Hospitalisation due to heart failure has not reduced in recent years and, in some cases, it even continues to increase. There is also a high rate of readmission in patients within a month of being discharged from hospital, which worsens their prognosis. In many cases, the progression of this disease is characterised by a vicious circle of worsening symptoms, acute decompensation, hospitalisation and subsequent stabilisation and discharge.
An exhaustive study analysing numerous publications in this field concludes that there are five main reasons for the frequent use of health services in patients with heart failure. Firstly, the main reasons for the high rate of readmission are due to treatment not being properly or regularly adhered to, which in many cases means it is only taken when symptoms appear. On the other hand, the study observes that there is a general lack of knowledge amongst patients about the signs and symptoms that indicate someone is suffering from cardiac decompensation. The above can be summarised as a single general cause: patients do not properly understand the treatment plan and, as such, they do not properly understand their condition. Finally, on some occasions, a lack of communication between professionals at the hospital and primary care physicians has been detected, which does not help to clarify patients’ doubts.
Heart failure is a chronic and progressive condition that impacts upon the quality of life of those who suffer from it, because it limits their opportunities to carry out day-to-day activities. The main symptoms displayed by patients are unusual tiredness when making physical effort, laboured breathing due to stagnated liquids in the lungs, a persistent dry cough and a lack of appetite. Furthermore, reduced blood flow to the brain may cause a feeling of dizziness or confusion.
So that the patient can understand and identify these symptoms, and can break the cycle of being admitted to and then discharged from hospital, there are heart failure programmes that mainly focus on taking control of the disease and slowing its progress. To achieve this, patients should receive multidisciplinary care which includes periodic monitoring to adjust their treatment based on the clinical situation.
Some of the recommendations for achieving better understanding of heart failure are: educating the patient and their family, involving them in their care and treatment, ensuring that the patient recognises the warning symptoms of cardiac decompensation and putting them in direct contact with a leading healthcare professional at the Heart Failure Unit, the hospital or the health centre where they are treated. Another recommendation is giving the patient the option of visiting the hospital during the day for checks, or to carry out a rapid intervention when the primary symptoms of cardiac decompensation appear, thus preventing hospital admissions.
Furthermore, it is important to insist on the lifestyle changes that these patients should adopt to prevent the progression of the disease, such as drinking enough liquids, doing moderate physical exercise, eating a low-salt diet, avoiding smoking and drinking alcohol, etc.
By empowering the patient to take control of their condition, we can reduce the rate of admissions, and therefore prevent progression of the disease, reduce mortality and improve quality of life.
Author: Josefina Casal, nurse specialising in heart transplant, Clínic Cardiovascular Institute.