Heart Failure Clinic

Heart failure is a serious and costly chronic disease - 50% mortality after 5 years of evolution and 1 in 4 patients is readmitted to the Hospital within 30 days of his first hospitalization. Its prevalence is constantly increasing, especially as the population ages - more than 10% of people aged 70. It is a public health issue.
In Lebanon, there is no national heart failure management network. This disease reduces patients quality of life and creates social and financial problems.
In order to treat this health problem,  Aboujaoudé Hospital is engaged in a process of therapeutic education for the patient and his family. The patient training before leaving the Hospital in addition to his follow-up in clinic by a nurse specialized in heart failure increases his satisfaction leading to the continuity of his care, and its independence in daily activities. In addition, it reduces stress and disability in the cardiac insufficiency patient who becomes autonomus and can resume an acceptable pace of life. The heart failure clinic at Aboujaoudé Hospital is the first clinic opened in 2019 in a Hospital outside the capital Beirut and it is the third in Lebanon.

Heart Failure patients needs

 Patients with heart failure needs are medical and social :

• Management by a multidisciplinary team including nurses, dietician, physiotherapist, social worker, cardiologist...
• Education on poly-medication and prevention of drug interactions risks 
• Importance of compliance with medication
• Assessment of precarity and prevention of psychosocial disorders, especially the social isolation syndrome and loss of autonomy
• Motivation to resume progressive physical activity
• Initiation to a healthy lifestyle without tobacco, without alcohol; a healthy diet without salt, with a measured consumption of water quantity
• Vaccination against diseases especially influenza, pneumococcus, diphtheria, tetanus, pertussis

Department goals and objectives

Based on the Sustainable Development Goals identified by the United Nations (good health, well-being and quality education), the heart failure clinic aims to:

• Provide the best education to the patient and their loved ones on the disease's different aspects and treatments
• Make the patient more autonomous and involved in his management to avoid pushes and evolution towards more advanced stages
• Accompany the patient and those around them throughout the illness and limit decompensation therefore the need for readmission
• Improve compliance with treatment and ensure a better quality of life

It is a “case management” model of care based on holistic management. The patient is accompanied by the same nurse until his independence and his ability to make informed decisions is restored,  The nurse looks after the patient and follows up with a series of appointments.

Clinical staff consists of two-state certified nurses

 Mrs Marleine Saad has 25 years of experience in intensive and coronary care and 11 years in interventional cardiology. She is renowned for her exceptional approach and her support for the patients and their families

 Mrs Rita Akiki has 11 years of experience in pediatric and neonatology service and 8 years as a nurse manager at Aboujaoudé Hospital. She gives time and care for clinical work next to her patients

A dietician and a Physiotherapist

Also presents a permanent support

 Mrs Nayla Laffi dietician

 Mr Alain Sleiman physiotherapist

The heart failure clinic is situated at the ground floor of the Aboujaoudé Hospital. Patients and their companions are welcomed in a very calm atmosphere.

The team provides therapeutic education for patients who suffer from heart failure. The consultation is by appointment. The patient is addressed to a specialized nurse

The clinic nurse works with the cardiologist to develop a treatment that will adapt to each patient. A specialized nurse in heart failure clinic mainly follows the patient. The consultation is regularly at 1 week of the first visit, one month to 3 months, to 6 months and to 1 year.

The nurse is always available for questions and patients could reach her through her phone number during clinic hours (A phone application will soon be launched to facilitate patient-nurse interaction)

In heart failure clinic, the nurse takes care of the patient’s care

The consultation is free. The specialized nurse ensures a care plan in a 5 stages during personalized meetings:

1. Evaluate the educational needs of the patient for establishing a educational diagnostic
2. Define the educational objectives with the patient
3. In indiviuals sessions, teach the patient and his compagion on the way of life based on learning tools such as educational book in Arabic, French and English and illustrating it with photos
4. Perfom a clinical nurse examination to detect signs of clinical aggravation and teach the patient how to detect warning signs based on simplified tool (symptom checker)
5. Maintain patient’s expertise and update them to enable the patient te acquire the best quality of life.

The patients here are all from Lebanese regions

Officially opened in May 2019, it welcomes patients and their families. A cardiologist doctor refers these patients after hospitalization or a private consultation in clinic. The average ages of patients who join are 74 ±10. They live with their families. Half of them are women and the other halves are men. Given the situation in Lebanon, more than half of them are workers who didn’t retire yet, although they passed the retirement age (65 years), These patients live with co-morbidities such as hypertension (60% of patients currently followed and 30% diabetes.

