How Home Health Care Can Benefit Heart Failure Patients

Heart Failure Defined

Heart failure is the inability of the heart to keep up with the demands placed on it and a loss of normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs such as the brain, liver and kidneys.

Heart Failure Signs and Symptoms

Heart failure may be due to failure of the right or left or both ventricles. The signs and symptoms depend upon which side of the heart is failing. They can include shortness of breath (dyspnea), asthma due to the heart (cardiac asthma), pooling of blood (stasis) in the general body (systemic) circulation or in the liver’s (portal) circulation, swelling (edema), blueness or duskiness (cyanosis), and enlargement (hypertrophy) of the heart. Other symptoms may include pain, depression, edema, insomnia, anxiety, confusion, anorexia and constipation.

Symptoms of Right-Sided Heart Failure

  • Shortness of breath (dyspnea)
  • Swelling of feet and ankles
  • Urinating more frequently at night
  • Pronounced neck veins
  • Palpitations (sensation of feeling the heart beat)
  • Irregular fast heartbeat
  • Fatigue
  • Weakness
  • Fainting (syncope)

Symptoms of Left-Sided Heart Failure

  • Cough (produces frothy or blood-tinged mucus)
  • Decreased urine production
  • Difficulty lying down; need to sleep with the head elevated to avoid shortness of breath
  • Irregular or rapid pulse
  • Palpitations (sensation of feeling the heart beat)
  • Shortness of breath (dyspnea)
  • Waking up due to shortness of breath (paroxysmal nocturnal dyspnea)
  • Weight gain from fluid retention
  • Fatigue
  • Weakness
  • Fainting (syncope)

Causes of Heart Failure

There are many causes of congestive heart failure including:

  • Coronary Artery Disease (CAD) leading to heart attacks and heart muscle weakness
  • Primary heart muscle weakness from viral infections or toxins (prolonged alcohol exposure or abuse)
  • Heart valve disease causing heart muscle weakness due to too much leaking of blood or heart muscle stiffness from a blocked valve
  • Hypertension (high blood pressure)
  • Rarer causes include hyperthyroidism (high thyroid hormone), vitamin deficiency, and excess usage of amphetamines

Goals of Therapy

The aim of therapy is to improve the pumping function of the heart. General treatment includes:

  • Sodium (salt) restriction
  • Diuretics also called water pills (to get rid of excess fluid)
  • Pharmaceuticals
    • Digoxin (to strengthen the heart)
    • Spironolactone has been found to be a major help in treating congestive heart failure its beneficial effects are additive to those from ACE inhibitors, another class of drugs commonly relied on in treating heart failure.
  • Devices
    • A pacemaker-like device is also now available to treat heart failure. The implantable device delivers synchronized electrical stimulation to three chambers of the heart, enabling the heart to pump blood more efficiently throughout the body
  • Exercise & Daily Activity

Heart Failure Facts

  • About 5.7 million adults in the United States have heart failure
  • More than 600,000 Americans die from Heart Disease annually
  • One in 9 deaths in 2009 included heart failure as contributing cause
    • Heart Disease is the #1 killer of Americans outpacing all of the cancers combined
  • About 50% of people who are diagnosed with heart failure die within 5 years
  • Heart failure costs the U.S. over $40 billion annually
    • This total includes the cost of health care services, medications to treat heart failure, and missed days of work
    • Compared to all other patients, heart failure patients incur the greatest costs
    • Heart failure patients spend twice as many days in the ICU than other patients

Heart Failure Risk Factors

  • Coronary heart disease (the most common type of heart disease) and heart attacks
  • High blood pressure (hypertension)
  • Diabetes
  • Unhealthy behaviors can also increase your risk for heart failure, especially for people who have one of the diseases listed above.  Unhealthy behaviors include:
    • Smoking Tobacco
    • Eating foods high in fat, cholesterol, and sodium
    • Not getting enough physical activity
    • Being obese.

Other Contributors to Worsening Symptoms and a Poor Prognosis

  • Non-compliance with pharmaceutical therapy and prescribed treatments
  • Not making behavioral changes
  • Not making dietary changes
  • Not increasing activity and exercise
  • Not losing weight
  • Episodic care
  • Lack of a caregiver

New York State Heart Failure Classification

The most commonly used scale for heart failure based on symptoms. Generally, Class II and III would be home health appropriate patients depending on their individual NYHFClasssymptoms and the physician’s judgement. Class IV are generally hospice eligible patients who are experiencing symptoms at rest…miserable just sitting there in their living room chair.

Enter Home Health

Because of the progressive nature of Heart Failure, your doctor may refer you to home health care services to try to achieve any number of individualized goals to improve your
current status. This most often happens after a recent hospitalization for a heart failure decompensation, as your physician will try to help you to improve by establishing goals and expected outcomes on those things that may have caused you to go to the hospital, like dyspnea (shortness-of-breath) for example.

Possible Goals and Outcomes for a Heart Failure Patient

“By the end of the projected episode of care, the patient and/or family/caregiver will:”

  1. Demonstrate the ability to administer oxygen as ordered and manage equipment safely. (The doctor may prescribe oxygen therapy to help increase oxygen levels in a heart failure patient’s blood)
  2. Demonstrate pulse measurement and signs/symptoms which require physician notification.
  3. Achieve effective regulation of the medications to maximize optimal cardiac function.
  4. Optimize functional capacity while minimizing hospital admissions/re-admissions within the limits of the disease process
  5. Demonstrate effective diaphraghmatic breathing techniques, purse lipped breating to decrease SOB for maximum functional activity level
  6. Demonstrate improvement in angina.

An Interdisciplinary Approach

Different members of the home health care team will focus on different aspects of your care at your home that ties to their areas of expertise.

Skilled Nursing – Your RN might focus on  goals #1, #2, #3 and #6.  Additionally, the nurse will conduct a safety inspection of the home to ensure that the patient is safe and not a fall risk due to exposed electrical cords running across the floor for example. The nurse will also conduct a prescription reconciliation to make sure that only the currently prescribed drugs are being taken and that a schedule of what to take daily and when to take it is also provided.

Physical Therapy – Your PT might focus on goal #5occupational-therapist1

Occupational Therapy – Your OT may focus on goal #4

And if you are struggling with any aspect of your activities of daily living (ADLs), the home health aide will be utilized to assist with things like bathing, feeding or dressing for example.

Your team will assess your progress during your treatment episode and report to your physician on how you are doing and what progress is being made.

Benefits of Home Health Care for Heart Failure Patients

Yes, it is the obvious…you get all of your treatment and care in the comfort of your own home.   You avoid trips to the doctor’s office and avoid trips to a rehabilitation facility. Your also being taught on  how to navigate and ambulate around your own home, so the education and training are more relevant and effective.

For example, think of a senior with advanced heart failure (New York Heart Failure Classification III – symptoms with moderate exertion) receiving oxygen therapy and using a walker to get around. For this senior to go see their doctor or a therapist, they have to get their walker & oxygen tank and drag them out to the car, into the car, making the drive, getting out of the car, dragging themselves across the parking lot to the building front door; then down the hall to the elevator, then down the hall to the clinician’s office. They finally arrive out of breath, exhausted and very uncomfortable. Home health can help avoid many such trips while providing quality care focused on achieving the goals and outcomes that your physician has ordered.

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