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YELP Holistic First Business Plan Defined Terms YELP Holistic First Business Plan SWOT Analysis Executive Summary Deliverables And Costs Snapshot Page To Benchmark Techniques Phil Johnston's has highlighted sections relating to exercise and physical activity Your guide to positively managing congestive heart failure The MBF Congestive Heart Failure Management Program The MBF guide to positively managing Congestive Heart Failure (CHF) is for adults and the parents of children with CHF. It may also be a useful resource for family members and other people around them who want to know more about heart failure and how they can help. The guide is part of the MBF Congestive Heart Failure Management Program, one of the programs MBF Health offers at no additional cost for members with MBF hospital cover to help them better manage their health conditions.Based on the latest information and research on heart failure, the program can assist you to take positive action to reduce its effects, enjoy life more and feel better, for longer. The MBF Congestive Heart Failure Management Program helps you take the best possible care of your health. It includes tools, resources and information such as: an MBF Congestive Heart Failure Action Plan that you can take to your doctor or cardiac rehabilitation specialist to complete (you will find it at the back of this guide). It will help you set physical activity goals and stay on track with your medication. You can learn how to monitor your everyday health and know when to seek help; Contents The MBF Congestive Heart Failure Management Program 1 What is Congestive Heart Failure? 3 Why do I need an MBF Congestive Heart Failure Action Plan? 5 How is Congestive Heart Failure managed? 7 Medications for Congestive Heart Failure 9 More information to help you with managing your Congestive Heart Failure 13 The MBF Congestive Heart Failure Action Plan 23 Where can I get further information? 33 1 April 2007. a Personal Health Record where you can record the date and results of your check-ups; information on heart failure and the best ways to reduce its impact on your general wellbeing; and a professional nursing telephone service trained to answer queries on your general health.* Medical evidence has proven that people with heart failure can reduce the risk of further heart disease with a combination of a Healthy Diet, physical activity and the right medication. The MBF Congestive Heart Failure Management Program was developed to help you do just that. Note: MBF does not pay any benefits for doctors’ and specialists’ services provided outside of hospital unless we specify otherwise under your level of cover and we have an agreement with the provider for that treatment. *Operated by ETI Australia Pty Ltd, trading as Mondial Assistance What is Congestive Heart Failure? Congestive Heart Failure is also known as CHF, Congestive Cardiac Failure (CCF) and Chronic Heart Failure. The term ‘failure’ refers to the difficulty or inability of the heart to do the job of pumping blood around the body as it needs to do. The ‘congestion’ is the build up of fluid in the lungs or typically, in the feet. If you have heart failure, it means that your heart doesn’t pump blood around your body as effectively as it should. Your heart has four chambers. The pair on the right has the job of pumping blood from the rest of the body into the lungs, where it takes up the oxygen all our cells use to function. The pair of chambers (an atrium and a ventricle) on the left then draws this oxygen rich blood from the lungs and pumps it back to the rest of the body. Heart failure is usually noticed when there is a problem with the left side of the heart (most often its lower chamber, the ventricle). When the blood isn’t pumped out properly, a number of things happen. Firstly, the body doesn’t receive freshly oxygenated blood as efficiently and effectively as it should. A steady supply of oxygen is essential for all the cells in the body. Lack of oxygen can leave you feeling tired and breathless. Reduced blood supply to the heart muscle can also cause temporary chest pain or discomfort known as ‘angina’. Secondly, when blood cannot effectively circulate, excess fluid that would normally be excreted after passing through the kidneys and other excretory organs has nowhere to go. Instead, it stays in your body. This is known as ‘fluid retention’. The fluid may stay around your heart and lungs, causing further breathing difficulty and discomfort. The force of gravity can cause fluid to stay down in your lower limbs, in the feet, ankles and calves, causing puffiness, swelling and sometimes tight, irritated skin. This type of swelling is known as ‘oedema’. Sometimes it can even accumulate in your hands and wrists, or in your lower back if you have to spend a lot of time in bed. Excess fluid retention can also cause problems because it can put strain on other organs. What causes Congestive Heart Failure? CHF is the result of damage, overwork and/or scarring of the heart. The most common reasons for this damage are coronary heart disease, often after past heart attacks and high blood pressure, which is not well controlled so that the heart has to work against abnormally high pressures in your arteries. Other causes are heart valve disease and congenital heart problems that you are born with. There is a broader range of conditions that can affect various organs of your body and sometimes have similar effects on the heart. One of these is excessive alcohol intake over a long period of time. Sometimes, viral infections can cause generalised damage to your heart muscle, though this is rare. Any of these conditions can cause the heart muscle to not function properly, a condition known as ‘cardiomyopathy’. Who is affected? The National Heart Foundation of Australia (Heart Foundation) estimates that there are around 300,000 people living with some degree of heart failure, while another 30,000 people are newly diagnosed with it each year. It may be that the incidence is even