Heart Failure Toolkit Launch
We have confirmed that Pumping Marvellous will be handing over it’s first Heart Failure toolkits to the NHS on 14th February 2013 on the cardiology wards at the Royal Blackburn. the HEart Failure toolkit has 42 components and is a complete self care patient management system. We believe that this is the most comprehensive discharge and educational coaching tool for heart failure patients. If you have any questions about our toolkit or would like to have the toolkit for your trust then please email us.
US Heart Failure admissions drop
Is this a welcome trend in Heart Failure treatment through adveances in medicine and both management and self management of the condition?
Hospital admissions for elderly US patients with heart failure fell by nearly 30% over a decade, an analysis of federal Medicare data shows, a surprising finding that offers fresh evidence of progress in the battle against cardiovascular disease.
The report, being published on Wednesday in the Journal of the American Medical Association, is the first to document a decline in admissions in the US for the condition, an enormously costly and debilitating problem and the most common reason for hospitalization among Medicare beneficiaries.
The finding is based on data from more than 55 million patients in Medicare’s conventional fee-for-service program who were hospitalized for heart failure between 1999 and 2008. Researchers estimated there were 229,000 fewer admissions for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels. As a result, the Medicare program saved $4.1 billion in hospital costs related to heart failure.
Coming as the US population ages and as obesity and diabetes—both risk factors for heart disease—are enormous public-health concerns, were a welcome surprise to some heart experts. Many attributed the improvements to better preventive measures and disease management, as well as a reduction in elderly patients’ rates of heart attack—a common cause of heart failure.
About 5.8 million Americans are diagnosed with heart failure, according to the American Heart Association, which estimates that total costs for treating patients, including associated indirect costs, were $39.2 billion in 2010.
Flying with Heart Failure
It’s the holiday season and before we go on talking through this frequently asked question the information in this post is purely opinion and you must always discuss with your clinician. In fact the stipulation of many travel insurance companies means that you must be certified to fly usually by a consultant. Irrespective whether you need certification we would recommend you speak to your consultant. In our opinion we feel it is crucial. Anyway here goes -
Over one billion people travel by air each year.The information in this post refers to considerations regarding fitness to fly as a passenger. This is not about assessing your ability to fly but it includes the measures which are taken into consideration when assessing your ability to fly.
The information given is general and not exhaustive; individual patients may need to have several conditions taken into account and different airlines have varied policies. The sources of advice used are only guidelines and clinical judgement should always be used in their interpretation.
Some airlines require medical certificates confirming that a patient is currently stable and fit to fly. Most have medical advisors who provide advice and ‘clear’ passengers as fit to fly. They may ask for a medical information form (MEDIF). The British Medical Association (BMA) advises doctors ‘to word statements on a person’s fitness to fly carefully, indicating the information on which the advice is based, rather than positively certifying a person’s fitness’. For example:
- ‘I know of no obvious reason why this person should not fly’; OR
- ‘There is nothing in the medical record to indicate that flying is risky for this patient’.
This ensures that the doctor is not guaranteeing in any way that this patient can travel without any problem but rather saying that, on the available evidence, there is nothing to indicate a greater risk for this person than for others. However, the doctor is partly dependent on what the patient chooses to disclose to them about past health problems.
The main factors to take into account are whether air travel could adversely affect a pre-existing medical condition and whether or not a patient’s condition could adversely affect the comfort and safety of the other passengers, or the operation of the flight. Regardless of a doctor’s opinion on this latter question, the ultimate sanction to refuse travel lies with the airline and captain of the flight. If they consider there is a risk to the aircraft or its passengers, they may refuse to carry a particular passenger.
Modern aircraft are not pressurised to sea level. Cabin altitude equivalent is usually between 5,000 and 8,000 feet which means that there is a reduction in barometric pressure and a reduction in the partial pressure of alveolar oxygen. Sometimes during flight, although not usually for long periods, oxygen saturation levels can fall to around 90%. A healthy individual can usually tolerate this with no problems but it may not be the same for someone with Heart Failure.
