Pumping Marvellous

Pharmacists and their useful role in managing Heart Failure 

A review shows that pharmacists play a very useful role in managing heart failure. Their involvement reduces the risk of hospitalisation which both improves patient quality of life and reduces the public health burden of heart failure.

Medications for heart failure include angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. The problem is that these are under-used. A multi-disciplinary approach, including input from a pharmacist, could perhaps improve outcomes for the patient with heart failure. Researchers at the University of Alberta, Edmonton, Canada, have looked back at research on heart failure that has involved input from a pharmacist.

The researchers found 12 studies covering over 2,000 patients with heart failure where care given by a pharmacist was compared with usual care. In seven studies, the pharmacist was the key person, helping with medication, education, adherence, and communication with the physician. In other studies, the pharmacist was part of a team looking after the patient with heart failure. The team analyzed whether involvement of the pharmacist reduced mortality and hospitalisation for both all causes and for heart failure.

There was no overall reduction in mortality with pharmacist intervention. But there was a significant reduction in hospitalisation rates, by around one third, both overall and for heart failure if the pharmacist was involved.

Heart failure is one of the leading causes of hospitalisation. These hospitalisations are, the researchers say, too often attributed to problems with medication. Therefore, more input from the pharmacist, who is the one who knows most about medication, might be expected to decrease the risk of hospitalisation.

It is also not clear from the current study what kind of pharmacist intervention makes the most difference when it comes to looking after patients with heart failure. But the finding that their work can reduce hospitalizations by one third underlines the key role medication plays in managing heart failure. Therefore, a pharmacist should always be involved in caring for the patient with heart failure.

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Heart Failure and Holdiays – Sensible in the Sun

There are some unique points you need to observe and they revolve around fluid, exposure and heat and then the normal things apply.

Ok around fluid – It is important you manage your fluids even when it is scorching hot. Be very careful how much fluid you take on board, however not being able to advise you on this as everybody is different  one of the methods to employ is to buy an atomiser, when you feel thirsty spray your water filled atomiser in your mouth. It really stops your thirst and you don’t take on lots of fluid.

If you are taking amiodarone stay out of the sun as much a possible and if you have to go in it cover up as it will make your skin photsensitive which means it will burn no matter what you do.

If you are taking betablockers you will be generally more susceptible to changes in heat, therefore where you can stay out of the heat do so.

Ok reference the general advice -

To avoid sunburn, the most important thing you can do is protect your skin. You can enjoy the sun safely by using a sun protection factor SPF of 15, spend some time in the shade and wear a t shirt and hat. Apply plenty of sun cream around your shoulders, neck and arms and then move onto your body and legs. Always follow the instructions on the back of the product, if you swim reapply regulary. Don’t forget your eyes so always wear 100% UVA protection sunglasses.

Hmm those warm breezy days

Heart Failure Patients preparing for their holidays

It’s not as straight forward as it looks and it’s a good idea to get your carer involved with the preperation of your Holiday. Ok it’s not rocket science but in our opinion it is better to be prepared than not. Whether you are going on a domestic holiday or you are flying away somewhere you should do some research and always involve your carer.

Research tips -

Contact your clinician and check you are ok to fly and visit the country you want to go to. Check the airlines policy on you flying and if you have insurance check it is valid or whether you need a doctors note?
What’s the temperature?
What is the climate like? is it humid or is it a dry heat this can make a big difference
Medical facilities? what do they look like
Take into consideration what your carer thinks dont just be gung ho
Accomodation – make sure it is accessible for you eg steep walks and lot’s of stairs?
Make sure you are not too remote, it’s better to be close to facilities than a long walk
Assess the type of holiday, cruise, coach tour, beach, adventure etc etc this always creates a physical demand and if you know your capabilites then you will make the right choice for you and your carer.

Once you have assessed your ability for your holiday we would suggest you take the following notes into account and use it as a checklist -

• Get your Doctors note – Get your Doctor to include in that note all your current medication, include doses and generic names as well. This is very important as what your drugs are called in the UK maybe and probably are different from your destination. For example

An anti-arrythmic drug is called and prescribed in the UK as Dronadorone however it is not called this all over the world as it is marketed as Multaq“. Another example is the Beta Blocker which in the UK we know as Bisoporol but the genetic name is “Zebeta“. If you don’t understand then make sure your doctor notes it down on your prescription list.

