Congestive Heart Congestive Heart Failure Patient Failure Patient AdvocateAdvocate

Joe R. Anderson, PharmD, PhC, BCPSJoe R. Anderson, PharmD, PhC, BCPSAssociate Professor Pharmacy Practice and Associate Professor Pharmacy Practice and Internal MedicineInternal MedicineUniversity of New Mexico College of University of New Mexico College of Pharmacy and School of MedicinePharmacy and School of Medicine

Living with Heart Living with Heart FailureFailure SymptomsSymptoms

– Shortness of breath, fatigue, lack of Shortness of breath, fatigue, lack of energy, swelling, bloating, decreased energy, swelling, bloating, decreased appetite, difficulty sleepingappetite, difficulty sleeping

– Symptom burden effects quality of Symptom burden effects quality of life and ability to function life and ability to function (Eur J Cardiovasc (Eur J Cardiovasc Nurs 2005;4:198-206)Nurs 2005;4:198-206)

– Depression, anxiety, confusion Depression, anxiety, confusion (Eur J Cardiovasc Nurs 2005;4:198-206; Arch (Eur J Cardiovasc Nurs 2005;4:198-206; Arch Intern Med 2001;161:1849-56; Am Heart J Intern Med 2001;161:1849-56; Am Heart J 2006;152:940e1-940e8)2006;152:940e1-940e8)

Living with Heart Living with Heart FailureFailure MedicationsMedications

– Minimum of 2 drugs (ACE inhibitor and beta-Minimum of 2 drugs (ACE inhibitor and beta-blocker)blocker)

– Typically, 3 to 5 drugs to control heart Typically, 3 to 5 drugs to control heart failure (diuretic, digoxin, spironolactone, failure (diuretic, digoxin, spironolactone, angiotensin II receptor blockers)angiotensin II receptor blockers)

– Additional medications typically needed for Additional medications typically needed for other cardiovascular conditions or co-morbid other cardiovascular conditions or co-morbid disease states (exp: aspirin, cholesterol-disease states (exp: aspirin, cholesterol-lowering medications, nitroglycerin)lowering medications, nitroglycerin)

Living with Heart Living with Heart FailureFailure Lifestyle ModificationLifestyle Modification

– Taught to recognize signs and Taught to recognize signs and symptoms of heart failure symptoms of heart failure ((Circulation 2007;116:1549-54.)

– Low-sodium dietLow-sodium diet– Supervised exercise program Supervised exercise program

(Circulation 2003;108:554-9.; Circulation 1999;99:1173-(Circulation 2003;108:554-9.; Circulation 1999;99:1173-82.) 82.)

– Discontinue harmful behaviors Discontinue harmful behaviors (tobacco, alcohol, illicit drugs)(tobacco, alcohol, illicit drugs)

Circulation 2007;116:1549-54.

Living with Heart Living with Heart FailureFailure Healthcare VisitsHealthcare Visits

– Heart failure clinic visits may be every Heart failure clinic visits may be every 2 weeks initially for medication 2 weeks initially for medication titration and patient education.titration and patient education.

– Cardiac rehabilitation three days a Cardiac rehabilitation three days a weekweek

– If have a cardiac device, need follow-If have a cardiac device, need follow-up every 3 – 6 monthsup every 3 – 6 months

– Primary care provider visitsPrimary care provider visits

Living with Heart Living with Heart FailureFailure CostsCosts

– MedicationsMedications– FoodFood– Clinic visitsClinic visits– TransportationTransportation

Disability ProcessDisability Process

Application processApplication process– Confusing to patient and providerConfusing to patient and provider– Limited time for providers to assist Limited time for providers to assist

patient with processpatient with process– LengthyLengthy– Rule of “3”Rule of “3”

Disability ProcessDisability Process

Application processApplication process– Patient quotes:Patient quotes:

““They try to discourage you in hope that They try to discourage you in hope that you will give up.”you will give up.”““I would give anything to be able to work I would give anything to be able to work again.”again.”““They don’t realize that in addition to the They don’t realize that in addition to the medications and doctor visits, we have to medications and doctor visits, we have to pay for food, property taxes, utilities, car pay for food, property taxes, utilities, car and home insurance, phone bill.”and home insurance, phone bill.”““The hardest thing was having to ask our The hardest thing was having to ask our daughter to lend us money to buy food.”daughter to lend us money to buy food.”““I’m not any good to nobody.”I’m not any good to nobody.”

Disability ProcessDisability Process

ConclusionConclusion– Heart failure is a condition that affects Heart failure is a condition that affects

both physical and mental well being both physical and mental well being resulting in functional limitations.resulting in functional limitations.

– If patients and providers manage If patients and providers manage appropriately, the functional appropriately, the functional limitations can be improved and limitations can be improved and stabilized.stabilized.

– Appropriate management requires the Appropriate management requires the patient to have adequate financial patient to have adequate financial resources.resources.

Disability ProcessDisability Process

ConclusionConclusion– My wishMy wish

Provide temporary SSI or SSDI to Provide temporary SSI or SSDI to patients with heart failure provided they patients with heart failure provided they have valid documentation of their have valid documentation of their condition.condition.

Reevaluate their status at 6 or 12 Reevaluate their status at 6 or 12 monthsmonths

Simultaneously, appoint patients to Simultaneously, appoint patients to vocational rehabilitationvocational rehabilitation