Pumping Marvellous

Heart Failure Rehab rears its ugly head again

We presume this article rings bells with people?

More heart patients should benefit from cardiac rehabilitation, health campaigners have said. They made the plea after new figures showed just 3% of eligible patients with heart failure were offered this, compared to about two-thirds of those who have had either a heart attack or cardiac bypass surgery.

Across Scotland, a total of 65.2% of heart attack patients were referred for cardiac rehabilitation, as were 68.5% of people who had bypass surgery. But just 3.1% of those with heart failure were referred for rehabilitation, along with only 7.4% of those with unstable angina. Pumping Marvellous find this digraceful and this indicates the attitude towards Heart Failure and how to deal with the ever growing problem by the NHS.

While 7,845 heart attack patients were referred for rehabilitation between April 2010 and March 2011, only 144 people with heart failure and 340 with unstable angina were put forward.

The British Heart Foundation (BHF) Scotland and Chest, Heart and Stroke Scotland are now calling for more of these patents to benefit from the treatment. The two charities argued that rehabilitation only costed about £600 per patient, and could help save lives, with heart patients 30% less likely to die over a 10-year period if they have taken part in a cardiac rehab programme.

Ben McKendrick, senior policy and public affairs manager at BHF Scotland, said: “Cardiac rehab saves lives but there is an unacceptable gulf between the levels of support offered to patients with different heart conditions.

“When someone suffers a heart problem – be it angina, a heart attack or heart failure – they not only suffer a damaged heart but often a damaged spirit as well. Heart patients tell us that cardiac rehab helps mend that spirit and puts them on the road to living a full life again.”

Scottish Health Secretary Nicola Sturgeon said “excellent” progress had been made in offering rehabilitation. She said: “In 2007 around 45% of people in the clinical priority groups had access to cardiac rehabilitation, this figure has now risen to 65%. While this substantial increase is a great achievement, we recognise that there is still much more to do to help improve the quality of care for people living with heart failure.

“Our National Advisory Committee on heart disease will continue to work closely with cardiac services and the voluntary sector to take this forward. Our focus is not just on providing the best possible care in the acute setting, but also on helping people’s longer-term recovery in their own communities.”

Is Telehealth really the solution?

There is currently a lot of reporting in the press on “Telehealth” trials and how it could save the NHS £billions by remotely monitoring a patients condition. I suppose what they are intimating is it’s like having a nurse at the other end of the phone 24hrs a day 7 days a week. We do agree that this approach is a good addition to services for people with long term conditions that need managing however what a machine can’t help you with is the emotional isolation from information that a human can give. The output is black and white.

It is all well a good that these systems can save valuable resource in the long term however our opinion is that if clinicians become over reliant then patients will inevitably make mistakes, not be consistent how they use the telehealth system, a bit like forgetting to take your prescribed medicines and therefore you get to a “what’s the point in having it” as misinformation is worse than no information sometimes. You will also have the spectre of “Big Brother” looking over your shoulder. Many patients are brusied and battered with the torrent of information that they recieve and a lot of the time if this information is not delivered correctly it can be seen as “Big Brother” telling you what to do. The system is great for producing Health Data.

There is a place for “Telehealth” in the pathway to self management but it is only one element and should be treated as an information provider not as a golden solution. Unfortunatley the obsession with this system has led to yet another justification that it’s all about saving money.

The seasonings aisle at the supermarket can be overwhelming, especially if  you’re trying to find a healthy alternative to salt. There are many seasoning  products on the market and the ways the food industry promotes them can make it  difficult to find a healthy choice.  Sea salt has long been touted as a  healthy alterative to table salt and it’s no surprise that 61% of respondents in  a survey conducted by the American Heart Association believed sea salt to be  low-sodium alternative to table salt. Sea Salt is no better for you than normal table salt.

There are many other products  that are marketed as being healthy alternatives to salt. Commercial “salt  substitutes” are one such product.  Most salt substitutes contain potassium  chloride in place of sodium chloride.  By replacing sodium with potassium  in the chemical structure of salt, food scientists have developed a variety of “salt substitutes” that taste similar to table salt and that can help reduce  overall sodium intake when used in place of table salt.

You might be using a potassium based salt substitute  without realising it. It would be wise to go through your cupboard and  check ingredient labels — if you see potassium chloride listed, the seasoning is  a potassium based salt substitute.

British Red Cross First Aid Training

Pumping Marvellous has teamed up with the British Red Cross to train Heart Failure patients and their Carers on basic First Aid techniques that are pertinent to their conditions. Below you will see Jason who is the Pumping Marvellous Tai Chi instructor refreshing his First Aid Training and a Heart Failure patient learning CPR.

Giving CPR

CPR and Defib training

If you know what a Bounty Pack is then visualise this as a concept if you don’t put Bounty Pack into Google and you will find out about it. Pumping Marvellous has developed a Heart Failure Toolkit which will help Heart Failure patients along with their carers and families to manage this long term condition.  It is a lifelong toolkit for self-management.