Basic considerations when assessing a patient’s fitness-to-fly include:
- The effect of mild hypoxia (deprivation of oxygen) and decreased air pressure in the cabin.
- The effect of immobility.
- The ability to adopt the brace position in emergency landing.
- The timing of regular medication for long-haul/transmeridian travel.
- The ability of the patient to cope mentally and physically with travel to and through the airport to reach the flight and on disembarkation.
- Will the patient’s medical condition adversely affect the comfort or safety of the other passengers and the operation of the aircraft?
- What health insurance cover does the patient have in case of problems?
Cardiovascular contra-indications to commercial airline flight include:
- Unstable angina.
- Decompensated congestive cardiac failure.
- Uncontrolled hypertension.
- Coronary artery bypass graft within 10 days.
- Uncontrolled cardiac arrhythmia.
- Severe symptomatic valvular heart disease.
- Uncomplicated percutaneous coronary interventions (e.g. angioplasty with stent placement) within 5 days – individual assessment is needed after that to ensure fitness and stability.
The decrease in oxygen saturated during air travel may affect those with cardiovascular disease. Indications for in-flight oxygen in cardiovascular disease include:
- Need for oxygen at baseline altitude.
- Heart failure – New York Heart Association’s (NYHA) Class III-IV
- Angina Canadian Cardiovascular Society (CCS) Class III-IV.
- Cyanotic congenital heart disease.
- Primary pulmonary hypertension.
- Other cardiovascular diseases associated with known baseline hypoxia (deprivation of oxygen)
It is unusual for patients to be allowed to take their own oxygen supply and oxygen is usually arranged by the airline who must be aware in advance. A fee is usually charged. This may change in the future and there are ongoing discussions regarding this.
Patients with pacemakers and implantable cardioverter defibrillators can fly once medically stable
The article below is commenting on the new “polypill” that is being touted around medical circles as being the answer to reduce cardiovascular disease and some cancers. Obviously not commenting on the Cancer element then for cardiovascular disease there is no substitute for a Healthy Lifestyle. What we are concerned with is that people will not look after them selves more readily if they think they are taking the “miracle” pill, in other words the pill will somehow cleanse them!
Anyway enjoy the read below and understand it for what it is and build your own opinion around it.
Researchers say the combined red heart ‘polypill’ could reduce deaths from bowel cancer, kidney failure and cardiovascular disease. The four-in-one drug combines low-dose aspirin, a statin called simvastatin to reduce cholesterol and two blood pressure-lowering medicines, lisinopril and hydrochlorothiazde.
Separate pills are already prescribed to millions around the world to lower their chances of heart attacks and strokes. But many doctors believe a combined pill could save more lives, save the NHS money and be more convenient for patients. Some even argue that a heart-boosting polypill should be taken by everyone over 55 to cut the risk of disease.
The pill will cost £4 a month per patient, but it is unlikely to be available in Britain for several years. Scientists say larger trials are needed to test whether the drugs are best provided in the form of a polypill, or as separate medicines. The latest study, published yesterday in the journal Public Library of Science One, tested the pill on 378 people who did not already need any of its components, but who had more than a 7.5 per cent estimated risk of cardiovascular disease. Twelve weeks after the start of the study, experts analysed the effect of the drug on blood pressure and cholesterol and how well it was tolerated.
Professor Rodgers, of The George Institute for Global Health in Sydney, said: ‘The results show a halving in heart disease and stroke can be expected for people taking this polypill long-term. ‘We know from other trials that long-term there would also be a 25-50 per cent lower death rate from colon cancer, plus reductions in other major cancers,
heart failure and renal failure. ‘These benefits would take several years to “kick in”, but of course one of the hopes with a polypill is it helps people take medicines long-term.’
Around one in six people experienced side effects including stomach irritation and coughs. One in 20 stopped the treatment because of the side effects.
We will just have to wait and see on this one.