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Reducing the risk of CHD

Reducing the risk of CHD. Jane Dudley Heart Failure Specialist Nurse. Cardiovascular Disease – a Public Health Issue. Diseases of the heart and circulatory system are called cardiovascular diseases or CVD.

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Reducing the risk of CHD

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  1. Reducing the risk of CHD Jane Dudley Heart Failure Specialist Nurse

  2. Cardiovascular Disease – a Public Health Issue • Diseases of the heart and circulatory system are called cardiovascular diseases or CVD. • CVD are the main cause of death in the UK - approximately 198,000 deaths a year( BHF 2006)‏ • Main forms of CVD are coronary heart disease (CHD) and stroke. • Approximately 48% of all deaths from CVD are from CHD; approximately 28% are from stroke. • CHD is the most common cause of death in the UK – 1 in 5 men and 1 in 7 women die from the disease. • 94,000 deaths in the UK are from CHD ( BHF 2006)

  3. Health inequalities • Death rates from CHD are highest in Scotland and the North of England, lowest in the South of England.(BHF 2006)‏ • Estimated that every year 5,000 lives and 47,000 working years are lost in men aged 20 to 64 years due to social class inequalities in CHD death rates. • In England and Wales evidence of strong links between deaths from cardiovascular disease and levels of deprivation. • To reduce socio- economic inequalities CVD inequalities targets have been introduced in England, Scotland and Wales(BHF 2006)‏ • Latest evidence suggests that progress towards the CVD indicators is steady but if it continues the inequalities gap should be reduced by 2010.

  4. Cardiac Markers • Cardiac markers are cardiac enzymes and cell contents. • The measurements of Troponin I and T are of equal clinical values (SIGN 2007)‏ • Optimum time to measure troponin for diagnosis or prognostic risk is 12 hours from the onset of symptoms (SIGN 2007)‏

  5. Cardiac Markers Continued • STEMI: Elevated cardiac markers, which indicate necrosis in the heart muscle (plus ST elevation on ECG) • NSTEMI: Elevated cardiac markers which indicate necrosis in the heart muscle (no ST elevation on ECG). • Unstable Angina: No elevated cardiac markers, no necrosis of heart muscle (no ST elevation on ECG)

  6. ST Elevation

  7. Definitions • ACS: Acute Coronary Syndrome. • Refers to a range of acute myocardial ischaemic states. Encompasses Unstable Angina, NSTEMI and STEMI • Unstable Angina • Ischaemia caused by obstruction of a coronary artery due to plaque rupture with thrombosis and spasm

  8. Definitions continued • NSTEMI: Non ST segment elevation myocardial infarction • STEMI: ST segment elevation myocardial infarcton • Unstable Angina and NSTEMI account for approximately 2.5 million hospital admissions worldwide • 25% of admissions of chest pain (not necessarily cardiac in origin)‏

  9. Coronary Heart Disease • CHD kills 110,000 people • 1.4 million people suffer with angina • 275,000 suffer a heart attack Each year

  10. Smoking Cessation • 70% of smokers under 65yrs want to stop. • 43% of smokers over 65yrs want to stop. • Main drivers are health and financial. • Awareness of the dangers of passive smoking seemed to have an affect on motivation. • Smokers who have support with cessation are most likely to succeed. • NRT doubles the chances of successful cessation.

  11. Physical Activity • Physical activity reduces the risk of chd • The physically inactive have twice the risk of developing chd • 3% of all disease and 24% of chd can be attributed to physical inactivity • Aerobic activity provides most benefit • 30 mins of moderate exercise 5 times a week is optimum

  12. Hypertension • Direct link between chd and BP. • Each rise in BP by 20mmgh systolic and 10mmgh diastolic will double chd mortality risk. • 11% of all disease, 50% of CHD and 22% of heart attacks attributed to hypertension. • Optimum: 120/80mmgh. • Treatment should be commenced at BP over 140/90mmgh or 135/85mmgh in diabetics.

  13. Alcohol • High alcohol intake accounts for 9% of all disease and 2% of chd • Is beneficial in small quantities • Women 2-3 units per day • Men 2-4 units per day • Binge drinking increases the risk of chd

  14. Psychosocial Well Being • Work stress • Lack of social support • Anxiety and depression • Personality traits such as hostility

  15. Healthy Eating and Obesity • 30% of CHD deaths are caused by an unhealthy diet • 4% of disease and 30% of CHD is due to poor consumption of fruit and vegetables • Abdominal fat distribution is an indicator of greatest CHD risk in the obese • 7% of disease, 1/3 of CHD, 60% of hypertension and 63% of heart attacks are caused by obesity

  16. Every kg of excess weight contains 7500 Kcals, a reduction of 1000 cals per day will lead to 1kg weight loss per week Food diaries to look at: Meal patterns Likes and dislikes Hard to resist foods Portion sizes Work and home arrangements for cooking and eating General Weight Loss Advise

  17. Portion sizes: 3 tbls breakfast cereal 2 heaped tbls rice 2 egg sized potatoes Carbohydrates, proteins, fruit and vegetables all create a feeling of fullness. High fat and sugary foods should be avoided but an occasional treat will not jeopardise months of dieting.

  18. Eating for a Healthy Heart • 5 portions of fruit and vegetables a day • Reduce saturated fat and replace with poly or mono unsaturated fats • Oily fish once a week • No more than 6 grams of salt a day • High fibre to reduce absorption of dietary cholesterol

  19. Fatty substance produced by the liver Also found in some foods Cholesterol is released when saturated fat is digested Cholesterol is carried around the body by LDL, HDL and triglicerides LDL cholesterol contributes to the development of atheroma HDL cholesterol transports cholesterol out of the body Optimum is to have high HDL and low LDL What is cholesterol?

