Which risk factor does the nurse include when providing community education about heart failure

The highly skilled medical experts at the St. Joseph Hospital Heart Failure Program provide evidence-based care for heart failure patients at a compliance level that is higher than the national average.

Our mission is to equip our patients and their families with the tools necessary to manage heart failure for improved quality of life and minimal hospitalization. We provide one-on-one education to our patients and their caregivers on topics that include: medications, lifestyle modification, symptoms to recognize and when to contact the physician.

Our assessment and follow-up includes:

• Telephone calls: a registered nurse will call you at home after discharge from the hospital or to follow-up. You may contact the heart failure nurse at any time if you have questions or concerns.
• Inpatient (hospital) education: Prior to discharge, you will receive educational materials and resources. If possible, it is best to have your significant other or caregiver with you during this education session. A video about heart failure is available for you and your family to view as many times as necessary.
• Outpatient visits: A registered nurse will work closely with your cardiologist or primary care physician to help you manage symptoms of heart failure and prevent hospital admission. These visits have a large emphasis on education and should include the attendance of family members or caretakers whenever possible.

How do I enroll in the St. Joseph Hospital Heart Failure Program?

You may be referred to the program after a hospital admission or directly from your doctor’s office. Talk with your cardiologist or primary care physician about whether or not the St. Joseph Hospital Heart Failure Program is right for you.

What is Heart Failure?

Heart Failure is a condition that affects the heart’s ability to pump and receive blood. This decreases the ability of the heart to maintain the needs of the body and might lead to congestion of the lungs and body with fluid; thus the old term “Congestive Heart Failure”.

What are the common risk factors for heart failure?

• High Blood Pressure
• Coronary Artery Disease (CAD) or Previous Heart Attack
• Diabetes
• Increased age
• Smoking
• Obesity
• Drug or Alcohol abuse
• Family History

What can I do to decrease my risk?

According to Maged F. Azer, MD, FAAC, medical director of the St. Joseph Hospital Heart Failure Program, “The best treatment of heart failure is prevention.”You can decrease your risk by:

• Adequately treating high blood pressure
• Exercising
• Losing weight (speak with your physician about a goal that is right for you)
• Quit smoking and avoid second-hand smoke
• Avoid excessive alcohol intake (ask your physician about what is right for you)
• Eat a low-cholesterol and low-fat diet

Early detection (knowing what to look for)

• What are the symptoms of heart failure?
• Swelling in the feet, ankles or abdomen
• Shortness of breath or cough that won’t go away
• Excessive urination at night
• Weight gain of more than 2 pounds overnight
• Fatigue, dizziness or lightheadedness
• A change in ability to do daily activities
• “Racing” heart rate

What should I do if I have these symptoms?

• Seek medical advice from your health care provider early on; avoid waiting until symptoms grow worse.
• If symptoms progress, go to the Emergency Department for evaluation.
• The key to successfully treating heart failure is to diagnose the condition in its earliest stages and manage it aggressively to prevent symptoms from worsening.

After you have described your symptoms and your physician has performed a physical examination, one of several diagnostic tests may be used to diagnose heart failure and assess your current heart health.

These diagnostic procedures may include:

• Echocardiogram: An ultrasound of the heart that is used to evaluate the structures of the heart and its ability to pump blood.
• Chest X-ray: used to check for congestion of the lungs and to detect an increase in the size of the heart.
• Stress testing (stress echo or stress nuclear studies): usually done after an initial phase of treatment and helps to evaluate for blockages in the heart vessels or coronary arteries.
• Cardiac catheterization: a procedure involving the injection of dye into the heart through a needle inserted into the groin. It is used to find out if there are blockages in the heart vessels.
• Devices such as a stent or angioplasty may be placed during this procedure that help to “open” the blockages.

When talking about heart care, experience matters. The St. Joseph Hospital Heart Failure Program treats more than 495 patients every year for heart failure with the most advanced medical therapies available.

For three consecutive years, the Society of Thoracic Surgeons rated St. Joseph Hospital in the nation's top 12 percent for adult cardiac surgery. This top-tier, three-star rating reflects outstanding outcomes in key areas such as complication and mortality rates, and adherence to evidence-based care throughout the patient's stay.