The reason for the doctors note is that if you get admitted to hospital then they know exactly what you are taking. For example the delays many people had over Icelandic ash cloud.

Take double the amount of prescribed drugs you need so if you are going for 1 week take 2 weeks worth of supplies – don’t forget any supplements you take as well, treat them in the same way. An example of this is the delays many people had over Icelandic ash cloud.

Use tablet holders to reduce the space whilst you are packing. Take empty flat pack pill boxes becuase of easy identification

If you take warfarin then take your yellow book with the recorded INR levels – this is an international standard and will be understood.

If you are on diuretics you may find that you get very thirsty if you are going to a destination that is hot it is important to keep yourself hydrated however you need to be careful you don’t drink too much fluid, remember alcholic drinks will dry out in even further. Take an atomiser, fill it with water and when you feel thirsty spray your mouth.

Make sure you take the appropriate sun tan lotion with an effective SPF value, I take a minimum of an SPF 30 lotion.

Take a first aid kit and in that kit take your usual pain killers, most Heart Failure patients cannot take anything other than a parcetamol/co-codamol based pain / fever reliever. Very very important don’t rely on local facilities at your destination. Be prepared and prepare well.

These are just snippets of information so keep watching pumping marvellous over the next 10 days as we will be posting lots of useful information

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Frightening Similarities

As you may or may not know one of the goals of Pumping Marvellous is to get Heart Failure patients to the specialists in cardio care they deserve. See our main site for our goals pumpingmarvellous.org.

In December 2010 the National Heart Failure audit indicated at least 5,000 sufferers in the UK die needlessly each year because they are treated on the wrong hospital wards, while others are prescribed too little medication to be effective.

The June edition of the American Heart Journal reported nearly 70,000 Americans die each year because they do not receive optimal therapy as called for in guidelines promoted by national health authorities, researchers said Monday. Physicians have been slow to implement many of the procedures called for in the guidelines, according to the first national study of adherence to the treatment goals, the team reported in the June edition of the American Heart Journal.

Dr. Gregg D. Fonarow of UCLA’s Geffen School of Medicine and his colleagues studied six evidence-based therapies for heart failure, using data from clinical trials, in-patient and out-patient registries for heart failure patients, quality-of-care studies and other published sources.The six treatments are highly recommended for heart failure patients by the American College of Cardiology and the American Heart Association. The researchers found that 2,644,800 heart failure patients were eligible for the therapies, but did not receive them. The total number of potential deaths that could be prevented each year with optimal implementation of all six therapies is 67,996, they reported.

The therapies included four different families of drugs, cardiac resynchronization therapy (which helps coordinate heart contractions and arrythimias) and implantable cardioverter-defibrillators (which shock hearts beating erratically back into a normal rhythm). The estimated number of lives that could be saved by wide implementation of each therapy, they estimated, are:

– Aldosterone antagonists, 21,407.

– Beta blockers, 12,922.

– Angiotensin-converting enzyme (ACE) inhibitors, 6,516.

– Hydralazine/isosorbide dinitrate, 6,655.

– Cardiac resynchronization therapy, 8,317.

– Implantable cardioverter-debrillators, 12,179.

The findings “have significant clinical and public health implications” because tens of thousands of lives could be saved with optimal implementation of the therapies, Fonarow said in a statement. Pointing out which therapies are not sufficiently used, he added, will push clinicians toward a more careful examination of their treatment strategies.

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Don’t get depressed with Heart Failure

Having Heart Failure myself I fully understand why people get depressed – for me the reasons for this are long and complicated however it is not all doom and gloom and if ou follow this website then it will benefit you as you will see your life in a different. I am not saying it is a substitute for clinical and professional support service guidnace but it is a realistic bolt on. Anyway here is the article.

A recent study has reported that people who have suffered heart failure and are provided treatment for depression are more likely to die, when compared to people, who don’t develop the psychological problem. It has been reported that almost 50% people, who develop the condition after heart failure and are treated for it die within a span of one-and-a-half-years.

