Please Be Careful With My Heart Episodes

[Azalee Freas]

Improvingquality of life for patients with heart failure can include lifestyle modifications and require successful behavior change strategies. Learn best practices to apply to your clinical setting from nurse providers Colleen McIlvennan, PhD, DNP, ANP, FAHA, FHFSA, of the University of Colorado in Denver, and Binu Koirala, PhD, MGS, RN, of the Johns Hopkins University School of Nursing in Baltimore.

Welcome to Heart to Heart Nurses, brought to you by the Preventive Cardiovascular Nurses Association. PCNA's mission is to promote nurses as leaders in cardiovascular disease prevention and management.

Colleen McIlvennan (guest): Yeah, thanks so much, Geralyn, for having us today. I am Colleen McIlvennan. I'm a Nurse Practitioner and researcher at the University of Colorado. And I also serve as the section head of advanced practice providers in the Division of Cardiology. [00:01:00] My primary work is on the inpatient advanced heart failure and transplantation service. And my research focus includes patient engagement around treatment options for heart failure.

Binu Koirala (guest): And hi, and this is Binu Koirala. I'm an Assistant Professor at the Johns Hopkins University School of Nursing. My clinical background is I'm a cardiovascular nurse, primarily working with people living with heart failure. And currently as a research faculty, my research focus includes cardiovascular disease prevention and management, palliative care, and care of people living with multiple chronic and complex disease conditions, including heart failure. Happy to be here today.

Geralyn Warfield (host): Thank you so much to you both for being with us today and let's get started talking a little bit about heart failure as a chronic disease. We know that using guideline-directed medical therapy includes things like lifestyle, [00:02:00] pharmacotherapies, and other treatments. So, if you wouldn't mind, let's talk first about lifestyle modification and, specifically, behavior change. Colleen, would you like to start?

Colleen McIlvennan (guest): Thanks, Geralyn. I think that's a great place to start when we're talking about management of patients with heart failure. And when we talk about behavior change, like chronic disease, it's ongoing. It's something that we touch upon with every clinic visit, every hospital stay, in which we are educating patients about different areas that would help improve their quality and quantity of life.

I also think, in my research we've done a lot around shared decision-making. And we talk about shared decision-making in the context of medical devices, and medications, but I would argue that having lifestyle changes or behavior changes and a shared decision-making approach in that respect is really important, because we really need to understand what's important to patients around their values, preferences, and goals in order to recommend, and coach them, really, through these lifestyle and behavior changes.

And last point, I think, when we talk about behavior change is that often in the initial diagnosis of heart failure, [00:04:00] patients are overwhelmed and we're focused very much on treatment options, diagnostics, and, and really kind of the care plan going forward. That, a lot of times, the lifestyle and behavior changes fall to the bottom.

And I think as we continue to see these patients and follow up is really when we can get down to what it is that we can do to help them change lifestyle, change behaviors, that will lead to, an improved quantity and quality of life.

And when we talk about lifestyle modifications, which can include like, changing diet by eating a heart healthy diet low in salt, getting more physical activity, maintaining or losing weight, quitting smoking, limiting alcohol intake, managing stress and anxiety, and more. And, for example, our research studies suggest that dietary interventions aimed at increasing patient's appetite may increase diet variety and enhance the nutritional quality of diets [00:06:00] for people with heart failure.

And as a healthcare provider, it is really important for us to improve health outcomes of our patients by identifying their modifiable risk factors and providing follow-up behavior change, goal-setting education, and interventions.

Geralyn Warfield (host): Those were exceptional examples of how behavior change and heart failure management for our patients really are closely intertwined. And I appreciate, Colleen, you sharing that real-life example of behavior change is not linear, nor are our patients ready for that behavior change process at the times we would wish that they would be. So, using our shared decision-making with those patients can be a really important tool in that trajectory of care, where we're working to improve those patient outcomes alongside those patients and, as you said, Binu, with their families, with their caregivers. It definitely is indeed a team [00:07:00] effort.