The St. Joseph Home Health program provides nursing care at home. This may be appropriate for patients who are unable to visit the outpatient Heart Failure Program and want to avoid unnecessary visits to the hospital or Emergency Department. Physical and occupational therapy can assist with energy conservation techniques. You or your loved one may be referred to the Home Health program after a discharge from the hospital or after discussing this option with your primary healthcare provider.

The St. Joseph Hospice Cardiac program provides excellent care to those with end-stage cardiac disease who would like to stay at home without having to come back to the hospital for pain or other cardiac symptoms such as fluid overload. A hospice nurse will be available 24 hours a day, 7 days a week, and other team members such as a social worker, chaplain and aide are available for support, counseling, assistance with accessing community resources and personal care. Hospice provides medications, equipment and supplies to ensure patient comfort and safety. Bereavement services are also available.

St. Joseph Hospital offers a Heart Failure Discussion Group that meets on the fourth Monday of every month from 11 a.m. to noon in the second floor boardroom of the St. Joseph Hospital Outpatient Pavilion. The Outpatient Pavilion is located at 1140 W. La Veta Ave. in Orange. For more information, please call (714) 744-8858.

Tools of the Trade: These are documents designed to help you manage heart failure and include the following:

• Daily Weight Tracker: this grid allows you to track your weight and blood pressure on a daily basis. You should complete this grid and bring it with you to each doctor’s appointment.
• Reading a Food Label for Sodium Content: this tool is designed to help you understand what to look for when reading a food label. Share these tips with family members or caretakers who prepare your meals.
• Telephone Calls to Your Doctor: a prompt to help you communicate effectively with your doctor when you are having symptoms of Heart Failure.

The following are additional websites that may help you understand heart failure and how it is treated.

• American Heart Association
• About Heart Failure
• American College of cardiology

The main goals in treating heart failure include:

• Finding a potentially treatable cause and halt or (in certain circumstances) reverse this condition.
• Controlling symptoms and improving the overall outcome using the appropriate therapy.

However, recognizing symptoms of heart failure is the first step in managing and treating heart failure. Early detection can prompt you to seek medical care in a timely manner.

Lifestyle modification

Lifestyle modification is one of the main ways to treat heart failure and includes the following:

• Quit smoking and avoid second-hand smoke.
• Follow a low-sodium diet. You should consume no more than 2,000 mg of sodium per day (refer to nutrition labels). Do not cook with salt or add salt to your food.
• Exercise: consult your physician prior to beginning any exercise routine. It is important to know how well your heart is functioning so you have realistic expectations for your activity level.
• Weigh daily: this is one of the most important ways to detect fluid retention. You should call your physician if you gain more than 2 pounds overnight.
• Fluid restriction: you should consume no more than 2 liters (64 oz.) of fluid per day.
• Take all the medications as they are prescribed by your physician.

Medications

Medications are prescribed to improve quality of life, symptoms of congestion, avoid hospital admissions and prevent stroke or heart attack. Your doctor may prescribe any combination of the following types of medications:

• ACE Inhibitors: improve the heart function and efficiency (examples include: Lisinopril/Prinivil, Captopril/Capoten, Enalapril/Vasotec)
• Beta-Blockers: decrease the workload of the heart (examples include: Coreg/Carvedilol, Metorprolol/Toprol)
• Diuretics: work in the kidney to rid body of excess fluid (examples include: Lasix/Furosemide, Aldactone/Spironolactone, Metolazone)
• Digoxin: improves the heart’s ability to pump blood effectively
• “Blood thinners” help prevent heart attack and stroke (may include Aspirin and Coumadin/Warfarin)

Opening Blocked Arteries

If you have blocked coronary (heart) arteries, your physician may advise you to have a Coronary Artery Bypass surgery or a stent or angioplasty (devices to open the blockage).

Cardiac Resynchronization Therapy

Your physician may advise you to have Cardiac Resynchronization Therapy (CRT). This is a surgical procedure that includes placing a device in the left upper part of your chest (like a pacemaker) that is designed to synchronize your heart contractions so that your blood is pumped more effectively.

Heart Transplant

Your physician may refer you to a heart transplant center for evaluation. Not all heart failure patients qualify for a transplant.

Left Ventricular Assist Device

Left Ventricular Assist Device (LVAD) is an implantable heart pump that may be used as a temporary treatment until a heart transplant can be performed. This is used in patients with advanced stages of heart failure.

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