KTB 2013: Congestive Heart Failure

Feb 18, 2013

WSIU Radio continues its "Keep the Beat" series this week, focusing on heart issues affecting southern Illinois.

Congestive Heart Failure is an end-stage of several long-term heart conditions. Left untreated, high blood pressure, high cholesterol, diabetes and other conditions can put excess strain on the heart - and in some cases even change its structure. Those changes can cause increased fatigue, shortness of breath, and many more symptoms that drive patients to their doctor, and to a cardiologist.

Doctor Nabil Al-Sharif with Prairie Cardiovascular in Carbondale says this region has an older population, with a high number of smokers and people with a sedentary lifestyle.  All of those things are risk factors for CHF.

“It comes in because people are living longer, because we are living longer with heart disease that’s treated better. Patients are having stents and bypasses and people are living well beyond their age and they end up with heart failure.”

Dr. Al Sharif says better drugs mean longer life, but Americans need to understand that preventing chronic conditions would go a longer way toward putting off CHF:

“These medications, if started early, will prevent heart failure from developing. Diabetes is a very important issue, because we’re growing bigger and fatter as a nation. Diabetes incidence is increasing, and this also leads to heart failure in the end.”

CHF in its early stages can be reversed. But once there is structural damage or change to the heart tissue, that’s much harder. That means the longer a patient puts off seeing a doctor when symptoms come up, the less likely a reversal can be found.

Like many conditions, medicines for CHF are getting better all the time, meaning patients who are hospitalized with heart failure feel better much more quickly. But Dr. Al Sharif says sticking to the meds and lifestyle changes can be difficult:

“About 27-30% of patients are readmitted within a month of being discharged for heart failure, and half of these patients are readmitted because of noncompliance with medication or food.”

Which is why Dr. Al Sharif and Southern Illinois Healthcare are partnering to create a Cardiac Management Center - a place where patients and caregivers can get more information and support for heart failure and its guidelines.

Vicki Miller is the CHF Program Director for SIH. She’s helping to coordinate the new Cardiac Management Center. She says having that additional support for patients who are discharged can make a big difference:

“Their outcomes are not as good if they don’t have those resources to contact. Sometimes it’s merely a phone call of, ‘I have my medications and need to go over them with somebody’ or they actually need to see someone in the clinic like a mid-level provider or a physician.”

If the outcome isn’t good after a patient leaves the hospital, if they don’t take their new medicines and stick to the strict rules on diet and fluid intake, Miller says they’re more likely to return to the hospital with complications.

“It’s all about managing this condition. It doesn’t go away. It can get better, with the right medications and following your diet and recommendations from your physician.  But this is kind of a big part of this, that one-on-one, ‘OK, what don’t you understand? Let’s go over it again.’ And that’s what we really want to reinforce to them, over and over and over again. And then we want to be available for questions as well.”

Dr. Al Sharif says readmissions are costly for the hospital and the patient, and preventing them boils down to better education and more support for the patients and their family and friends:

“We can treat heart failure in three days in the hospital, the patient feels good and we send him out. A third of them will come back because we failed to make them understand that medication is very important, that their diet is very important, that their follow-up is very important.”

Both Al Sharif and Miller say it’s critical that patients have a strong support system to manage CHF successfully. They say that means family, friends and other caregivers need to have the information necessary to help each patient navigate what to eat, when to take medicine, and other issues.

“The thing people find most difficult, I think, about the whole diagnosis of heart failure diagnosis is that it’s a chronic condition. It is ongoing and the management of it is so very important to their quality of life.”

A CHF diagnosis can be devastating for a patient, many of whom think they can’t enjoy their normal life anymore. Miller says that’s not always the case, and that’s one benefit of having a Cardiac Management Center – to help those patients understand what their new life will be like.

“We want to help with that. We don’t want them to stop doing those things that they love. We want to help them maintain as much of that as possible. We can help do that through education, too, if they have questions. We can sit down with them. We’re trying to help them live their lives optimally.”

But even as there are ways to live a normal life with CHF, Dr. Al Sharif says the clinic will be critical in helping patients understand they can’t revert to bad habits just because the medicine is making them feel better.

“We have to tell them salt is no good. You can’t take more than a gram and a half. Any fast food meal is more than four grams of salt, so they have to know that they can’t do this. They can’t go for a fast food meal.”

Dr. Al Sharif acknowledges that in some areas of the region, residents depend on fast food for meals. He says education can only go so far there, and lifestyles and other choices must be changed on a larger level to turn that around.

As the Cardiac Management Center gets up and going, Vicki Miller says they are developing support groups for patients and their families, and they also eventually want to offer support groups and education for people all over the region.

Experts say as drugs and technology help people live longer, it’s likely more cases of CHF will be diagnosed. But they also say preventing the condition is key to maintaining a good quality of life as long as possible.