Heart Failure

In this section it is hoped to explain to patients, their family, their carers or to anyone interested the implications of living with Heart Failure ...

Education

Emotional Aspects

Depression

Sex & Intimacy

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The best way to describe what living with heart failure means is to reproduce an interview given to NHS Highland by Mandi Smith, Lead Heart Failure Nurse...

Education helps to improve quality of life for heart failure patients

26/07/2011   |  Mid Highland; North Highland; South East Highland

Chronic heart failure patients in Highland are enjoying a better quality of life for longer, thanks to the work of the Heart Failure Service, which is run jointly by NHS Highland and British Heart Foundation (BHF) Scotland.

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Mandi Smith - Lead Heart Failure Nurse

The service was set up to help support chronic heart failure patients and their carers by introducing them to self management aspects of care, which allows them to live with this long term condition.

The team of five heart failure nurses are busy educating other staff members on heart failure management to allow a more consistent flow of support and management.  

They are currently working with GPs and nurses in the community, providing them with training and education in heart failure management to enable them to provide joint heart failure care in the future.

And they recently won an award from BHF for the innovative way in which they are working together with primary care.

Lead Heart Failure Nurse, Mandi Smith, explained that there is a high incidence of heart failure with approximately one new case per 1,000 of the population being diagnosed each year.

She said: "There are an estimated 1,540 patients with diagnosed heart failure in Highland and possibly the same again who are undiagnosed. Each year, we have around 260 people admitted to our hospitals for whom the primary diagnosis is heart failure.

"Although the prognosis can be poor, with 50% of patients dying within the first 12 months, when heart failure is appropriately diagnosed, treated and ongoing support provided, heart failure patients’ quality of life can improve.

"It also helps to keep people alive for longer and means they are less likely to require unnecessary hospital admissions."

She added that hospital readmission rates have been reduced since the service commenced in October 2006.

However, there is still a need for education and collaboration with the medical teams so that patients admitted to hospital with heart failure due to Left Ventricular Systolic Dysfunction (LVSD) are referred to the service enabling appropriate education and treatment to start as quickly as possible.

Ms Smith said: "We are building relationships with the community teams and an educational package has been produced, which allows the practitioner to work through sections of the programme using their own experience and caseload.

"We have already established effective joint working with the Nairn community team, where we currently use shared care for our patients. This not only benefits the patients, but allows the staff to have a better knowledge of the patient prior to end of life management.

"We are now planning to roll out this way of working to other areas of Highland."

Since the service began, 376 patients have been supported by the heart failure nurses and they are currently working with 188 patients. This equates to a total of 3,450 home or clinic visits, plus many more telephone contacts.  

Ms Smith explained that, once a patient is stable and able to manage their condition, care is handed back to their GP practice for follow up. However, if there are any problems, either the patient or practice staff can refer the patient back into the Heart Failure Service.

The heart failure nurses also run a successful patient and carer forum in the Inverness area.

"To date we have held 13 forums with between 16 and 35 people attending the sessions.

"We use these forums to provide education sessions using topics picked by the patients and carers. The education sessions are well received, but those attending say they particularly enjoy meeting and talking to other people who share the same disease. 

"We would like to expand the forums to other areas, but at present we have struggled to get the representation," said Ms Smith. 

She added that they provide a newsletter after each forum, which allows them to pass on the information to others, and they are currently producing about 300 newsletters each quarter for distribution.

Patient Peter Briggs, 61, of Smithton, near Inverness, said the Heart Failure Service had made a big difference to his life.

He said: “Every time I get a visit, it makes me feel so much better. I think I’d have been quite depressed without them. Just knowing they’re there makes me feel so much happier. I really feel as though I’m getting the support I need.”

Source: NHS Highland

Watch Mandi and her nurses being interviewed at the BHF National Awards 2011 -

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Emotional Aspects of Heart Failure

(With thanks to CHSS)

Depression

It is very common for people with heart failure to develop depression. This may happen when you notice that your quality of life is being affected by your symptoms.

Feeling down for some of the time is a natural reaction as you learn to accept, and adapt to, what you can and cannot do. However, if you are feeling low for most of the time you could be depressed.

Depression affects your mood and how you feel about life – you may feel as if there is no point in anything.

It can make you feel as if you don't want to get up in the morning or as if you don't want to go out or see family or friends. Often depression creeps up over a period of time.

Common symptoms of depression include:-

• Persistent sadness, crying spells
• Loss of interest in life
• Mood swings: feeling short tempered / irritable or easily upset
• Tiredness and loss of energy
• Loss of confidence and self esteem
• Difficulty concentrating
• Not being able to enjoy things that are usually pleasurable or interesting
• Feelings of guilt or worthlessness
• Changes in appetite / weight gain or loss
• Feelings of helplessness and hopelessness
• Sleeping problems – difficulties in getting off to sleep or waking up much earlier than usual
• Lack of energy, motivation
• Being less aware of others and more inward looking
• Physical aches and pains
• Loss of sex drive and or sexual problems
• Avoiding other people sometimes even your close friends
• Thinking about suicide and death

Most experts agree that if you have experienced four or more of these symptoms for most of the day, nearly every day, for over two weeks then you should seek help.

Speak to your Heart Failure Nurse or Doctor in the first instance. It may be hard, at first, to talk about how you are feeling but remember doctors are used to talking about emotions and are skilled at recognising and treating depression.

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Sex and Intimacy

Lack of energy, shortness of breath and impotence are common difficulties with sexual activity for people with Heart Failure.

Retaining closeness and intimacy within your relationship will help to overcome difficulties. Remember that you can express your feelings in many different ways, through talking but also with body language and physical contact such as kissing and cuddling.

Making the most of rest time and experimenting with positions may help to make sexual intercourse easier. Impotence in men can be caused by the side effects of the drugs used to treat Heart Failure, but it can also be caused by fear or stress as well as diabetes or vascular problems. Speak to your doctor if this is happening to you.

If you or your partner have any questions or concerns regarding your sexual relationship try to talk to your doctor. Your doctor will be used to talking about personal matters even if you aren't, so try not to feel embarrassed.

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