CONGESTIVE HEART FAILURE IN THE ELDERLY

What is Congestive Heart Failure Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen. Basically, the heart can't keep up with its workload. At first the heart tries to make up for this by: Enlarging. When your heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood. With an enlarged heart, your body starts to retain fluid, your lungs get congested with fluid and your heart begins to beat irregularly. Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially. Pumping faster. This helps to increase the heart's output.

Congestive Heart Failure Symptoms Short of breath Excessive fluid buildup Tiredness, Fatigue Lack of appetite Confusion Increased heart rate *AHA (2015)

Congestive Heart Failure Congestive Heart Failure (CHF) is often caused by hypertension, diabetes, or coronary heart disease. 5.8 million individuals are diagnosed with CHF, out of the 5.8 million it was shown that most hospitalizations of congestive heart failure were for those aged 65 and older* In the United States, most CHF hospitalizations were for those aged 65 and over* *Blecker, Paul, Takslerm Ogedegbe, & Katz (2013)

Heart Failure in the Elderly The mean age average of patients admitted into hospitals due to heart failure were 73.1 to 74.2 years old.* Over 80% of all heart failure patients are 65 years and older The majority of patients that were admitted into hospitals were white females.* Towards the end of the study conducted by Blecker, Paul, Takslerm Ogedegbe, & Katz (2013), heart failure in men is increasing in comparison to women. *Blecker, Paul, Takslerm Ogedegbe, & Katz (2013)

Prevalence of Heart Failure Heart failure is the primary reason for 12–15 million office visits and 6.5 million hospital days annually and recurrent hospitalization is a major issue with the annual number of hospitalizations exceeding over 1 million for heart failure.* More than 650,000 individuals are diagnosed with CHF for the first time each year. * Re-hospitalizations with readmission rates due to CHF near 50% within six months of discharge.* *Butler, (2012)

Prevention of Heart Failure Those who lack the information, resources, or the support to manage their condition outside the hospital tend to bounce back in. The gap in care to address CHF is when the patient is being discharged from the hospital, education is important for the patients to understand the risk of exacerbating heart failure after being discharged. The American Heart Association has tools and resources such as medication trackers, blood pressure trackers, activity tracker, and information about the proper diet to maintain when diagnosed with heart failure *AHA (2012)

Prevention of Heart Failure Primary prevention of heart failure consist of the individual being physically active. Being physically active reduces the risk of coronary artery disease which may lead to heart failure Choose a healthy diet plan. Low salt diet Educate the elderly of a healthy diet by eating plenty of fruits and vegetables, fiber-rich whole grains, fish (preferably oily fish -- at least twice per week), nuts, legumes and seeds. *AHA (2012)

Prevention of Heart Failure Informing elderly individuals to choose foods low in saturated fat, trans fat, cholesterol, sodium, added sugars and sweeteners will help in the reduction of heart disease. Monitoring blood pressure and heart rate. Checking laboratory values indicative of heart failure and risk of heart failure i.e. BNP, cholesterol level, HA1C, liver enzymes, cardiac enzymes. Optimizing the medications patients were being discharged on

Goals in Heart Failure Prevention Heart Failure clinics to be available in all hospitals. Follow ups after discharged with patients diagnosed with heart failure. Assessing the educational needs of all patients being discharged and have an individualized discharged information packet specifically to the patient. Short term goal is educate all patients about heart failure and symptoms Long term goal is to reduce the readmission rate of patients diagnosed with CHF

Promoting Health Changes In the community, hold educational support groups for patients diagnosed with hearty failure. Allow for free blood pressure and heart rate screenings. Hand out educational pamphlets regarding CHF Inform the community of clinics that deal with CHF Hold free seminars about cooking healthy foods

References American Heart Association (2015). Preventing Heart Disease – At Any Age. Retrieved from Preventing-Heart- Disease---At-Any-Age_UCM_442925_Article.jsp American Heart Association. (2012). Heart Failure Tools and Resources. Retrieved from HeartFailureToolsResources/Heart-Failure-Tools- Resources_UCM_002049_Article.jsp Blecker, S., Paul, M., Taksler, G., Ogedegbe, G., & Katz, S. (2013). Heart Failure– Associated Hospitalizations in the United States. Journal of the American College of Cardiology, 61(12): doi: /j.jacc Butler, J. (2012). Primary Prevention of Heart Failure, ISRN Cardiology. doi: /2012/ Institute for Healthcare Improvement (2015). Good Heart Failure Care Follows Patients Home. Retrieved from ImprovementStories/GoodHeartFailureCareFollowsPatientsHome.aspx Thompson, P. D., Buchner, D., Piña, I. L., Balady, G. J.,Williams, M. A., Marcus, B. H.,... & Wenger, N. K. (2003). Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation, 107(24),