higher, because there are no definitive tests to confirm the diagnosis. Disturbingly, the number of people with some degree of heart failure is growing due to our ageing population and it is the only cardiovascular condition not to have declined in recent years. Why do I need an MBF Congestive Heart Failure Action Plan? CHF is one of the most common reasons for deterioration of quality of life, usually as we get older. As well as severely limiting your ability to live an active life, it is also one of the most common reasons for admission to hospital for the elderly and all too often results in death. The treatment of many types of chronic disease is difficult because the disease progresses slowly and you may not be aware of the deterioration. However, once heart failure becomes severe, the deterioration is easily recognised. For this reason, it’s better if the condition can be diagnosed early so that it can be arrested before getting worse. Taking effective action to manage heart failure and its symptoms is important for a number of reasons. It can reduce the risk of: * further heart problems and possibly hospitalisation; * other serious health problems such as kidney failure; * your heart stopping suddenly if you have severe disease; and * many of the uncomfortable and debilitating effects of heart failure so that you feel better more of the time. In addition, treating your heart failure effectively will probably have beneficial effects on other chronic conditions you may have. It can enable you to enjoy more physical, social and other activities and to have more fun. It can also increase your understanding of your own health, so you can be more confident about what you can and cannot do. In this way, you can be alert to the signs that indicate you might be in need of urgent medical help. Evidence suggests that people who take an active role in managing heart failure and adopt the strategies provided in this guide will have the best success in achieving their goals. Taking positive action can allow you to help you and your doctor to slow down the progress of heart failure and perhaps prevent any further deterioration to your health. What to expect when you visit the doctor A careful physical examination is important for the initial diagnosis of CHF and to identify the potential causes and aggravating factors. An ongoing evaluation of the status of the disease is also necessary to manage your health. It is recommended that even with moderate heart failure, there is a comprehensive clinical assessment and investigation to determine whether there are any reversible causes of heart failure. Your doctor will determine the clinical level of your limitations and this will, in turn, make a difference to the treatment recommended to you. Investigations may include an ECG (electrocardiogram), chest X-ray, blood tests and possibly an ultrasound scan (echocardiogram) that visualises the actual pumping of the heart and how effectively the heart pumps the blood through. Other investigations will be performed to exclude any other factors that might be contributing to or affecting your heart failure. How is Congestive Heart Failure managed? Although in most cases there is no cure for CHF, we do know that effective management may slow down or even stop the progress of the disease. It can also reduce the debilitating symptoms and increase your quality and length of life. The active management of this disease provides you with the opportunity to become aware of the causes of heart failure and the strategies for optimising your heart function. Despite the damage to the heart, you can learn to minimise the symptoms and perhaps arrest the progress of any further damage. Often, there is no single way to manage CHF. The best results are achieved using a combination of medication, a healthy lifestyle and self-monitoring so that you don’t allow the symptoms to progress. It is usually helpful for members of your family to be informed and counselled by the doctor about your condition and your program for management. They can get involved and help you to follow your program and they may even notice any changes in your condition before you do. Once your CHF is being managed, the Heart Foundation recommends the following guidelines1 for seeking medical attention. You should contact your doctor if you are experiencing: * weight increases of more than 1.5kg in one day; * shortness of breath and NOT exercising at the time; * very rapid heart beat; * increased swelling in your ankles, legs or abdomen; * a high temperature, or you are shivering or confused; * coughing fits, especially at night; * more tiredness than usual; and/or * redness, swelling or tenderness in your joints. It is also advisable to visit your doctor if you have asthma and need more medication than usual. Medications for Congestive Heart Failure A number of different medications are often used in the treatment of CHF because it can have various causes and symptoms. Some medications are used to treat the underlying heart condition that causes your heart failure such as coronary artery disease and/or high blood pressure. Commonly, other medications are used to treat the symptoms of heart failure itself, for example, fluid retention. It is important to remember the following points about your medication: You may need to take several different medications together to get the maximum, or adequate benefit. If this is the case, you may need to discuss this with your doctor and pharmacist regularly. It is also recommended that you check that you are taking them all in the correct manner, otherwise you may need to modify your treatment. There is a general consensus among international researchers about which drugs should be included in your treatment regime, depending on the extent of your symptoms. You can help maximise your health by working with your doctor to check that you are getting the benefits of those medicines. Because of the complexity of symptoms and underlying causes of CHF, there may be a period of trial and error before the combination of medicines that is right for you can be found. During this adjustment period your doctor may want to try different options or doses if the first does not succeed. For this reason, it is important to take your prescribed medicines in the right dose at the right time, even though it is not always easy to do so. It is recommended that you develop a systematic approach that works for you to ensure that you always take the right medications at the right times and in the correct dose. It is also essential that you stick to your regime. You should tell your doctor and pharmacist about any other medications you are taking, such as vitamins, ‘natural remedies’ or over-the-counter cold, flu or pain medications. These other medications may alter the way your CHF medications work. The need to contact your doctor is more urgent if you are experiencing:
