Heart Failure Disease Management Program King Fahad Medical

Heart Failure Disease Management Program King Fahad Medical

Heart Failure Disease Management
Program
King Fahad Medical City Experience
Abdiqani Qasim, MScN, FNP, ACNP
Chairperson, Nursing Education Department
King Fahad Medical City
January 19, 2012
Objectives
1) Brief Introduction to King Fahad Medical City
2) Brief Introduction to Prince Salman Heart Center
3) Brief introduction of Heart Function Clinic at King
Fahad Medical City
4) Brief Introduction of Heart Failure
5) KFMC experiences in the Management of Heart
Failure
6) Conclusion
Objectives
King Fahad Medical City is a acute tertiary, university
affiliated hospital and JCIA accredited.
Four hospitals:
Main Hospital
Children’s Hospital
Women’s Specialised Hospital
Rehabilitation Hospital
Four centers:
National Neuroscience Center
Comprehensive Cancer Center
Prince Salman Heart Center
Diabetic center
Brief Introduction to King Fahad Medical City
1000 bed capacity with approximately 6000 staff (plan to
expand)
Over 3000 staff nurses (plan to expend(
Prince Salman Heart Center is state of art cardiac center that has
a full compliment of cardiac services:
• 115 Beds
• 500 staff nurses
• Coronary Care Unit
• Adult Cardiovascular Intensive care Unit
• Paediatric Cardiovascular Intensive care Unit
• Coronary Angiography Labs
• Electrophysiology Labs
• Non-Invasive Cardiac Lab
• Cardiovascular Operating Rooms
• Adult and Paediatric monitored and non-monitored cardiac
wards
• Adult and Paediatric Cardiac Surgical Wards
Outpatient Clinic
• General Cardiology Clinic
• Cardiovascular –Pre and Post Surgery Clinic
• Heart Function Clinic
• Congenital Clinic
• Hypertension Clinic
Cardiology Out-Patient Clinics
Run by general cardiologist
Patient may see multiple cardiologist
Inconsistence of care
The beginning of 2009, a heart failure clinic run by trained
specialised was established
Members of these team include:
Heart failure specialised cardiologist- Consultant
Advanced Practice Nurse
Dietician
Pharmacist
HCA
There are 1-full day clinic (Wednesdays)
I/2 day clinic (Mondays)
Post MI
Pregnancy
Related
Hypertensive
Heart Disease
Alcohol
Idiopathic
Cardio toxic Drugs
Familial
Chemotherapy
Heart failure (HF) is a syndrome of shortness of breath and
fatigue. It occurs when forward flow of blood out of the heart is
impeded.
This is the only cardiovascular condition that continues to
increase in prevalence and incidence.
It is a major healthcare problem, not only for the patient, but
also for significant others and the community at large.
HF is a leading cause of hospitalization and death world wide,
and its prevalence continues to increase.
The clinical care of patients with HF encompasses a continuum
from the treatment of acute episodes requiring hospitalization to
chronic management in the outpatient office setting.
The condition accounts for approximately 12–15 million office
visits and 6.5 million hospital days annually in the United
States.
One third of those discharged from the hospital are readmitted
within 90 days because of recurrence of symptoms.
The cost of HF patient care is approximately $38.1 billion
annually, draining limited resources of patients, treatment
facilities, and society
5 million Americans have Heart Failure
1/2 million new diagnosis of HF annually
250,000 deaths from HF annually
Leading cause of hospitalization for those over 65 years old
Heart Failure Impact
Purpose: The heart function assessment registry
trial in Saudi Arabia (HEARTS) is the first
national project to study the clinical features,
management, and outcomes of patients with acute
decompensated heart failure.
Methods: Prospective registry of patients
presented/referred to Heart Function Clinic
between October 2009 and December 2011.
