Introduction: I felt strongly compelled to write this blog on heart
failure as it is such a pertinent issue in the aging population today. Before I
go into details on this, Id like to address the definition of this disease
process. Heart failure occurs when the heart doesnt pump well and fails to
deliver adequate oxygen to the body. As a result, fluid builds up in the body
and vital organs dont get the blood that they need. This can make it harder
for individuals to perform everyday tasks and can lead to eventual overall
decline. Problem:Heart failure is the number one reason for hospital
admissions in older adults, and often leads to multiple readmissions (Agarwal
et. al., 2021). As a cardiac nurse for many years, I can attest to the fact
that heart failure is the biggest reason for multiple hospitalizations in
seniors. Patients come in and out for problematic symptoms, sometimes coming
into the hospital as often as every month. The three biggest symptoms I see
that result in hospital admissions are shortness of breath (particularly when lying
flat), weight gain, and swelling in the legs.One reason for such frequent admissions is the complexity of
heart failure itself. It is a complicated clinical syndrome and is notoriously
difficult to manage. A lot is put on patients to manage their heart failure at
home, and this can be a challenge. In addition, individuals may have some level
of cognitive impairment or multiple other comorbidities, making it even more
challenging to perform the extensive monitoring needed to prevent heart failure
from worsening. The importance of education:Education is also important in the treatment of heart
failure. Unfortunately, this often does not get done. When I first started
working in acute care back in 2004, every patient received
extensive education in managing their heart failure prior to discharge. Nurses
would provide lengthy verbal education on the importance of medication
adherence, daily weights, low salt diet, and other factors, in addition to
providing the patient with a heart failure educational pamphlet prior to
discharge. Over the years, however, hospitals have increasingly faced staffing
shortages and high nurse turnover. As a result, a lot of important patient
education is not getting addressed. A lack of awareness and understanding in
patients on how to manage their heart failure is definitely a key reason for
worsening heart failure and repeated hospitalizations. Management:From a clinician standpoint, the goal in addressing heart
failure is twofold: we want to reduce symptoms and prevent mortality. The best
way to do this is through patient/family education and implementation of a
treatment plan. A proper treatment plan will include such lifestyle
modifications as a low salt diet, quitting smoking, and getting regular
physical activity. A low salt diet can be incredibly helpful in preventing
further fluid build up in the body. The American Heart Association recommends
that all individuals consume no more than 2,300 mg of sodium
per day (AHA, 2024). In todays era of processed and packaged food, a majority
of the American population consumes much more than that, and it comes in the
food itself rather than the saltshaker. Maintaining a low sodium diet has one
other priceless benefit that I often do not see emphasized enough in heart
failure: it can help reduce blood pressure. Almost half of all heart failure
patients have uncontrolled hypertension (Heart Failure, 2022). It is a major
risk factor in the development of heart failure and managing it can greatly
reduce heart failure symptoms and decrease stress on the heart. Current
guidelines recommend maintaining a systolic blood pressure of less than 130. Medication management is another important factor in the
management of heart failure. This often includes the use of diuretics, beta
blockers, and other medication classes that I will not go into detail on. I
wanted to discuss diuretics and beta blockers because these are the two
medications in heart failure that I see non-compliance with the most. I witness
individuals often not taking one or the other for two main
reasons: they either dont understand the importance of them or they
dont like the side effects. Seniors can often have difficulty getting up to go
to the restroom. Diuretics cause frequent trips to the restroom because their
purpose is to get excess fluid off the body. Many individuals do not comply
with their prescribed diuretic because of the hassle of frequent bathroom
trips. Unfortunately, ineffective diuresis causes heart failure to worsen and
puts further stress on the heart. I often see non-adherence to beta blockers
due to their side effects. The two biggest symptoms that get reported to me are
fatigue and dizziness. As in the diuretic, a beta blocker can also help reduce
the stress on the heart, and heart failure symptoms can worsen if the
prescribed dose is not adhered to. Its important to maintain prescribed
medication regime and if any negative symptoms are experienced to discuss them
with the doctor. One final thing:I wanted to touch on one final monitoring recommendation for
heart failure because it so often gets missed: daily weights. Weighing oneself
daily is of tantamount importance in heart failure and can identify early on if
heart failure is worsening. This can lead to early intervention, thus
decreasing potential hospitalization. Adherence to this all too often does not
occur. I see patients come into the hospital for large amounts of weight gain
often 20 or more lbs. Many patients report that they never stepped on the scale
to assess for weight gain and often do not get admitted to the hospital until
symptoms are severe such as severe weakness and shortness of breath. In heart
failure its recommended to contact the doctor if weight goes up by more than 2
pounds in a day or greater than 4 pounds in a week. The doctor can make
modifications in the treatment regime and hence reduce potential
hospitalizations and mortality. Conclusion:Heart failure is complex but manageable. Early action can
prevent hospital admissions, reduce mortality, and optimize quality of life.
Having ongoing guidance from an experienced clinician can be of great benefit
if you or your loved one is having difficulty managing heart failure and other
disease processes. Please do not hesitate to reach out to me if you have any
further questions. I want to help and make the process of aging as stress free
as possible while promoting positive health outcomes. My name is Laura Carson and I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. Contact me for a 20 minute free consultation at 714-403-7040. References:Blood Pressure and Glycemic Control Among Ambulatory US
Adults With Heart Failure: National Health and Nutrition Examination Survey
2001 to 2018 (April 28, 2022). Heart Failure. Almost half of heart failure patients have uncontrolled
hypertension and diabetesAgarwal, M., Fonarow, G., & Ziaeian, B. (February 10,
2021). National Trends in Heart Failure Hospitalizations and
Readmissions From 2010 to 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC7876620/Weber, C. (May, 2023). Heart Failure Pharmacology. How much sodium should I eat per day? (2024).
American Heart Association.
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day
