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Jules Grange HF Specialist Nurse Eastbourne DGH. Cardiovascular Risk Assessment. October 2010. Facts. Cardiovascular disease is the leading cause of premature morbidity and mortality in the UK Effective prevention and treatment is a fundamental priority for the NHS

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jules grange hf specialist nurse eastbourne dgh
Jules Grange

HF Specialist Nurse

Eastbourne DGH

Cardiovascular Risk Assessment

October 2010

facts
Facts....
  • Cardiovascular disease is the leading cause of premature morbidity and mortality in the UK
  • Effective prevention and treatment is a fundamental priority for the NHS
  • Early identification leads to early treatment
  • NHS Health Check programme

NICE 2010

chd statistics
CHD Statistics

CHD is the most common cause of premature deaths in the UK

CHD is the most common cause of HF in westernised countries

CHD causes approx 70% of HF cases in UK

UK has one of the highest death rates from CHD

BHF Heartstats 2006

slide4
BUT…

Death rates from CHD have been falling since the late 1970’s

46% reduction for men under 65 in the past 10 years

BHF Heartstats 2006

racial and ethnic groups
Racial and Ethnic Groups

CVD is the leading cause of death for African Americans, Latinos, Asian Americans, Pacific Islanders, and American Indians

African American women are at the highest risk for death from heart disease among all racial, ethnic, and gender groups

CHD is less common in Black Caribbean and Chinese men compared to the general population.

Chinese women have significantly lower levels of CHD than the general population.

Source: Rosamond 2008

women receive less interventions to prevent and treat heart disease
Women Receive Less Interventions to Prevent and Treat Heart Disease

Less cholesterol screening

Less lipid-lowering therapies

Less use of heparin, beta-blockers and aspirin during myocardial infarction

Less antiplatelet therapy for secondary prevention

Fewer referrals to cardiac rehabilitation

Fewer implantable cardioverter-defibrillators compared to men with the same recognized indications

Sources: Chandra 1998, Nohria 1998, Scott 2004, O’Meara 2004, Hendrix 2005, Chou 2007, Hernandez 2007, Cho 2008

slide7

Risk factors for CVD

9 major risk factors account for over 90% of the risk of acute MI

- smoking

- abnormal lipids

- hypertension

- diabetes

- obesity

- diet

- physical activity

- alcohol consumption

- psychosocial factors

Smoking and abnormal lipids account for 2/3 of the risk

INTERHEART study Lancet 2004

heart failure in the uk
Incidence likely to increase

Ageing population1

Advances in cardiac treatment which increase survival2

Projected number of Hospital admissions for HF 2011/12= 869,0003

38% die within 12 months of diagnosis4

Survival rates lower than breast or prostate cancer5

Heart failure in the UK

References: 1. Bonneuxet al. Am J Public Health 1994

2. Kelly Circulation 1997

3. Gnoni et al (2001)

4. BHF CHD Stats: HF Suppl 2002 Ed

5. Stewart et al. Eur J Heart Failure 2001

heart failure in the uk1
Heart failure in the UK

Reference: Stewart et al. Eur J Heart Failure 2001

the donkey analogy
The Donkey Analogy

Ventricular dysfunction limits a patient's ability to perform the routine activities of daily living…

shape study
SHAPE Study

29% of General Public viewed HF as ‘severe’

67% wrongly believed that more people died from cancer

66% wrongly believed that more people died from HIV

SHAPE Survey Results to the General Public Annual Congress of the European Society of Cardiology in Vienna, September 2003.

www.heartfailure-europe.com

problems with current hf management
Problems with current HF management

Sub-optimal medication at discharge1,2

Failure to emphasise non-pharmacological management2

Little patient/carer education

HF symptoms not taught

Daily weight not explained

Lack of cardiac rehabilitation

References: 1. Toal & Walker. Eur Heart J 2000. 2. Cited in Moser DK 2001.

problems with current hf management1
Problems with current HF management

Inadequate access to healthcare personnel1

Poor follow-up1

Non-compliance1

Reference: 1. Cited in Moser DK 2001.

problems with current hf management2
Problems with current HF management

Elderly patients are particularly vulnerable1

Co-existing conditions

Poly pharmacy

Cognitive/functional limitations

Isolation & inadequate social support

Financial concerns

Anxiety & depression

Reference: 1. Cited in Moser DK 2001.

problems with current hf management3
Problems with current HF management

64% of re-admissions caused by non-compliance1

54% of re-admissions are preventable2

Referencea: 1. Ghali J et al. Arch Intern Med 1988. 2. Michalsena et al. Heart 1998.

chf patient cycle
CHF patient cycle

Decompensation

Lack of follow-up

No recognition of decompensation

Lack of compliance

Hospitalisation

Home

Stabilisation

Additional medication

No additional education

No additional CHF management

why are medications not optimised
Why are medications not optimised?

Lack of knowledge/expertise

Lack of time

Difficult diagnosis

Co-morbid conditions

Lack of co-ordinated care

optimal care
Optimal care

Education

Pharmacological management

Non pharmacological management

Patient empowerment

Essential link for advice

symptoms and signs of heart failure
Symptoms and signs of heart failure

Common symptoms

Common signs

  • Dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Ankle swelling
  • Fatigue
  • Exercise intolerance
  • Weight gain
  • Anorexia
  • Palpitations
  • Memory loss
  • Tachycardia
  • Raised JVP
  • Displaced apex beat
  • Right ventricular heave
  • Basal crackles
  • Wheeze
  • S3
  • Oedema
  • Hepatomegaly
  • Ascites
  • Cachexia, muscle wasting
the patients perspective
The Patients perspective...
  • I’m tired
  • No energy
  • I really need my fags to get through the day
  • Doctor says my blood pressure is ok
  • Those tablets make me pee all day
  • I hardly eat a thing!
  • I’m out of puff
  • I can’t get my shoes on
  • Things don’t work as well as they used to
  • …But then I am getting on a bit now!
self management
Self Management

Encourage daily weights

Set targets for fluid intake as necessary

Recommend low salt diet

Maintain healthy weight

Encourage daily exercise

Reinforce benefits of medication

Encourage flu/pneumococcal vaccination

Promote smoking cessation

Consider temporary increase in diuretics according to local protocol

pharmacists role
Pharmacists role?
  • Obviously medication management
  • Look for other clues
  • Signposting to other health care providers
  • Supporting patients and families
  • Communication
  • Promoting healthy living and positive behavioural change
invitation
Invitation

To sit in on hospital based Heart Failure Clinic

Questions?

jules.grange@esht.nhs.uk

Tel 01323 417400 ext/bleep 4732