Des gestes simples pour prévenir l’aggravation d’une insuffisance cardiaque

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 The American Heart Association conducted a collective expertise on behaviors to limit the worsening of heart failure and improve the quality of life of patients. The Association recommends integrating these behavioral changes in a comprehensive, sustainable and coordinated with professionals and closed persons.

The American collective expertise of Riegel and colleagues, published in the journal Circulation in 2009, requested by the American Health Association for highlights self-care to prevent worsening of heart failure. This education for self-management of the disease is primarily based on better adherence to treatment and behavioral change in terms of diet and physical activity. Acting on these three components reduces spending on health and especially spare patients new treatments and new hospitalizations.

The Study Rationale

Heart failure is a disease of the heart, the latter being no longer able to ensure the blood flow required by the body. Its origin is diverse, hypertension, heart defect, coronary artery disease, diabetes. Heart failure is mainly present in the elderly. This chronic disease deteriorates the quality of life and causes premature death. It represents a significant human and economic cost to the health system. For example, 1 million Americans suffering from this disease are hospitalized each year.

The “self-care”, known in France under the restrictive concept of self-management that some authors still limit to mere compliance with drug prescriptions (i.e., compliance) is defined as a patient’s active engagement in the process and decisions behaviors related to his illness and his health. The behaviors designed to maintain physiological balance and optimal adjustment to the symptoms of chronic disease. In the case of heart failure, behavior also aim the prevention of comorbidities such as hypertension and diabetes, anxiety and depressive symptoms, cognitive impairment and sleep disorders. Finally behaviors aimed optimal fit to advancing age. A relevant self-care strategy should take into account all these aspects. The American Heart Association has asked experts how it should be put into practice for people with heart failure?

The Question

What actions to recommend to patients and health professionals to develop self-care?

The Method

The American Health Association  sponsored a collective expertise. The report by Rieger and colleagues offers a state of knowledge on education for self-management of heart failure. It describes firstly behavioral self-management techniques and their benefits on health indicators associated with heart failure, and other factors that impede and facilitate behavior change.

Non Pharmacological Intervention (NPI) assessed

The self-care programs are based on learning strategies of behavioral self-management techniques of heart failure. They aim adherence to drug therapy, a healthy diet and regular physical activity. They also train patients with worsening signs related to heart failure such as a change of body weight, loss of appetite, abnormal shortness of breath, persistent fatigue, sleep disorders, memory disorders , ongoing stress and mental confusion. A limited supply of salt, sugar and fat is recommended. Alcohol consumption must be minimized and where possible halted. A body weight change must be alerted. Regular physical activity is recommended as the cessation of all forms of smoking, dental hygiene and annual vaccination against influenza.

Main Results

Strengthen self-care strategies in patients with heart failure would reduce the number of hospitalizations, increasing survival rates, reduce the cost of health care and improve the quality of life. Motivational and social support measures should be initiated to maintain sustainable change health behaviors. Upstream, the coordination of professional care and prevention in the messages and actions proposed to patients will be crucial not to confuse. Research in the field of self-care should be encouraged.

What it means for Patients

The experts convened by the American Health Association encourage patients with heart failure more work with caregivers in order to develop effective behavioral strategies. This is the “Self-Care”. The involvement of family, friends and people with the same disease is a guarantee of success. Patients must learn to recognize the signs and symptoms of heart failure when they occur (lack of appetite, fatigue, depression, memory impairment, ongoing stress, mental confusion). A limited supply of salt, sugar and fat is recommended. Alcohol consumption must be minimized and where possible halted. A body weight change must be alerted. Regular physical activity is recommended as the cessation of all forms of smoking, dental hygiene and annual vaccination against influenza.

What it means for Healthcare Professionals

The article emphasizes the importance of taking into account comorbidities in heart failure. A significant proportion of this population feels depressive symptoms, anxiety and cognitive disorders. Sleep disorders are relatively common and can compromise the effectiveness of self-management or self-care. Health professionals should integrate these behavioral strategies to care pathway.

What it means for Researchers

Further researches on the self-care are needed. They should allow a better understanding of the role of diet, symptoms of anxiety and depression and cognition disorders on behavior of self-care of heart failure. Specific methods, and consistent monitoring of symptoms should be developed. The field of interventional studies should take more account of health indicators (including survival and quality of life) and measures of cost-effectiveness. The report encourages conduct randomized controlled trials to make credible and generalizable implementing programs of self-care in the current health system.

What it means for Policymakers

The management of a million people with heart failure in the United States must change according to experts convened by the American Health Association  at the origin of this report. Disease management by patients themselves is not optimal. It causes considerable human and financial costs. Scientifically validated educational programs to the self-care should be systematically integrated into course care of each patient, and from the hospital to the patient’s home through the city of medicine.

 The Reference

Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL Gurvitz MZ, Havranek EP, CS Lee, JA Lindenfeld, Peterson PN, Pressler SJ, DD Schocken, Whellan DJ (2009). Promoting self-care in persons with heart failure: A scientific statement from the American Heart Association. Circulation, 120, 1141-1163.

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To reference this Blog en Sante © article.

Ninot G (2015). Behaviors to prevent worsening of heart failure. Blog en Sante, A38.

© Copyright 2015 Grégory Ninot. All rights reserved.