The findings were reported after a study was carried out by a team of scientists from Denmark. The total numbers of people involved in the study were around 3,300, who had suffered heart failure. It was also reported by the researchers that people, who were the most likely to suffer a heart failure were prescribed a lower quantity of beta blockers.

Meanwhile, another research that was carried out in the UK has reported that people who suffer a heart failure and are admitted to a general ward hospital are two times more likely to die, when compared to those who receive treatment in a cardiology wards.

The study has already appeared in the journal, Heart and was carried out by a team of researchers from universities and colleges across the country.

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Variation in Mortality Rates for Heart Failure Patients

Another reason for Pumping Marvellous to exist and flourish, especially for those without support.

A major new audit of heart failure patients in England and Wales has uncovered wide variations in mortality rates.

The National Heart Failure Audit analysed 21,294 medical records for patients admitted to hospital for heart failure between April 2009 and March 2010. It found that, overall, about 32 per cent of heart failure patients died within a year of hospital admission.

The report underlined the value of cardiologists and specialist heart failure services, as mortality rates fell to 23 per cent for patients with access to these. It also showed that in-patient mortality is 12 per cent for heart failure patients on a non-cardiac ward, compared to just six per cent for those on dedicated cardiac wards.

Clinical lead Dr Theresa McDonagh, chair of the British Society for Heart Failure, said: ‘This audit shows that patients admitted to hospital with heart failure have an unacceptably high death rate.

‘Outcomes for these patients can be significantly improved by having specialist cardiology input to their care, administration of appropriate evidence-based doses of key drugs and follow-up by specialist services.’

The audit, which is run jointly by the NHS Information Centre and the British Society for Heart Failure, also revealed that many patients do not get the recommended dose of drugs such as ACE inhibitors and beta blockers.

Just 60 per cent of patients for whom dosing information was available were prescribed beta blockers – which can reduce mortality by around a third – and two-thirds received less than half of the recommended dose.

And of those patients for whom information was available on ACE inhibitors – which can halve mortality during the first year after discharge – half received less than 50 per cent of the target dose.

Dr Mike Knapton, associate medical director of the British Heart Foundation, said that treatment for heart failure should be given the same priority as that for heart attacks.

‘But while there have been huge improvements in the management of heart attack patients, the same cannot be said for people with heart failure,’ he claimed.

‘There are more than 700,000 people living with heart failure in the UK and this number is set to increase, so it’s vital we address this issue.’

Without sounding arrogant we could have told you so on each statement made within the commentary above.

Driving on drugs

Warnings given on over-the-counter and prescription drugs relating to possible driving impairments are being ignored, a new study has claimed. Road safety charity Brake conducted the survey, which discovered that one in eight drivers do not check whether the medication they are taking could affect their driving ability.

The charity is concerned that some road traffic accidents may be caused by people becoming drowsy behind the wheel after taking drugs like Beta Blockers or anti-

depressants.

The Royal College of GPs is calling on pharmaceutical companies to employ a simple to understand ‘traffic light’ colour coding system to warn drivers over the dangers of various medications.

Professor Steve Field of the Royal College of GPs told the BBC:; “I think the public is unaware of the side effects of these common drugs.”

What are Beta-blockers

Beta-blockers have been proven to extend life and improve the symptoms of heart failure. Your doctor may start you on a low dose and increase it over a few weeks or months.

All beta-blockers have names that end in lol. There are several different beta-blockers, including atenolol, bisoprolol, carvedilol and metoprolol.

They work by slowing your heart rate and reducing blood pressure. Your doctor will probably start you on a beta-blocker after you have started taking an ACE inhibitor.

The most common side effects are tiredness, cold hands and feet, insomnia, dizziness or giddiness.

Beta-blockers

Commonly associated with some sports people for the wrong reasons.

Beta-blockers have been proven to extend life and improve the symptoms of heart failure. Your doctor may start you on a low dose and increase it over a few weeks or months.

All beta-blockers have names that end in lol. There are several different beta-blockers, including atenolol, bisoprolol, carvedilol and metoprolol.

They work by slowing your heart rate and reducing blood pressure. Your doctor will probably start you on a beta-blocker after you have started taking an ACE inhibitor.

The most common side effects are tiredness, cold hands and feet, insomnia, dizziness or giddiness.