We would like to have your thoughts and have therefore put the project out for consultation. We would like you to tell us what you think should go into this toolkit, what you would expect to see in this toolkit if you were a newly diagnosed patient, a carer or member of the family.

All feedback and recommendations are well received and hopefully we can pull as comprehensive a pack together and make a real difference to patients and the way they manage their Heart Failure in the community.

1,000,000 people in the UK suffer from Heart Failure and over 6,000,000 in the US. You may know one and if you do give some thought to some feedback that could make a real difference.

Contact us via a Facebook post  or email hearts@pumpingmarvellous.org or friend us on twitter @pumpinghearts and send us a DM.

Thanks for considering this, the Trustees.

Has our idea been stolen?? read on as it shows we are all focussued on the correct areas.

An old-fashioned checklist has the potential to keep patients with heart failure out of hospital — and save money for  health services around the world.

The checklist aims to help ensure that patients stay healthy after discharge, instead of quickly returning to the hospital because their symptoms return or get worse, according to a study of 96 patients presented at the American College of Cardiology‘s annual meeting. The list prompts doctors to make sure that patients understand when and how to take their medications, for example, and how to monitor their blood pressure and modify their diet and exercise.

All patients in the study had been admitted to the hospital for a heart problem. Researchers then randomly assigned half to go through the 27-point checklist before leaving the hospital, and half to get the usual discharge instructions.

Only 2% of patients whose doctors used the checklist were readmitted within a month, compared to 20% of other patients, according to the study, led by Abhijeet Basoor, from St. Joseph Mercy Oakland Hospital in Pontiac, Michigan. Readmission rates continued to be much lower after six months, as well, with 23% of checklist patients returning to the hospital in that time, compared to 42% of others.

Patients whose doctors used the checklist were more likely to be taking the proper drugs for blood pressure, as well, Basoor said. Using the checklist, which incorporates advice from broadly accepted guidelines, should take only a few minutes.

“It’s a reminder to do things that they should be doing anyway,” Basoor said. “If they are doing these things anyway, it shouldn’t add much time.”

The checklist prompts doctors to make sure that patients are taking recommended medications and have been counseled to follow a low-salt diet and to watch for early warning signs that their disease is getting worse, such as leg swelling and weight gain, instead of waiting for an emergency that could send them to the emergency room, Basoor said. The checklist doesn’t require that doctors provide detailed nutritional counseling, but it does prompt them to schedule a consultation with a nutritionist before patients leave the hospital. Studies show a “hospital effect,” Basoor said, with patients more likely to take medications if they are prescribed in a hospital, instead of at a doctor’s office.

In general, about 25% to 40% are readmitted within 30 days of treatment, a problem that costs governments around the globe dearly. Previous studies have shown that half of these readmissions could have been prevented with better care or education.

Educating patients before discharge is a critical part of care, says cardiologist Steven Nissen, of the Cleveland Clinic, who wasn’t involved with the study. That’s because heart failure patients often take a half-dozen drugs or more. Patients sometimes stop taking their medications, or take them irregularly, especially if the drugs don’t offer any immediate symptom relief.

As few as 20% to 50% of patients prescribed a statin to lower cholesterol actually take them, says Nove Kalia of the University of Saskatchewan in Canada. Kalia presented two studies exploring ways to motivate patients to change their behavior. He showed them their coronary artery calcium scoring, an imaging test that uses a CT scanner to take pictures of the heart, which can show patients a build-up of calcium in their hearts. Very high levels of calcium increase the risk of a heart attack. Seeing those images helped patients visualize their heart disease, Kalia said. Among those with high scores, patients who saw images of their hearts were 2½ times as likely to take their statin drugs and more than three times as likely to lose weight. Most patients lost around five to 15 pounds, he said.

Seeing these images can be a “come to Jesus moment” for many patients who aren’t taking their heart risks seriously, said Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who wasn’t involved in the studies.

Like all CT scans, these tests expose patients to radiation. Even the cheapest versions cost hundreds of dollars, Kalia said. And while he doesn’t advocate performing the scans solely to motivate lifestyle change, Kalia said it makes sense to show the pictures to patients if they’ve already been taken.

Checklists have virtually no costs or side effects, Nissen says.

And while checklists may seem like a simple idea, they’re considered crucial in other high-risk industries, such as aviation, Nissen says. “There is a reason why pilots do a checklist before takeoff,” Nissen says.

Patterson called checklists “a low-tech, innovative way to save money and take better care of patients,” noting that, “Medicare and insurance companies are shining a bright light on heart failure readmission rates. We know they are a significant component of the cost of care for heart failure.”

Atul Gawande, a surgeon at Boston’s Brigham and Women’s Hospital and author of The Checklist Manifesto, noted that the checklist study was very small, and only involved one hospital. He said he would like to see the checklist study evaluted in a peer-reviewed journal to make sure it’s sound.

Peter Pronovost, a physician at Johns Hopkins University who has pioneered the use of checklists to prevent hospital infections and other complications, said making a list is only a first step. Getting hospital staff to use these kinds of standards can be a challenge. He’s found that it’s important for staff to be able to give feedback and for officials to measure their results. Really successful checklists can require changing an institution’s culture so that doctors and others will accept these kind of suggestions from others.

