"Dartmouth Cardiac Care"-an inspirational new approach to heart failure

Heart failure is a common and often disabling condition. There are 66000 new cases in the UK each year. It will affect 1 in 75 people. It is a major cause of hospital admissions. Some patients become lonely, isolated and really struggle. The aim of this service is to improve the quality of life and satisfaction of patients with heart failure.

Do I have heart failure?

Heart failure is a condition with many different causes. It mainly affects those over 60 and the incidence rises steeply in those over 80. Most people with heart failure will have been told so by their GP or Consultant. If however you are concerned that you may have heart failure please arrange to see your GP who will try to help you.

How does heart failure make people feel?

Symptoms vary in type and severity. Mild heart failure may make people less energetic, especially on exertion. More severe heart failure may give swollen ankles, breathlessness when lying down at night and more severe breathlessness on exercise. Sometimes these symptoms can be associated with chest pain and , if this is so, you must let your GP know.

A useful way of looking at symptoms is to think how they affect your everyday activities. If this is rarely the case then we term this mild heart failure, if your life is more severely affected your GP may term this moderate, severe or even very severe heart failure. The extent of heart failure is often given a number 1, 2 3 or 4 depending on its severity. Your GP or Consultant may use this number to personalise your medications and other aspects of your care.

Why do I need to take medications?

Most people with heart failure will be advised to take a number of different medications-it is the combination that works. These medications will be introduced gradually, so as not to upset your constitution. You may not notice an immediate benefit from each tablet as it is added, some of the benefits are much more long term, but your doctor will discuss this in more detail. Further details are included in the “medications” section of this webpage.

Who is involved in Dartmouth Cardiac Care?

We believe that to offer you the best care possible, we need to enlist the help of a number of different professionals. Your care will be co-ordinated by your GP. They will enlist the help of Shenda Diaz-Consultant Nurse Specialist in Heart Failure. We are very fortunate that Shenda will be running weekly clinics in Dartmouth. She will be able to advise on all aspects of heart failure. Your GP may enlist the help of a Consultant Cardiologist. Dr Adam Morris, our clinical lead for cardiovascular disease, will provide additional help where required. We also have the help of Steve Cooke, our resident expert pharmacist. Our dietician, District Nurses, Community Matron and practice nurses make up a dedicated multidisciplinary team. We also have access to exercise sessions at Dartmouth Leisure Centre. We think we have thought of everything!

What are expert patients?

We believe that because patients have to live with their illnesses they are best place to be able to help other patients. Your experience is vital to the success of this new approach. Your experiences can help new patients come to terms with their diagnosis, learn how to take charge of the illness, remain motivated and healthy. Remember, you are in charge of the illness not the other way round. Some of you may wish to take this further, enrolling on the expert patients programme-a course designed to make the most of your experiences. Please enquire at the surgery if you are interested.

Medications

The following are the types of medications used in the treatment of heart failure and why they are used.

Diuretics (Furosemide, Bumetanide)

Patients with heart failure carry too much salt and water. Diuretics act on the Kidney to get rid of this excess. They also take the strain off the heart. They are usually taken in the morning, with a second dose being added at lunchtime if needed. Patients taking diuretics should be weighed regularly-this information is important for your GP or Shenda

ACE inhibitors (Ramipril, Lisinopril, Enalapril, Captopril)

These drugs act on the Kidney and circulation to control blood pressure. They influence the way your Kidneys deal with salt and water. They also invigorate the muscle of the heart and stabilise the lining of your blood vessels. They are generally felt to be “good for the heart.

ARBs (Candesartan, Irbesartan, Losartan, Valsartan)

These work in a similar way to ACE inhibitors but are suitable for those patients who develop side effects. Your GP may wish to use both ACE inhibitors and ARBs together

Nitrates (Monomax, Imdur)

These help to take the pressure off the heart. They are available as tablets or patches.

Digoxin

Derived from Foxglove poison these tablets are used to stimulate the failing heart.

Aspirin

Most patients with heart failure will take Aspirin-it makes the blood less sticky and stabilises the lining of the circulation. It must be taken with food.

Statins (Simvastatin, Atorvastatin, Rosuvastatin)

Your doctor will probably want you to take these tablets at night to lower the cholesterol.  This protects the circulation from further damage and acts as an anti-inflammmatory on the lining of your circulation.

Spironolactone

This is a special type of diuretic that has been shown to improve longterm outcome and reduce hospital admissions for people with moderate or severe heart failure.

How do I access the service?

Please feel free to speak to your GP or Dr Adam Morris.

Weblinks

www.bhf.org
www.heartstats.org

Staff

Dr Adam Morris, GP partner and clinical lead for Cardiovascular disease.

Shenda Diaz

Tom

Dietician

Steve Cooke