A New Program’s Focus on Managing Chronic Heart Failure
When you have heart failure, your heart can’t work hard enough to pump blood through your body. As the blood flow in your body slows down, fluid can leak into your lungs and other tissue. This fluid is the congestion that is frequently seen in heart failure.
Signs of heart failure
One of the most common signs of heart failure is shortness of breath. This is caused by excess fluid in the lungs. It can happen when you’re at rest or when you’re exercising. Other signs include:
- Sudden weight gain
- Swelling in the legs or ankles
- Swelling or pain in the abdomen
- Trouble sleeping, and waking up short of breath
- Dry, hacking cough
- Loss of appetite
Most of the time, people don’t notice heart failure symptoms until the condition has been present for quite a while—sometimes even years. That’s because your heart adjusts to the pumping difficulties by becoming larger, by strengthening its muscle fibers and by contracting more frequently. These adjustments can delay the symptoms, but eventually, the heart cannot keep up, and the symptoms of heart failure appear.
Heart failure is one of the most common health problems. It’s a chronic condition that affects approximately 4.9 million people in this country. When patients, along with their healthcare team, manage CHF well, hospital visits are decreased, stays in the hospital are shorter and patients feel better.
But to manage heart failure well, you need a system that helps doctors stay on top of the latest research findings, that helps patients understand the lifestyle changes they need to make, and that helps patients and their healthcare providers work closely together to meet common goals.
At Catholic Healthcare Partners, a new initiative is doing just that—helping patients and healthcare providers manage CHF as effectively as possible. The overall goal of the project is to improve the quality of care for heart patients by translating the latest research findings into improved patient outcomes.
The Heart Failure Gap Project at CHP
CHP is one of a 22 healthcare organizations in the U.S. participating in the Partnerships for Quality Projects. The federal Agency for Healthcare Research and Quality is sponsoring and funding the project. This collaboration helps all of CHP’s hospitals bring the latest guidelines directly to the patient. CHP’s regions are building their knowledge base, improving care by using protocols that are proven to work, and identifying new ways of getting guidelines implemented quickly.
Why the focus on CHF? According to Margie Namie, Director of Clinical Quality Improvement and Patient Safety at CHP, “CHF is the number one problem in our own health system and in the U.S. It’s a huge problem. And it’s chronic, so we nee to know how to manage it over time. We want to better understand how to do that, and how to teach patients and families how to do that, and maybe avoid hospitalization in many cases.”
Improved coordination of care, increased follow-up at discharge
“Many times,” says Namie, “patients say, ‘I go to my cardiologist for my heart problems, I go to my regular doctor for routine care, but are they really talking to each other? Do all my healthcare providers know what’s going on with me?’
“Under this new program, care is better coordinated, “says Namie. “All the people who care for them will be brought closer around them. They’ll feel like there’s a conductor coordinating care for the project.”
The Heart Failure Gap Program doesn’t affect only what’s going on in the hospital. Patients who leave the hospital are followed closely after discharge. The Heart Failure Gap Project includes “telemanagement clinics,” from which a nurse follows up on patients’ weight, medication and other issues in the management of CHF. “The calls gradually decrease as the patient learns about day-to-day management of care,” explains Namie.
What are the patient’s responsibilities?
Although hospitals are responsible for providing high quality care, CHF patients have important responsibilities for their own care as well. “In the old model,” says Namie, “you had what we call physician-directed care. Doctors told patients what to do, and patients followed. It’s still important to listen to doctors, because their advice is important, but patients have to communicate back to the doctors.
“For example, many patients take herbal over-the-counter medicine and they don’t tell their doctors. Patients need to tell their doctors what they’re doing in their lives. And patients need to be committed to lifestyle change—cooking the right foods, exercising, reporting symptoms quickly to their doctors. Patients need to understand that having a big, special meal that’s loaded with salt really can make a difference, so they need to learn how to make that meal special without all the salt.”
Making “significant strides”
Is the Heart Failure Gap Project making any difference? “In 2003,” says Namie, “we looked at four national measures of CHF management success—the use of ACE inhibitors, extensive discharge instructions, physician assessment of heart function and physician assessment of smoking cessation. In all of our participating hospitals, we made significant strides in all four categories.”
The program has additional goals for the next two years. “We’re looking at a goal of reducing 30-day admission rates, meaning that when a patient leaves the hospital, we want to reduce the chances of a repeat visit occurring within 30 days,” says Namie. “Taking the steps to do this takes us past the hospital walls and enables us to focus on community involvement.
“And we’re also focusing on finding out about patients’ quality of life. We ask things like, ‘Do you feel better? Are you happier?’ Basically, everything we’re doing is helping us to understand how we can continue to make improvements in the way we care for our patients with CHF.”
American Journal of Cardiology, 15 April 2002; The Australian Family Physician, February 2002; Stroke, March 2000; Journal of Cardiopulmonary Rehabilitation, July-August 1999;