Two recent statements from the American Heart Association (AHA) on the treatment of heart failure looked not only at ways to better help the patient, but also the people at home helping to manage the patient’s condition.
A press release from the AHA noted that more than 6 million Americans live with the condition every day. With the right medication, changes in their lifestyle, and a solid support system, the release notes that these patients can have a high quality of life for many years. However, issues like insurance, disability, race, and income inequality can make life with heart failure significantly more challenging.
“Patients who don’t have insurance coverage, enough to eat, struggle with transportation, don’t have a safe place to be physically active, can’t afford medications and/or have less education and/or insurance coverage may have significantly poorer heart failure outcomes, compared to people who don’t experience those factors,” said Connie White-Williams, PhD, RN, senior director of Nursing Services and Heart Failure Transitional Care Clinic at the University of Alabama at Birmingham Hospital. “It’s important that we ask patients about the life issues and challenges they may be facing: these issues have a direct impact on the patient’s ability to adhere to any care plan.”
The statement makes several suggestions on how providers can help their patients in these situations, including an “interprofessional healthcare team” working together in conjunction with patients, families, and caregivers. The suggestions include:
assist patients seeking insurance coverage, financial assistance, affordable housing or employment;
present health information in formats tailored to meet each individual's language, level of education and health literacy;
support nurse-led collaborative clinics that assist patients in becoming better stewards of their own health;
use medication access programs to help provide drugs out of patients' financial reach; and
partner with local food banks to help provide groceries to food-insecure patients.
“Addressing social determinants of health can be resource-intensive, and many clinical practices do not have the resources nor are they set up to deal with these challenges,” White-Williams said. “However, when nurses, physicians, social workers, pharmacists, and mental health professionals all work together, an effective plan of care can be designed to keep heart failure patients healthier and out of the hospital.”
At a time where the children of the baby boomer generation are playing a larger role in the medical care of their parents, the AHA issued a statement providing an overview of the challenges these family members face daily. The press release from the AHA noted that caregivers for patients with heart failure can spend an average of 22 hours per week providing that care, in addition to the other tasks of their lives. This can affect a caregiver’s earning ability, which can put even more of a burden on them. There are also psychological concerns that need to be addressed.
As heart failure worsens, patients need more help with everyday tasks, including bathing, dressing, medication adherence, and navigating the ever-complicated healthcare system.
“There is a critical need for health care providers to clearly understand the demands of caregiving and how these change throughout the trajectory of heart failure,” said Lisa Kitko, PhD, RN, associate dean of graduate education at Penn State University College of Nursing. “It is also important to assess caregiver capabilities, including the motivation to provide care; their physical, sensory, motor and cognitive ability to perform required tasks; their level of distress and depression.”
Kitko said it is also important for healthcare providers to make referrals to the patient and their families for supportive services like counseling and respite care.
“In our current health care system, there is a lack of incentives for clinicians to evaluate caregiver needs and offer direct support,” Kitko said.
While noting that the lack of payment and reimbursement for clinicians to provide direct support to caregivers is a considerable roadblock, Kitko said other challenges include a lack of funding for community-based agencies that provide services for caregivers, and limited time for providers to interact with caregivers to better understand the issues they face.