Brief Introduction of Heart Failure
1
KSU, KKUH, King Fahad Cardiac Center
2
KSU, KKUH, King Fahad Cardiac Center
Security Forces Hospital
King Fahd Medical City, Prince Salman Heart Center
Prince Salman Hospital
Al Iman Hospital
King Faisal Specialized Hospital and Research Centre
Prince Sultan Cardiac Center, Riyadh
King Saud Medical Complex, Riyadh
Prince Sultan Cardiac Center, Qassim
King Abdulaziz University Hospital
National Guard Hospital
King Fahd General Hospital
King Fahd Hospital, Al-Baha
Prince Sultan Cardiac Center, Al Hasa
IMC
King Khalid Civilian Hospital
North West Armed Forces Hospital
Armed Forces Hospital Southern Region
Madinah Cardiac Center
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
HEARTS
Acute Heart Failure
Patient
808
Chronic heart Failure
Patient
436
Acute Heart Failure Patient
Chronic Heart Failure Patinet
Gender
Female
28%
Male
72%
Site of Referal
297
Site of Referral
%
Cardiology
67%
Emergency Room
19%
Other
14%
81
58
Cardiology
Emergency
Department
Other
Reason for Referral
237
Reason for Referral
%
Severe LV Dysfunction
54%
HF Associated with VHD
21%
HF Associated with SRI
12%
Poor tolerance and/or Compliance to medical therapy
8%
Multiple >=2 Hospitalization
5%
93
54
33
Severe LV
Dysfunction
Heart Failure with
Severe Valvular
Heart Disease
Heart Failure
associated with
significant Renal
Impairment
Poor Tolerance
and/or Compliance
to Medical Therapy
22
Multiple >=2
Hospitalization
Age
88
18
Youngest
Eldest
Age
<50 Yrs
50-70 Yrs
>70
18%
37%
45%
Heart Failure Risk Factors
417
HF Risk factors
300
263
%
HF
96%
Hypertension
69%
IHD
60%
PCI
15%
CABG
11%
Other valvular Disease
8%
RHD
4%
176
67
46
35
18
8
4
0
Smoking
248
98
56%
Never Smoked
90
22%
Ex-Smoker
20%
Smoker
Type of Smoking
187
80
43%
Cigarerres
18%
Shisha
1
0%
Cigarerres
0
Pipe
0%
0
0%
Oral Tobacco
Alcohol
10
1
Alcohol Consumption
Alcohol Dependency
Diabetes Mellitus
79
72
18%
OHA
69
17%
Insulin only
16%
OHA &
Insulin only
4
1%
Diet only
0 0%
None
0 0%
Unknown
Alcohol Consumption - Extra
5
3
2
50%
2-7 drinks per week
30%
One or Fewer drinks per
week
20%
8 or more drinks per
week
History of Diseases
History of Diseases
107
103
88
70
53
%
ICD
25%
Renal Insufficiency
24%
Anemia
20%
Asthma
16%
AF
12%
CRT
7.6%
Acute Renal Insufficiency
6%
CVA
6%
COPD
4%
33
27
27
20
13
12
7
7
2
2
0
0
0
Body Measures
Height (cm)
Weight (kg)
BMI
Waist (cm)
136.29
76.55
28.1
23.57
Height (cm)
Weight (kg)
BMI
Waist (cm)
Chronic Renal Insufficiency-Extra
CRI Requiring Dialysis
CRI not on Dialysis
93
12
2.75%
21.33%
History/Symptoms Statistics
233
158
43
53.44%
NYHA-III
36.24%
NYHA-II
9.86%
NYHA-IV
2
0.46%
NYHA-I
Anginal Status
430
4
CCS - 0
Atypical / Not
Sure
3
CCS - II
2
CCS - I
1
CCS - III
0
CCS - IV
History / Symptoms
207
135
124
71
18
2
Generalized
fatigue
L.L or Abd.
Swelling
Orthopnea /
PND
Dizziness / PreSyncope
Palpitation
Syncope
Signs of Congestive Heart Failure
139
137
125
119
33
31.88%
Checked Patients of
Signs of Congestive
Heart Failure
7.57%
Gallop Rhythm
31.42%
Increase JVP/AJR
28.67%
Inspiratory Crackles
5
Ascites
1.15%
27.29%
L.L or Sacral edema
ECHO Done Statistics
434
434
428
60
42
99.54%
Echo Done
99.54%
LV Systolic
Dysfunction
98.17%
LV Diastolic
Dysfunction
5.50%
RV Systolic
Dysfunction
13.76%
Pulmonary
Hypertension
LV Systolic Dysfunction-Extra
318
72.94%
63
14.45%
36
8.26%
17
Severe
Moderate
Normal
Mild
3.90%
Pulmonary Hypertension-Extra
34
23
3
5.28%
7.80%
Mild
Moderate
0.69%
Severe
LAB Investigations
ProBNP
NA
Creatine
Albumin
Hemoglobin
BUN
RBG
HbA1c
FBG
TSH
K
Total Cholesterol
LDL
Digoxin Level
Creatine Clearance
Uric Acid
349.33
136.09
119.51
35.56
13.1 9.19 8.13 7.83 7.74 5.27 4.17 3.92 2.33 1.16
0
0
Medications
DIGOXIN
52%
ACEI/ARB
90%
ASA
60%
BETA-BLOCKERS
96%
LIPID
66%
SPIRINOLACTONE
64%
LASIX
88%
HF Etiology
186
HF Risk factors
165
35
%
Idiopathic Dilated CM
43%
Ischemic cardiomyopathy
38%
Hypertensive Heart Disease
8%
Primary Valvular Heart Disease
5%
Cardiotoxic Cardiomyopathy
2%
Pregnancy Related Cardiomyopathy
2%
23
9
7
3
2
2
2
1
1
0
0
Follow up:
Distance
Lack of general practitioners in the community
Shortage of qualified staff
Inability to optimise therapy in timely fashion
Lack of compliance
Medications
Diet
Lack of resources