Managing Congestive Heart Failure

Feb 25, 2014
Cardiovascular specialist pharmacists can help patients manage congestive heart failure and be adherent to their treatment regimen.
  • High Blood Pressure/Heart Disease

Heart failure, sometimes called congestive heart failure, affects more than 5 million Americans and is the only major cardiovascular disorder on the rise. It is a condition in which the heart muscle becomes weakened from events such as a heart attack, long-term high blood pressure or uncontrolled diabetes.

According to the American Heart Association, half of all Medicare patients hospitalized for heart failure die within three years. As the leading cause of hospitalization for Americans over age 65, clinicians agree that more patient education and cohesiveness of treatment is needed to successfully treat this progressive condition. To encourage better treatment, the 2010 Affordable Care Act has created incentives to reduce re-admissions by providing lower Medicare reimbursement for hospitals with high re-admission rates.

The Value of Clinical Specialization

Doctors and hospitals see the necessity for continuity of care to decrease the need for a hospital re-admission. This is where the Express Scripts cardiovascular specialist pharmacists can help. When we are able to assist patients in keeping their blood pressure under control, the risk of developing heart failure is reduced by up to 50%.

Many mistake the symptoms of heart failure as normal aging and may not become aware of their condition until years after their heart begins to decline. These signs include a general fatigue and weakness, weight gain with noted swelling in the ankles and legs from fluid retention, shortness of breath even with mild activity and difficulty breathing when lying down. These symptoms could be from a weakened heart that can’t pump enough blood to meet the body’s demands.

Early diagnosis and newer treatments are helping patients with heart failure enjoy everyday activities and have a more normal life expectancy. Medications such as ACE inhibitors or angiotensin receptor blockers, beta blockers, diuretics, digoxin and statins are common medications prescribed for patients with heart failure.

After diagnosis, cardiovascular specialist pharmacists can be invaluable to help patients adhere to their treatment regimen. We counsel heart failure patients to:

  • Remain compliant on their heart medications, especially daily dosing of their beta blockers and ACE or ARB. These medications have been proven to improve symptoms of the disease and help extend life.
  • Keep blood pressure at goal by encouraging medication compliance, noting that low blood pressure helps the heart pump effectively without extra stress.
  • Avoid certain medications, including decongestants such as Sudafed, antacids that contain sodium, and ibuprofen and other nonsteroidal anti-inflammatory drugs that can increase blood pressure.
  • Watch for sudden weight gain of more than 3 pounds in one day or 5 pounds or more in one week. Educating patients to weigh themselves daily and report unexpected gains to their doctors helps curb worsening of the disease.
  • Quit smoking. Smoking increases heart rate and blood pressure, and smoking cessation greatly improves symptoms.
  • Exercise regularly and eat a low saturated fat and trans-fat diet with high fiber and low salt. Salt retains fluids and worsens heart failure.
  • Track daily fluid intake, avoid alcohol and limit caffeine.
  • Keep track of shortness of breath, persistent coughing or wheezing, lack of appetite, confusion, increased fatigue and increased heart rate. All can be signs of worsening heart failure.

Heart failure can be a debilitating and life-threatening disease that requires significant lifestyle changes. Medicare hospital re-admissions cost the American public more than $15 billion each year. After a treatment regimen is put in place for heart failure, it is important for patients to be adherent to their therapy, keep track of symptoms, and report any sudden changes to their physicians and healthcare team. This will help patients avoid hospital admissions and will put them on the road to better heart health.

Cardiovascular specialist pharmacists here at Express Scripts are an integral part of that team.

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