Managing ‘Acute Heart Failure’ Sometimes CHF can start quickly or even deteriorate rapidly. Doctors refer to ‘Acute Heart Failure’ when there is a sudden deterioration in your breathing, low blood pressure and a fast heart rate. This can indicate a medical emergency and you should call for an ambulance or get help without delay. If you or someone else is experiencing Acute Heart Failure, there are some guidelines you can follow while waiting for the ambulance or doctor. These are:
It is also important to call an ambulance by dialling ‘000’ if you have:
The MBF Congestive Heart Failure Management Program aims to help you stay on track with your medication. There are internationally accepted medication guidelines that will suit most people with heart failure. You can use these guidelines as an opportunity to check that you are on the recommended medications to match the extent of your condition. You can also, if appropriate, check with your doctor to understand why they have recommended that you be on your particular treatment. In the following section, there is a list of commonly recommended medications and what they will do for you. Medications for heart failure The following list of common heart failure medications from the Heart Foundation can help you understand your medications better. But if you are unsure, ask your doctor to explain your medications and take note of the explanations so that you can refer to it later. The medication information outlined below is for general explanatory purposes only and is not medical advice. You should always check with your doctor prior to taking any medication. ACE inhibitors Some common names for ACE inhibitors include Captopril, Lisinopril, Perindopril, Enalapril, Ramipril, Fosinopril and Quinopril. This medication helps to open blood vessels throughout your body to ease the heart’s workload. ACE inhibitors are essential in the management of symptomatic heart failure. In fact, the Heart Foundation’s guidelines for Ace inhibitors recommend that all people with systolic heart failure should be taking ACE inhibitors unless there are valid reasons why they should not. The reasons for not taking them should be noted by your doctor as ‘contraindications’ in your MBF Congestive Heart Failure Action Plan. This will make it easy for another doctor in an emergency to know what medications you cannot take and why you are or are not, on certain treatment. It is important to remember that these drugs can have side effects, which may include dry, persistent cough, nausea or dizziness. If you develop side effects, you should discuss them with your doctor.Beta-Blockers Some common names for Beta-Blockers are Carvedilol, Metoprolol and Bisoprolol. This medication helps to slow your heart rate and lower blood pressure by blocking nerves that act on the heart and other blood vessels. The Heart Foundation’s guidelines for beta-blockers recommend that most people with mild to moderate heart failure will benefit from treatment with a beta-blocker unless ‘contraindicated’, particularly if they are already taking an ACE inhibitor. Again, your doctor should note these ‘contraindications’ in your Action Plan. It is important to remember that these drugs can have side effects, which may include wheezing, tiredness and increased shortness of breath. If you develop side effects, you should discuss them with your doctor.Diuretics Some common names for diuretics are Frusemide and Thiazide. This medication helps your body to get rid of excess fluid. Patients with signs and symptoms of fluid retention should be prescribed a diuretic. These drugs are used to control the symptoms of your heart failure, such as fluid retention, especially as they relieve the symptoms faster than other drugs. Diuretics cause your kidneys to produce more urine, so it is best not to take them before you go to bed, unless you suffer from breathlessness at night. Nor is it recommended that you take them before taking a long trip because you will need to regularly go to the bathroom. You will also need to have the level of potassium in your blood monitored to make sure you are not losing excessive amounts of potassium in your urine. It is important to remember that these drugs can have side effects, which include dizziness, nausea and skin rash. If you develop side effects, you should discuss them with your doctor.Potassium supplements Some common names for potassium supplements are Slow K and Span K. Potassium supplements help maintain normal potassium levels which can become low when taking some diuretics. As a first choice, many doctors prescribe eating a banana rather than a supplement, but sometimes it isn’t enough. Side effects are unusual with potassium supplements, but in rare cases they may cause stomach upset.Aldosterone antagonist The common name for this drug is Spironolactone. This medication is a special type of diuretic that has re-emerged as helpful for people with moderate to severe heart failure. (New York Heart Association functional Class III or IV heart failure, see page 32). It helps to remove excess fluid from the body and also lowers blood pressure. Your doctor should use caution when prescribing this drug especially for anyone with kidney failure or impairment. It