Virginija Ežerskienė, a cardiologist specially trained for this work, and Rita Ščefanovičienė, a general practice nurse, work in it. After inpatient treatment and meeting the criteria, doctors provide a patient with heart failure with the necessary information and teach them how to live with this disease, in which the ventricles of the heart no longer push blood into the small or large circulation circles. About one in ten elderly people suffer from this common pathology. With severe heart failure, over 50% die. people.
Learning to live with the disease
This year, more than twenty patients learned how to live with heart failure in the Heart Failure Room at the Heart and Vascular Center. In the office, patients with heart disease are consulted and taught to recognize the disease, control it and live with it. The office is staffed not only by a cardiologist specially trained for this work, a general practice nurse, but also by a team of medical specialists.
Today, female specialists can already enjoy the results of the Heart Failure Cabinet, and its effectiveness is unquestionable. However, enthusiasm alone is not enough: it was necessary to train specialists for this work, to equip an office. Cardiologist Virginija Ežerskienė, who was one of the first to work in this office, gained knowledge in special courses. General practice nurse Rita Ščefanovičienė has joined since January.
“You have to learn to live with this disease, keeping it under control. During those years, the number of patients suffering from heart failure and who understand that the quality and even the duration of their life depends on how well they know their disease”, – convinced doctor V. Ežerskienė.
However, the flow of sick people does not decrease. Doctors see that after inpatient treatment, a few weeks later, they are often waiting for their turn in the Emergency Department and are again admitted to the Cardiology Department, because the disease worsens: the person is short of breath, his legs are swollen.
“When a person suffering from heart failure frequently visits a hospital, it is evidence that his health is only getting worse. After each episode, life expectancy becomes shorter, and after each exacerbation, the quality of life becomes worse,” says the doctor.
After inpatient treatment, the patient is sent for consultation to the Heart Failure Office, where it becomes clear whether the person is capable of cooperation. Family members can also help a lot, as training requires effort from both the patient and family members.
Doctor cardiologist V. Ežerskienė says that not every hospital patient treated for heart failure in an inpatient setting can become a patient of this office. A person must be oriented, must understand the requirements and want to cooperate with doctors.
Highly qualified specialists, prepared for this work in special courses, not only diagnose changes in the disease, prescribe treatment, and teach how to recognize the exacerbation of the disease and how to manage it.
We work with the patient individually. It is clear that training is necessary, because thanks to it, the patient’s condition is stabilized and the quality of life is returned to him. “And the most important thing is that a person does not return to the hospital so often because of the same problem,” says cardiologist V. Ežerskienė.
Everyone is equal in the team
There are three people working in the heart failure room: a cardiologist, a general practice nurse and a patient with a family member who cares for him. If help is needed, consultants pulmonologists or nephrologists are invited, because heart failure and lung function or kidney function disorders are side by side.
After inpatient treatment, a patient who meets the criteria for training in the Heart Failure Clinic is provided with the necessary information. Every new patient receives a “Patient’s Diary” prepared by the Association of Heart Failure Patients, in which they write down the daily measurements of arterial blood pressure, heart rate, weight and other body conditions: swelling, shortness of breath, fatigue (assessed by points), physical activity, blood glucose level. (if you have diabetes).
“Knowing the indicators, the patient himself can understand how much his condition is improving, decide whether the dose of medication needs to be adjusted,” says nurse Rita Ščefanovičienė, who also teaches patients about physical activity, without which a quality life is impossible when suffering from heart failure.
Specialists in the office work on Fridays. Two patients can visit per day. Four visits are planned for each patient. During this time, he will be taught how to live with the disease, how to manage the situation. In training, patients learn to understand medical terms, learn what pulse rate monitoring is, how to weigh yourself, and how to drink fluids. Only after learning to manage the disease, a person will no longer feel fear and will learn to live a full life even with this serious disease.
The results are encouraging
Five years ago, doctor Virginija Ežerskienė organized trainings for cardiologists at the hospital, so that cardiologists would not make mistakes when recruiting patients for training in the Heart Failure Room. According to the doctor, the most important thing is for the patient to be motivated to change his life and to understand that the doctor will not constantly check and monitor him, but he will have to take care of himself and his well-being. Cardiologists spend a lot of time selecting motivated patients.
Currently, NT-proBNP (a marker of heart failure) is tested for every patient who has symptoms of heart failure. The study is intended for acute, chronic heart failure detection, monitoring and selection of patients with the highest risk of heart failure. Also, this test is performed to assess whether the patient is being properly treated for heart failure. When the results recorded in the patient’s self-monitoring diary worsen, the doctor conducts a blood test to determine the amount of potassium, doctors are happy, and if necessary, an ultrasound of the heart is also performed. Therefore, the NT-proBNP test is performed for each patient. For this, blood is taken from a vein in the arm.
The most frustrating thing for doctors is when heart failure indicators improve, but the general condition of the patient worsens. This happens when the patient also has other diseases.
An impedance test is performed on a patient who has come to the Heart Failure Clinic for the second time. As part of the heart failure program, the hospital recently purchased a new generation bioimpedance electrocardiography machine, which is designed for non-invasive monitoring of patients’ hemodynamic parameters. The patient’s dry weight is examined and excess fluid is determined. After purchasing this device, the procedures are performed in the cardiologist’s office in a non-invasive way, and this painless and very safe procedure takes about 5 minutes.
Then other necessary tests are performed: heart rate, arterial blood pressure are measured.
The most important thing for a specialist working in a heart failure office is to review the self-monitoring diary of a patient with heart failure, which is filled out by the patient himself. He weighs himself daily, checks his heart rate and arterial blood pressure. By registering these parameters every day, the patient himself can clearly see whether his well-being is improving.
The patient learns not only self-control in this office. The doctor and nurse teach how to behave when some parameter worsens. In such cases, patients call the Heart Failure Office and V. Ežerskienė and R. Ščefanovičienė adjust the amount of medications they take, specify the amount of salt they use, diet, and even physical activity. Especially since innovative drugs are already used to treat this disease, which help to get rid of the troublesome symptoms – weakness, fatigue, and protect against exacerbations of the disease.
Tags: life expectancy patient depends
-