Clinic activities are free. It gather the following interventions

- An individualized nurse-patient meeting

- Clinic examination with a file of the clinical status of the patient

- Therapeutic education on heart failure and taking into consideration the following 8 points :

1- Heart failure disease and NYHA (New York Heart Association) The use of cardiologist facing warning signs

2- Compliance of drugs and their sides’ effects

3- Daily surveillance of weights

4- Water restriction.

5- Adapted diet especially without salt

6- Daily physical activity

7- Stop smoking

8- Vaccination of the patient with cardiac insufficiency

• A file is opened for each patient. The patient takes a copy of the record of the meeting with his nurse to facilitate the communication with his cardiologist during medical visit
• When needed, the nurse directly communicate with the cardiologist to adapt the patient’s management program
• Each year, a study is conducted on the impact of therapeutic education of the patient with heart failure on its quality of life
• The reults of the study conduced in 2019 are shared with nursing colleagues at the 12th Annual Congress of the Lebanese Society of Critical Care Medicine

Benefits of therapeutic education in heart failure clinic in the literature review

• Make the patient be part of his health
• Reduce mortality to 2 years after diagnosis (30%)
• Reduce global mortality by 17%
• Reduce hospitalizations for heart failure by 43 %
• Reduce the cost

The advantages retained in our clinic following the study we conducted

• 64 % of our patient in the clinic were able to go back to their normal and social life
• A therapeutic observation over patient on hygienic and dietary
• Nurses are more respected by families and physicians
• Patients refers to nurses and have more confidence in them
• Nurses are the ones providing therapeutic education to patients specifically about chronic diseases. They are credible and respected
• With few resources, nurses are able to do projects that will make a big difference in people’s daily life and reduce their health expenses while improving people’s quality of life. The therapeutic education clinic and follow-up of patients is held by two nurses who are able to serve patients and their families. Thus, with little resources nurses are capable of radical change in the future and quality of the population

The education provided to patients with heart failure and their families allows them to be independent and more observed to the treatment 

The rate of re-hospitalization decreases and the cost on health is lower

The key to success of our clinic is the dedication of the nurses to their patients. Nurses and cardiologist makes a team and approach patients with a holistic approach.

A patient later summarized his satisfaction, written in Arabic following the courses of therapeutic education. One of our patients was not following the recommendations given for water restriction. Later, after our educational interventions, he developed a strategy and no longer suffers from water retention

A mother could not afford the medicine given because of money. After visiting our clinic, we referred her to a health center next to her home where she can buy medicine at a low and reasonable price

After the follow-up in heart failure clinic, more than 100 consultations in 3 months, a clear improvement is noted. Patients at the meeting says that they adapt to the their disease better and they are more autonomous

We believe that nurses are capable, with little human resources to make a big difference in the health of the communities. The most important thing is to get involved and provide evidence-based services

Heart Failure Clinic - 9/03/2019

https://drive.google.com/file/d/1RGD5_ifCu5hSWlmwJJ0krkovMFgvAqY2/view?u...

Literature Review

1. Quality of Life in Patients With Heart Failure: Ask the Patients; Seongkum Heo,  Terry A. Lennie,  Chizimuzo Okoli, and Debra K. Moser; BMC Fam Pract. 2016; doi: 10.1186/s12875-016-0473-4.

2. Impact of patient education on chronic heart failure in primary care (ETIC): a cluster randomised trial; Hélène Vaillant-Roussel, Catherine Laporte, Bruno Pereira, Marion De Rosa, Bénédicte Eschalier, Charles Vorilhon, Romain Eschalier, Gilles Clément, Denis Pouchain, Jean-François Chenot, Claude Dubray, and Philippe Vorilhon; BMC Fam Pract. 2016 doi: 10.1186/s12875-016-0473-4.

3. Therapeutic patient education in heart failure

Y. Juillière, P. Jourdain; La Lettre du Cardiologue, n° 449 - novembre 2011.

4. Effect of Self-care Education on Patients Knowledge and Performance with Heart Failure;

Parvin Mangolian Shahrbabaki , Jamileh Farokhzadian, Zahra Hasanabadi; Procedia - Social and Behavioral Sciences 31 (2012) 918 – 922; 2011.

5. Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure, Am J Public Health (1994);84: pp. 20-28.