Disease Management Basics

About 6 million Americans, and 26 million people around the world, have congestive heart failure.  Heart failure is most often caused, and worsened...

...by coronary artery disease, myocardial infarction (a heart attack), and hypertension.  Patients suffer from fatigue, shortness of breath, fluid retention (most significantly in their lungs and lower legs), lower leg skin breakdown and depression.

Treatment revolves around:

The two most effective treatment interventions are:

• Adherence to prescribed medications
• Early warning sign recognition

Caregivers are optimally positioned to reinforce medication adherence, recognize complications when they arise, and work with doctors to resolve problems, in order to return patients to stability.

Essential Treatments

The first aims of treatment for any CHF patient are managing high blood pressure and fluid overload. Antihypertensive agents include ACE inhibitors, Angiotensin Receptor Blockers, calcium channel blockers and beta blockers offer a variety of advantages, most importantly widening constricted blood vessels.  Diuretics, including thiazide, loop, and potassium sparing diuretics help to lower blood pressure by reducing blood volume.

Diuretics are also essential for managing fluid overload, or collection of fluid in the lungs, the lower extremities (feet and legs), and abdomen, along with the blood.  This is essential for mediating potentially severe shortness of breath from pulmonary edema and problems associated with lower leg swelling, including non-healing venous stasis ulcers and cellulitis infections that carry a risk for sepsis.  Skin breakdown is often treated with ongoing application of creams and bandages, as prescribed.

Depression is also a prevalent, and often devastating, problem for people with CHF.  All CHF patients should be assessed for depression and conscientiously treated for it if indicated.

It is also essential to address the medical problems that caused a patient’s heart failure in the first place— these problems will continue to contribute to progressive weakening of the heart, along with posing serious medical threats on their own.  Cardiovascular problems, including coronary artery disease (CAD—what is commonly thought of as “heart disease”), high cholesterol, and peripheral vascular disease (PVD-- problems with blood vessels in the legs) are extremely common among CHF patients, often requiring ongoing relationships with specialists.

Common co-morbidities, including diabetes and COPD, also require serious attention and ongoing treatment.

Watching for Complications and Warning Signs

Acute episodes are inevitable for CHF patients.  The good news is that episodic problems can almost always be resolved with a temporary change in medication doses, often without even a doctor’s appointment.  The bad news is that, when small problems are neglected, they can turn really bad really fast—too often requiring hospital treatment.  Complications and warning signs must be recognized early, reported to the doctor immediately, and addressed with diligence.

Patients should be monitored daily by caregivers for increased fluid retention.  The most important sign of increased fluid retention is new shortness of breath—New “SOB” should always be reported immediately to the doctor.  Caregivers can also assess for new swelling of the feet, ankles and lower legs, pitting edema, and weight gain.

Caregivers should also examine the lower legs daily to assess for new skin irritation, breakdown and wounds.

Because CHF is almost always associated with cardiovascular disease, caregivers should know the warning signs of heart attack and stroke.  Similarly, caregivers should be aware of common warning signs and complications of co-morbidities, like diabetes and COPD, if applicable.

Caregivers should also work with the doctor to develop a list of mental health benchmarks for ongoing assessment for depression in a CHF patient.