has the reverse effect to most other diuretics and keeps potassium in your blood, so caution is also required so that potassium levels don’t rise too high. It is important to remember that this drug can have side effects that include diarrhoea, cramping, nausea and itching. If you develop side effects you should discuss them with your doctor. Digitalis The most common brand names are Digoxin, Lanoxin and Lanoxin PG. This drug helps the heart pump more efficiently and regularly. The Heart Foundation’s guidelines for digitalis recommend that this medication may be prescribed for patients with more severe symptoms of heart failure. Other patients who have a cardiac condition known as ‘atrial fibrillation’ may also be prescribed digitalis by their doctor. This drug may also be useful if you cannot tolerate one of the drugs mentioned above or have poor function of your left ventricle (one of the heart chambers). It is important to remember that this drug can have side effects that include nausea, vomiting, altered vision and heart rhythm problems.If you develop side effects you should discuss them with your doctor. Angiontensin II receptor antagonists Some common names for this type of drug includes Candesartan, Irbesartan. These drugs have a similar action to ACE inhibitors and are sometimes prescribed when ACE inhibitors cannot be used. It is important to remember that these drugs can have side effects that include headache, dizziness, nausea and weakness. If you develop side effects you should discuss them with your doctor.Anti-coagulation and anti-platelets drugs The most common anti-coagulant drug is Warfarin and common anti-platelet drugs include aspirin and clopidogrel. These drugs help to ‘thin’ the blood to prevent or slow clotting. These are often prescribed when parts of the heart are not beating strongly and are more likely to allow blood clot formation. When you are on warfarin you will also need regular blood tests. These drugs can have side effects that include bleeding that can be difficult to stop and bruising easily. If you develop side effects you should discuss them with your doctor.More information to help you with managing your Congestive Heart Failure The following information is to help you to learn more about the day-to-day management of CHF, what complications it may cause and most importantly, how you can lower the risks of those occurring. Managing your fluid intake As fluid retention is a symptom of heart failure, one of the things that you may be asked to do is to limit the amount of fluid you drink (or eat). However, you are also likely to be treated with diuretics that override the normal bodily fluid control and increase urine excretion, so you may need to balance your daily fluid intake against your normal diuretic dose. Alcohol can increase the amount of urine you produce, so you will need to be careful that you top up your normal fluid intake, but be careful not to overcompensate. Fevers can cause increased loss of fluid, so you might need to adjust for any febrile illness, either by modifying fluid intake slightly or, on the advice of your doctor, reducing your diuretic. Smoking and heart failure If you have heart failure and you are still smoking, the risk of further and continuing heart damage resulting in premature death is dramatically increased. Giving up smoking should be your most urgent priority. Ask your doctor for advice and information to help you quit. Maintaining a healthy lifestyle We all know the value of a Healthy Diet and getting enough physical activity or exercise. If you have heart failure, this has never been more important. It is an essential requirement to stay as fit and well as you can. Studies have shown that for people with heart failure there is a close relationship between nutrition, weight, the amount of physical activity and the risk of further cardiovascular disease. An important part of staying in control of your heart condition is to exercise your heart safely and have excellent nutrition because the vitamins and minerals you take in are important in making sure your cells work to the optimum. Another consideration is to reduce the load on your heart by trimming down, losing weight and keeping your blood pressure under control. Remember, any excess body mass makes the heart work harder. The Heart Foundation has developed a number of guidelines and recommendations for the prevention and treatment of cardiovascular diseases. See the back of this guide for useful Heart Foundation contacts. Physical activity Physical activity of any kind, from walking or gentle stretching to lifting lightweights or cycling is also vital for your heart health and for helping you maintain a healthy weight. As a general rule:
A healthy state of mind It’s important to understand that depression can be treated. In the same way as you need to keep an eye on your physical health and symptoms, you should monitor your mental and emotional wellbeing. Feeling low every now and then is normal. However, if your depression continues for more than two weeks, and your low mood is affecting your ability to carry out your normal routine, it’s best to see your doctor. Dealing with these feelings is part of the path to greater control of your physical condition and your CHF. Cardiac rehabilitation Cardiac rehabilitation is an individually tailored program designed to optimise your health and help you carry out your day-to-day activities. Initially the healthcare team (which could include doctors, nurses, physiotherapists, exercise specialists and dieticians) will perform an assessment and create a program especially tailored for you. The program may include exercise training, nutritional advice and education about your condition. Other health conditions Exercise is also helpful in the management of diabetes, but it may require a different program, so check with your diabetes specialist as to the sorts of exercise you may need to include in the program. Keep a positive mindset Keep focused on a positive outcome |
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