So, I'd like to pivot just a little bit and focus in just on access to care. I'm hoping we could talk a little bit about how access to care specifically impacts these patients with heart failure. Colleen, could you start us off?

Colleen McIlvennan (guest): Yeah, I think access is a real issue. And, unfortunately, we are continuing to see disparities in care, and I worry that, instead of closing the gap, it maybe widening with advances in technology, and, and people not having access, to the areas of technology that we need, in order to meet them where they're at.

One of the areas that we, are hopefully making some strides are mail-order pharmacies, and then places like Amazon who are, I think, are dipping their toes into the pharmacy market, and, and legislation being passed around lowering prescription drug prices. I do think we are, we are moving in the right direction [00:09:00] and there are, people that are paying attention to this, but one of the things that I think would be really beneficial is having those conversations with patients about access to medications. And making sure that they not only can afford them, but can they pick them up? Can they pick them up in a timely manner? And does the pharmacy have the medications that we are actually, hoping to prescribe to them?

Binu Koirala (guest): So, when we are talking about access to care, I just want to remind our listeners, if you have not listened to the previous episode of heart failure podcast series, please do listen. We have talked in more detail about access to care and how it affects heart failure patients on prevention and management.

So today, when we are talking about self-care, access can mean a number of things, for heart failure, treatment and self-care. For example, access to knowledge, access to medicine, access to care team, [00:10:00] access to effective health programs, for example, self-care resources including healthy food. And with our work, with people living with heart failure, and as Geralyn said before, what we have learned is self-care in heart failure is not a linear process.

And access to care and heart failure management, specifically self-care, is compounded by the effects of several social determinants of health. And although there has been an increasing focus on social determinants of health to help reduce health inequalities, daily clinical practice and research agendas generally do not focus on assessment of complex relationship of these determinants and their effect on heart failure treatment, behavior change, and outcomes.

So, what we know already is, in heart failure, limited access to resources [00:11:00] about the disease and the lifestyle changes, as well as evidence-based guideline directed care, are associated with more frequent symptom exaggeration, increased symptom, burden, decreased quality of life, and multiple hospitalizations.

Geralyn Warfield (host): We're back speaking with Colleen McIlvennan and Binu Koirala about heart failure and some of the factors that affect our patients. And I know that there has been an increasing set of research that's related about quality sleep, and that really does affect our patients with heart failure. Binu. I'm hoping you can start us off talking a little bit more about those interconnections.

Binu Koirala (guest): Geralyn, I have to say thank you for having this question, because sleep is something that has been [00:12:00] less explored and less discussed in heart failure management. And recently, American Heart Association has identified sleep as one of the healthy behaviors in Life's Essential Eight.

And it is believed that adequate sleep promotes healing. It can also improve brain function, and it can also help reduce the risk for chronic disease, including heart failure. And specifically in heart failure, the relationship between heart failure and the sleep is a two-way street. For example, heart failure can affect your sleep, and sleep problems such as obstructive sleep apnea and insomnia can make heart failure symptoms worse

And specific to self-care, although the direct mechanism is not well understood, it has been found that sleep quality can mediate self-care. So, with the existing evidence [00:13:00] highlighting the potential importance of adequate sleep and quality sleep behavior in the prevention and management of heart failure, we need to explore this more and examine this more in our clinical practice, as well as the research.

Colleen McIlvennan (guest): Yeah, I would, agree. This is a great question. And an area that is not touched upon probably as much as it should be. And we've actually seen quite a bit of interest over the last several years, too, in screening, and treating central sleep apnea for patients with heart failure. And we are implanting some devices that help with central sleep apnea and presents with symptoms that don't correlate as much as people would think, like snoring, as you would see with obstructive sleep apnea.

So, I think we are under-diagnosing across the board. I [00:14:00] think sleep is, difficult, as Binu mentioned, for a lot of reasons, especially for patients with heart failure, but an area that we need to focus, and really need to have conversations with patients about their sleep quality.

3a8082e126