;4:198-206; Arch Intern Med
2001;161:1849-56; Am Heart J 2006;152:940e1-940e8)
Living with Heart Failure
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Medications
– Minimum of 2 drugs (ACE inhibitor and betablocker)
– Typically, 3 to 5 drugs to control heart failure
(diuretic, digoxin, spironolactone, angiotensin II
receptor blockers)
– Additional medications typically needed for other
cardiovascular conditions or co-morbid disease
states (exp: aspirin, cholesterol-lowering
medications, nitroglycerin)
Living with Heart Failure
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Lifestyle Modification
– Taught to recognize signs and symptoms
of heart failure (Circulation 2007;116:1549-54.)
– Low-sodium diet
– Supervised exercise program
(Circulation 2003;108:554-9.; Circulation 1999;99:1173-82.)
– Discontinue harmful behaviors (tobacco,
alcohol, illicit drugs)
Circulation 2007;116:1549-54.
Living with Heart Failure
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Healthcare Visits
– Heart failure clinic visits may be every 2
weeks initially for medication titration and
patient education.
– Cardiac rehabilitation three days a week
– If have a cardiac device, need follow-up
every 3 – 6 months
– Primary care provider visits
Living with Heart Failure
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Costs
– Medications
– Food
– Clinic visits
– Transportation
Disability Process
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Application process
– Confusing to patient and provider
– Limited time for providers to assist
patient with process
– Lengthy
– Rule of “3”
Disability Process
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Application process
– Patient quotes:
“They try to discourage you in hope that you will
give up.”
“I would give anything to be able to work again.”
“They don’t realize that in addition to the
medications and doctor visits, we have to pay for
food, property taxes, utilities, car and home
insurance, phone bill.”
“The hardest thing was having to ask our
daughter to lend us money to buy food.”
“I’m not any good to nobody.”
Disability Process
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Conclusion
– Heart failure is a condition that affects
both physical and mental well being
resulting in functional limitations.
– If patients and providers manage
appropriately, the functional limitations
can be improved and stabilized.
– Appropriate management requires the
patient to have adequate financial
resources.
Disability Process
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Conclusion
– My wish
Provide temporary SSI or SSDI to patients
with heart failure provided they have valid
documentation of their condition.
 Reevaluate their status at 6 or 12 months
 Simultaneously, appoint patients to vocational
rehabilitation
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