  20. Cholesterol and CHD • Direct link between cholesterol and CHD • Raised cholesterol accounts for 8% of all disease and 60% of CHD • 45% of heart attacks are caused by raised cholesterol • Recommended level- 4-5 with a HDL greater than 1

  21. Reducing cholesterol • Reduce saturated fat intake • Statins (simvastatin) reduce cholesterol and provide overall reduction in CHD risk • All patients who have had a heart attack, have angina or have a cholesterol greater than 5 should be on a statin unless contra indicated

  22. SMOKING • Ten million smokers in England • 20% of CHD deaths in men and 17% in women are attributed to smoking • Smoking cessation reduces risk of CHD by 50% in the first year, followed by a gradual decline to that of a non smoker • Smoking cessation following a heart attack reduces the risk of further heart attack by 24-29%

  23. Diabetes • Type 1 diabetics do not produce any insulin. • Type II diabetics have a relative lack of insulin due to resistance. • Men with type II diabetes have 2-4 fold risk of developing chd and women a 3-5 fold risk compared to non diabetics. • Diabetes increases the risk of heart attack by 3 fold. • Type II diabetes magnifies other risk factors and those with type II diabetes are more likely to have other risk factors. • 15% of heart attacks are caused by diabetes.

  24. Conclusion CHD is: • Hereditary • More likely to develop with increasing age • Is more prevalent in the male population HOWEVER For a large proportion of people it is PREVENTABLE • Simple changes can have significant results • Health care assistants can assist with the governments drive to reduce CHD in the UK

  25. References • Department of Health (2000) National Service Framework for Coronary Heart Disease • Hinchliffe S, Montague S, Watson R (2000) Physiology for Nursing Practice • www.bhf.org.uk • www.heartstats.org

  26. Heart Failure - a definition Heart failure is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation. (NICE 2010)‏

  27. Echocardiogram • An echocardiogram is a non invasive investigation to look at the atria and ventricles in the heart and assesses for any pathological changes that may be affecting the function of the heart. It also provides an ejection fraction figure which refers to the percentage of blood pumped out from the left ventricle. The procedure can be done as an outpatient or through the Community Echocardiogram service.

  28. ■ It is estimated that over 5% of all deaths in the UK are due to heart failure. • ■ People with heart failure have a lower quality of life than people with arthritis, chronic lung disease or angina. • ■ In England 2% of all inpatient bed days are due to heart failure. This is projected to increase by 50% over the next 25 years. • ■ Annual cost of heart failure to the National • Health Service in the UK is about £625 million

  29. The Health Service cost of Heart Failure

  30. Aims • Bridge the gap between primary and secondary care • Patient and carer focused • To optimise the management and improve the quality of life experienced • Prevent unnecessary hospitalisations • Patient journey as smooth as possible and not fragmented • Proactive intervention rather than reactive response.

  31. Aims of the Community Heart Failure Nurse • To offer interventions appropriate to the patients needs, incorporating psychosocial and educational input and a review of their medical condition/treatment.

  32. Causes of Heart Failure • Coronary heart disease/ischaemia • Hypertension • Heart valve disease • Arrhythmias • Thyroid Dysfunction • Chronic Anaemia • Cardiomyopathy – alcoholic, drug induced,congential, ichaemia.

  33. New York Heart Association Classification • NYHA class 1 – Symptoms do not occur during normal activity • NYHA class 2 – Symptoms slightly limit normal activity • NYHA class 3 – Marked limitation of normal activities without symptoms at rest • NYHA class 4 – Unable to undertake any physical activity without symptoms. Symptoms at Rest.

  34. Most sensitive symptom of heart failure • Pulmonary oedema (fluid on the lungs) – back pressure on the lungs from an overloaded left atrium. • Overdrive of the breathing muscles • Weakness of breathing muscles

  35. Signs and Symptoms of Heart Failure • Fatigue/tiredness • Breathlessness • Peripheral oedema • Disturbed sleep( nocturnal cough; breathlessness)‏ • Difficult in concentrating ( hypoxia; lethargy)‏ • Depression (anxiety; poor prognosis)‏ • Impaired appetite

  36. Assessment of fluid status • Daily weights • 1kg weight gain = 1 litre fluid • Look for oedema (usually evident when 5 litres of fluid is retained) • Feet / ankles • Calves • Thighs • Abdominal ascites • Sacral • Pitting?

  37. Fluid Retention / Oedema • Heart failure causes back pressure on the circulation. • Increased venous pressure causes fluid build up in other tissues e.g. lungs, peripheries, abdomen. • Reduced cardiac output leads to reduced blood flow to kidneys which results in sodium and water retention.

  38. Leg Oedema

  39. Tiredness / Fatigue • Fatigue is almost always present in heart failure. • Skeletal muscle changes • Effortful breathing • Poor sleep quality • Reduced oxygen in the blood • Reduced ability to respond to exertion

  40. Assessment of tiredness / fatigue • Changes in exercise / activity tolerance • Activities of daily living • Muscle weakness • Pain

  41. Day to day management • Review of daily weights – action if weight has increased over the last 3 days by 2-4 kgs (4-8lbs). • Fluid restriction if necessary (1.5-2litres)‏ • Symptom review • Blood pressure (sitting and standing)‏ • Heart rate and regularity

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