1. The STOP HF Screening Programme Elaine Tallon RGN, RM, PG Dip Clinical Specialist Nurse

2. The STOP HF Screening Programme The dreaded blood testing and cholesterol

3. The STOP HF Screening Programme The terrifying weighing scales

4. The STOP HF Screening Programme The ever so lovable blood pressure!!!!!

5. The STOP HF Screening Programme Look back at where The STOP HF programme has evolved from Where we are today Tips for keeping healthy Discuss

6. The STOP HF Screening Programme Definitions: BNP: B-type natriuretic peptide- which is a protein that is released from the heart muscle when it is under stress or strain. ECHO: Echocardiogram – scan of the heart. ECG: Electrocardiogram – looks at the electrical activity of the heart. Heart Failure: Where the muscle of the heart does not work as well as it should

7. The STOP HF Screening Programme The STOP HF research programme started in 2004 Main aim of seeing if the BNP blood test could be used to identify early signs of stress or strain on the heart muscle. Where we started:

8. The STOP HF Screening Programme 2005 began recruiting From GPs surgeries-Dublin, Wicklow, Wexford >40yrs of age Risk factors-hypertension, cholesterol, diabetes, prior heart attack Randomisation-control and treatment arm Reviewed yearly in GPs surgery If BNP > 50pg/ml treatment arm – had echocardiogram & seen by Prof McDonald to assess and ensure all risks under tight control Education re healthy lifestyle

9. The STOP HF Screening Programme In 2011 – all participants were reviewed in SMH and had ECG and ECHO done In 2012 – reviewed all participants data including events / admissions to hospital

10. The STOP HF Screening Programme Showed that the BNP is a good subtle indicator together with Collaborative care between hospital and GP Managing your risk factors tightly Good lifestyle choices resulted in less strain on the heart muscle, less incidents of heart failure and other serious cardiovascular events. Outcome of analysis / research:

11. The STOP HF Screening Programme Hence, we could not continue as a research programme but we are now a SCREENING programme where everyone gets the same care / follow up. Only reason we are consenting - so that we can use your blood for medical research including genetic testing and that it can be sent to facilities outside Ireland for testing.

12. The STOP HF Screening Programme Take history of risk factors, up to date medical & surgical history, medications prescribed, any symptoms Check your weight, height, BMI, abdominal girth, blood pressure, heart rate Blood sampling for BNP, Cholesterol, Glucose and medical research ECG and ECHO Assessment has not been changed:

13. The STOP HF Screening Programme Dependent on BNP result: –BNP <20pg/ml – every 3 years –BNP 20 – 50pg/ml – every 2 years –BNP >50pg/ml – every year IMPORTANT: Do NOT worry about BNP result Subtle indicator & guide to your treatment What really matters is how you are feeling and results of other tests Frequency of assessment

14. The STOP HF Screening Programme Nurse & doctor review your visit and all test results If we have any concerns we will ask you to come in and be seen by doctor / have further investigations if necessary Automatically whether you are seen by a doctor or not a letter with all investigation results will be sent to your GP After your assessment

15. The STOP HF Screening Programme Good blood pressure control Aim for <140/85mmHg How you can prevent stress / strain on the heart muscle

16. The STOP HF Screening Programme Good cholesterol control More happy: >1.0mmols/L-Exercise -Oily fish -Porridge Less lousy: -Low saturate fats <3.0mmols/L-Grill or bake food <2.5mmols/L – diabetes-Lean meat <1.8mmols/L-known heart disease

17. The STOP HF Screening Programme Good diabetic control

18. The STOP HF Screening Programme Keep your weight down - BMI < 24.9 Through what you eat, drink and exercise Weigh yourself weekly Aim to lose a pound a week Weight

19. The STOP HF Screening Programme Present weight statistics of those attending STOP HF: BMI < 24.9 (normal weight) = 25.1% –Male = 18.2%Female = 31.1% BMI 25 – 29.9 (overweight) = 40.9% –Male = 43.7%Female = 38.5% BMI >30 (obese) = 34% –Male = 38.1%Female = 30.4%

20. The STOP HF Screening Programme Half hour brisk walk/cycle/swim 5-6 times per week to keep healthy and well Up to an hour 5-6 times per week if you need to lose weight Exercise

21. The STOP HF Screening Programme Exercise If problems with joints / back walk in the pool

22. The STOP HF Screening Programme DIET Aim for a well balanced healthy diet plan that you can maintain for life Avoid fad diets Little and often of the right foods

23. The STOP HF Screening Programme DIET Suggest if you need to lose weight Breakfast- oat based cereals –porridge or unsweetened muesli with low fat milk or yogurt Mid morning – piece of fruit Lunch – 2 slices brown bread with your protein- oily fish or lean meat or low fat cheese or egg Mid afternoon – piece of fruit Dinner – 2 medium sized potatoes or ¼ plate wholemeal pasta or brown rice, ½ plate of vegetables, fish, chicken or lean red meat Avoid eating after 6.30pm

24. The STOP HF Screening Programme DIET Aim for 5 portions fruit / vegetables per day Watch sugary foods – cakes, chocolates, biscuits, sweets – have as treat only 1-2 times/week Watch the sugary drinks Avoid salt – use pepper, herbs, spices Watch the sauces, salad dressings Avoid processed foods, ready made meals, take aways - best make your own

25. The STOP HF Screening Programme Diet Remember: Watch what you bring into the house – if it’s not there you can’t have it!

26. The STOP HF Screening Programme ALCOHOL Women = 11units/week max Men = 17 units/week max (HSE guidelines – low risk drinking) One standard unit =

27. The STOP HF Screening Programme NO Smoking Never too late to stop Not easy to stop but well worthwhile for a good quality of life Smoking Cessation courses St. Vincent’s University Hospital

28. The STOP HF Screening Programme Reduce STRESS levels --->

29. The STOP HF Screening Programme Reduce STRESS levels Accept there are events you can’t control Good work / life balance If carer, make sure to take time for yourself Do pleasurable things -Walking, reading, gardening Try to keep positive Get enough sleep Eat well Avoid alcohol and smoking Seek social support Get help if you feel you are not coping

30. The STOP HF Screening Programme Take your medications as prescribed They are usually for life Don’t stop them unless doctor tells you to Know your medications Keep list of names, doses and how often you take them in your wallet / purse Try not to miss doses Be honest with your doctor if you are not taking your medications

31. The STOP HF Screening Programme Have regular medical check ups

32. The STOP HF Screening Programme Conclusion STOP HF SCREENING programme Frequency of visit as per your BNP results Your doctor will be informed of all your test results

33. The STOP HF Screening Programme Attempt to keep your risk factors under control through healthy lifestyle choices that you can maintain for life

34. The STOP HF Screening Programme Thank you all And I hope to