Heart failure
Heart failure monitoring: check-ups with health professionals
The National Institute for Health and Clinical Excellence (NICE) has guidance about heart failure management, which, in addition to lifestyle advice and drug treatments, includes recommendations for regular monitoring of the condition.
The frequency of visits to a health professional for people we spoke with varied enormously, ranging from yearly to weekly appointments depending on individual needs and local arrangements.
Some people we spoke to had their care managed entirely in general practice, some entirely by hospital specialists, and others by a mixture of professionals from both sectors.
Check-ups and appointments for monitoring heart failure
Check-ups sometimes took place at the hospital because the person was taking part in a research study.
Some people had been admitted and re-admitted to hospital for treatment to stabilise their heart failure and continued to be looked after by a particular cardiology team.
In other cases, people’s main point of contact was a specialist heart failure nurse based in the community.
GPs who had a special interest in heart disease might hold special clinics either at the local surgery or the hospital, meaning that their patients saw a hospital specialist less often, or not at all.
People who had a pacemaker or an ICD (implantable cardioverter defibrillator) attended ICD clinics (also called pacing clinics) with a technician for routine device monitoring. Some people said they kept a list of questions to ask at these appointments.
Philip sees his GP, cardiologist and specialist nurse several times a year each plus having his ICD checked.
Philip sees his GP, cardiologist and specialist nurse several times a year each plus having his ICD checked.
He has six follow-up appointments a year with his GP, his consultant and a practice nurse.
He has six follow-up appointments a year with his GP, his consultant and a practice nurse.
Oh yes, quite definitely I find it very reassuring that I am being monitored as I am even to the extent that I have been told both by my family doctor and my consultant if I have any queries get in touch, that's what they're there for.
He sees his cardiologist every 3 months and his GP once a month.
He sees his cardiologist every 3 months and his GP once a month.
No, there's a monthly clinic with my GP which was formerly with my cardiologist which was bloods and weights and everything, but no immediately post MI, post discharge, then you have the offer of attending rehab environment. I went once and, each to their own you know, it wasn't for me. I think I was the youngest by 40 years, but it really wasn't for me, and everybody talked about their illnesses, it's the last thing you want to talk about! And if you'd had an MI they'd had two or three, yeah okay fine, so no, I opted out of that one!
Experiences with heart failure monitoring from medical professionals
Daniel had been considered for a heart transplant in the past before his condition improved; he was still under the care of the transplant team at a specialist hospital as well as a cardiology team at his local hospital and his GP.
A 53-year-old woman said she was 'very surprised' to be given her treatment in a 'department for the elderly'.
As well as seeing a heart failure nurse monthly and a local cardiologist twice a year, Daniel has an in-depth check-up with a transplant team every 3 months.
As well as seeing a heart failure nurse monthly and a local cardiologist twice a year, Daniel has an in-depth check-up with a transplant team every 3 months.
She was surprised that she had to attend an appointment in a department for the elderly.
She was surprised that she had to attend an appointment in a department for the elderly.
This went on for about 3 or 4 months I should have said and then I had an appointment to see another doctor, the funny thing was it said 'Surgery for the Elderly' and I was quite annoyed about that! I said to my Mum, 'Will you come with me Mum, they'll think it's you not me?' Because I didn't feel elderly, I still don't feel elderly!
I saw this doctor and he explained to me the tablets I was on was helping me but they wouldn't prolong my life. This gave me a big shock. What did he mean, 'prolong my life'? He said, 'Go on beta-blockers,' and I said, 'No they make ill!' And he said, 'Please go on beta-blockers, it's proven that they will help you. You're still a young person,' (that cheered me up) 'You're still a young person, these will prolong your life'.
A woman whose heart failure was a consequence of congenital heart disease was particularly attached to a specific consultant who worked out of a hospital 400 miles away from where she lived, and she refused to see anyone else.
She travelled there at least twice a year and had her pacemaker checked at the same time.
Tests and reminders for heart failure monitoring
Some people had blood samples taken either at hospital or the practice in preparation for consultations with a doctor or a nurse.
People who were taking warfarin had regular blood tests done either at a specific hospital warfarin clinic or by a phlebotomist at their local surgery to measure their International Normalisation Ratio (INR) (clotting time).
These tests were typically every 2-4 weeks.
One woman had her own INR testing kit for home use.
As well as face-to-face consultations, some people received automated prompts to provide information about their condition to a professional.
Daniel received a weekly text message reminding him to send blood pressure, pulse, and weight measurements back to the hospital by text.
Anne received a weekly automated telephone call where she had to press buttons to indicate whether she was more breathless than usual, if her ankles were swollen, or if her weight had changed.
Anne describes the automated weekly phone call she receives to check up on her heart failure signs and symptoms.
Anne describes the automated weekly phone call she receives to check up on her heart failure signs and symptoms.
Okay, so it’s just a recorded voice?
Yes, yes and it is picked up on, because once or twice I’ve completely forgotten about it and gone out and missed the call and forgotten about it and not checked up on my recorded missed phone calls, and then later on or the next day, early, I get a call from the nurses saying, “We didn’t pick up the messages that…”, you know, “From the recorded voice. Are you alright?” So it is, it’s efficient.
Experiences with check-ups for heart failure monitoring
Check-ups commonly involved a physical examination, a chat about the person’s condition and their general well-being, plus blood tests and measurement of height, weight, and blood pressure.
Changes to medication were made by consultants, specialist nurses or GPs, while height, weight, fluid, urine, blood pressure and cholesterol checks were usually done by specialist nurses, practice nurses or unspecified hospital staff.
Some people mentioned attending hospital for occasional ECGs, echocardiograms, or other types of scans.
Paula mentioned having an exercise tolerance test and Daniel had a right heart catheterisation, a procedure to measure the pressure inside the heart.
Brian explains how his GP monitors his heart failure and what he is trying to achieved.
Brian explains how his GP monitors his heart failure and what he is trying to achieved.
Obviously what the doctor has explained to me is he wants to reduce the workload on my heart. Because is so weak he can make it last longer if he reduces the work it has to do so in that respect, reducing blood pressure, reducing blood viscosity, as a matter of interest, my blood pressure is normal but I still have medication to keep the blood pressure down because he doesn’t want to risk that anything that I do pushes the blood pressure up so I do take medication to keep blood pressure down and in terms of blood viscosity , I think aspirin is one of the medications I take which thins the blood somewhat.
He sees his GP for follow-up care every 6 months but has seen the practice in between for checks of his blood pressure and kidney function
He sees his GP for follow-up care every 6 months but has seen the practice in between for checks of his blood pressure and kidney function
Test knowledge and at-home visits from health practitioners
Knowledge about what was being measured in blood tests was limited, apart from specific INR tests to determine the dose of the blood-thinning drug warfarin. Some people were aware that a range of things were measured but didn’t know the details.
Others knew details about some health measures such as cholesterol, haemoglobin, or kidney function, but did not know the details about all of them.
One participant complained that the veins in his elbow often collapsed so blood had to be taken from the back of his hand instead.
Specialist nurses sometimes visited people at home, but one man said that he preferred to see his specialist nurse at the hospital because it gave him a reason to go out. The frequency of visits had reduced since his condition had been brought under control.
A man in his 80s said that his GP had visited him once or twice a week at home while optimising his medication regimen, but he had since attended his GP surgery every fortnight and had been told to only visit the GP when he felt a particular need to do so
See also 'Satisfaction with health professionals', 'Access to health professionals between appointments', and 'Heart failure monitoring at home'.
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