Still, Gawande said, “this is extremely encouraging. … This is exactly the kind of area in which a well-designed checklist would be expected to have a dramatic impact. …They show that the benefits could be extraordinary.”

Heart Stars in the Press

Mirrens story is going out in the Lancashire Evening Post on Saturday – she said she didn’t want to see a photographer today as she needed to get her hair done!!!! so she has agreed tomorrow for the photos and in the press Saturday!!!! be on the website as well

Visit Heart Stars

Pictures from our Heart Day Event in Blackburn

Eat Well Plate

Children at Queen Elizabeth Grammar School Exercising with the Blackburn Health Team

Children listening to their Heart

Can Cocoa help Heart Failure Patients?

So is Dark Chocolate good for Heart Failure patients – interesting article for Dark Chocolate lovers.

Patients with advanced heart failure showed improvement after three months of consuming epicatechin-enriched cocoa, U.S. researchers said. Dr. Francisco J. Villarreal of University of California, San Diego, said epicatechin is a flavonoid found in dark chocolate. The researchers examined five profoundly ill patients with major damage to skeletal muscle mitochondria, structures responsible for most of the energy produced in cells. These “fuel cells” are dysfunctional as a result of heart failure, leading to abnormalities in skeletal muscle, Villarreal said.

Patients with heart failure experience abnormalities in both the heart and skeletal muscle that can result in impaired functional capacity. They often complain of shortness of breath, lack of energy and have difficulty walking even short distances. Trial participants consumed dark chocolate bars and a beverage with a total epicatechin content of approximately 100 milligram per day for three months. Biopsies of skeletal muscle were conducted before and after treatment.

After three months, the researchers looked at changes in mitochondria volume and the abundance of cristae, are internal compartments of mitochondria necessary for efficient function of the mitochondria. “The cristae had been severely damaged and decreased in quantity in these patients,” Villarreal said in a statement. “After three months, we saw recovery — cristae numbers back toward normal levels, and increases in several molecular indicators involved in new mitochondria production.”

The findings were published in the journal Clinical and Translational Science.

Eat FRESH and manage that SODIUM

This is an excellent piece of advice from Donna Arnett president elect of the American Heart Association. In the excerpt it talks about sodium so what you need to know is the calcualtion that works this through to Salt. Here is the calculation –

“A healthy diet sustains us, but a poor diet can lead to increased blood pressure, cholesterol, blood sugar levels and weight and put you at heart disease risk.

According to Donna Arnett, Ph.D., chair of the Department of Epidemiology in the University of Alabama at Birmingham School of Public Health and president-elect of the American Heart Association, diet is only ‘one component of the overall cause of heart disease.’ But, Arnett asserted that it can exert a strong influence.

Sodium also is considered the culprit for the one in three Americans who develop high blood pressure. Sodium attracts water into your cells; the increased fluid raises your blood pressure and subsequently raises your risk of stroke and heart attack, heart failure and death, Arnett says.

Race also plays a role in risk. UAB researchers recently examined the effects of sodium intake by race using data from the ongoing Reasons for Geographic and Racial Differences in Stroke and found a stronger association with death in black participants than whites, says Suzanne Judd, assistant professor of biostatistics at UAB and the study’s lead author.

Blacks with the highest sodium intake (average of 2,600 mg/day) had a 62 percent increased risk of dying, while whites had no increased risk, she said. “This supports the AHA recommendation that there may need to be race-specific sodium guidelines, but everyone should reduce their sodium intake,” Judd says. The AHA has an aggressive sodium goal of 1,500 mg per day for everyone.

First, Arnett said, increase the amount of fruits and vegetables you eat daily, especially the leafy kind. “This provides more potassium, which is associated with lower blood pressure,” Arnett said.

“Fresh is the best source for fruits and vegetables, but canned versions can provide nutrition.” The primary drawback to canned and frozen foods is added sodium. But Arnett offers a solution: “Rinse these foods before cooking to help reduce sodium. Once rinsed, I think they are a great option for people on the go.” Fish also is on Arnett’s list of better food choices. “You should eat fish twice per week; fish are sources of the good fats associated with reduced risk of heart disease,” said Arnett.

When preparing your food, limit saturated fats such as those in butter, hard cheeses and red meats. “Avoid trans fats because they raise your bad cholesterol levels. So read food labels and look for partially hydrogenated oils, which is another name for trans fats,” Arnett says. Fats considered to be suitable for low consumption ? avocados, nuts, olives and olive oil ? are monounsaturated and polyunsaturated fats, which can help reduce the cholesterol levels in your blood and lower your risk of heart disease.

A big calorie-causing culprit is fizzy drinks and sports and energy drinks, Arnett says. “The hidden sugars in these beverages are a common cause of weight gain among young people. Limiting yourself to two 12 oz. cans per week to reduce the risk of obesity and diabetes,” Arnett added.” end