Supporting patients after a heart attack: In hospital In primary care In the community National Heart Foundation of Australia

Transcription

1 Supporting patients after a heart attack: In hospital In primary care In the community

2 Your requests Action plans Information on medicines Stents Follow-up protocols

3 Setting the scene: Mr Charlie Brown s experience Age 55yrs Overweight, smoker, truck driver, no medications prior Told he had a heart attack 2-3 days in hospital Anxious, visitors, information over-load (~5% recall) Given verbal information. Written education: My Heart My Life book Told to see GP within 5 days ( 5 day supply meds) Cardiology appointment often 8-12 weeks

4 Charlie Brown at home: The patient s perspective Told I only had a little heart attack, what does that even mean? Never taken meds before; now I rattle Unsure about my physical activity levels Not sure when can return to work (financial implications) Feel dizzy sometimes Niggles in chest: is that normal? My wife keeps asking how I feel all the time: SO ANNOYING Not sure whether I should be eating peanut butter Dying for a cigarette but know its bad for me Also said I was almost a diabetic, what does that mean?

5 Health Professional Engagement If you don t have a rapport, nothing you say or do matters Time constraints consider what is realistic what is important to ensure patient safety At patients level, their priorities too You require many skills Self Management Motivational Interviewing Goal setting Tools and tips to help you.

6 Patient resources /Love_your_heart_2016_WEB.pdf 14 languages Short version 28 languages

7 Heart Foundation HELPLINE Qualified Health Professionals: supporting you & your patients Phone:

8 Six steps resources Allow approx. 4-6hrs Certificate on completion

9 Stickers for notes: key education points

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11 What do you know about your heart condition? Explain diagnosis and care instructions do not assume patient understands what has happened. Ask patient if they have any questions. It is important patients understand that a heart procedure is a treatment and not a cure for heart disease. Patients have a key role to play in managing their condition.

12 NB. Interpreting reports e.g. PTCA LAD and Cx

13 Avoid the use of complicated jargon Your heart is about the size of your fist and made of muscle. This muscle pumps blood around the body. For the pump to work the muscle needs a blood supply with oxygen and nutrients, which gets to the heart muscle through the coronary arteries. It is these arteries that get blocked and can lead to heart attack and angina.

14 Use models, pictures, videos.

15 Check understanding of tests ECG Exercise Stress test Blood tests Ambulatory Monitoring X-ray Echocardiograph (TTE or TOE) or stress Echo Coronary Angiogram Cardiac CT CT Calcium score MRI Radionuclide testing

16 Coronary Angiogram X-ray image of coronary arteries and LVgram Risks Awake Lie flat if femoral access

17 Stents Image :

18 Explain relevant risk factors and importance of managing these. Discuss clinical and lifestyle risk factors and importance of management. Explain value of attending cardiac rehabilitation.

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20 Discuss importance and explain benefits of attending a program Refer the patient to cardiac rehabilitation and provide program information Heart Foundation Health Information Service health@heartfoundation.org.au

21 Online directory

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23 All patients should understand importance of taking their medication. Check patient understands the medications they need to take for their heart. Emphasize that they must not stop taking medication. Encourage them to discuss any concerns with their doctor.

24 Long term management Statin Aspirin - Dual antiplatelet therapy (DAPT) ACE inhibitor -blocker Nitrates - GTN Anticoagulation Warfarin / Apixaban / Rivaroxaban Insulin/oral hypoglycaemics (diabetes) Aldosterone antagonists (heart failure)

25 Antiplatelet medication advice card Fact sheets for consumers and health professionals.

26 Medications Most populations 30-50% NON compliance Patients beliefs are paramount attitudes towards medications Own knowledge Ideas Experiences May need to alter patients own expectations Compliance is linked to quality, duration and frequency of interventions with health professionals Use local pharmacist It is important the patient knows or keeps a record of: The names of the medication What they are used for How often and what times they are taken

27 All patients should know the symptoms of heart attack and chest pain management Discuss how to manage chest pain and instructions for GTN Advise that not all heart attacks are the same and that symptoms can vary STOP what you are doing and rest. TALK if someone is with you tell them how you feel. CALL Triple Zero and ask for an ambulance. Action plan: Magnet, wallet cards, DVD, HF YouTube channel

28 All patients should understand the importance of GP and Cardiologist follow up. Advise patient that regular GP visits are essential to help monitor heart health and medications. Encourage patients to discuss medication and recovery with their doctor.

29 Common issues heard by CR staff Limited information retained during hospital stay (anxiety/overload) keep reinforcing information sometimes needs a different way of explanation to resonate Increased awareness of sensations in chest Loss of confidence (eg to exercise, sex) New medication routine (cost, side effects; dizzy, tired) Off work: bored, income issues, driving guidelines: private/commercial Psychosocial changes: low mood/ anger, family overprotective Other priorities (family, other health issues) Need more support for lifestyle change eg smoking, diet

30 CR attendance ~30% not deemed important/don t understand benefits barriers such as rtw, transport, distance, cost, unwell, Primary care well placed to give regular education and can provide long term follow up. Patient will need prescriptions = opportunity to reinforce education

31 Mrs Brenda Green 65yrs BMI 30 Hypertension Smoker Diabetic Married, part time admin work AMI (Troponin 75) LAD stent, min diffuse disease RCA and Cx

32 Education (as time permits!) Check has My Heart My Life (+/- other information sheets) Use as a tool to explain diagnosis to pt Has good dietary advice & medication tips Walking plan: gradually increase exercise.?give personal copy of discharge summary Encourage to attend cardiac rehab education & exercise Can call Helpline (for CR Program location or resources and support)

33 Chest niggles? Know their chest pain action plan? Carry GTN? Keep a record of CP occurrence and tell GP May have remaining diseased vessels Having staged PTCA need cardiology review sooner if symptoms? Med changes eg Isordil?

34 Medications Ask if given a copy of medication list Encourage to carry UP TO DATE med list in wallet Dose, generic and trade names Remind of importance of meds Antiplatelet medication Antiplatelet card Do not cease without cardiologist advice Most meds life long Need good routine,?use dosette box or phone app reminder Important to budget for meds (no medication sharing!) Home medicines review? Encourage to use same pharmacist

35 BP Check BP May be much lower now: on BB and ACE - dizzy Body getting used to new meds Advise to get up more slowly and avoid hot showers May need to be seen more regularly initially Advise normal for Dr to titrate ACE dose up if tolerated (research) Correct cuff size? Purchase/ hire home sphygmomanometer?

36 Blood tests.. Check cholesterol 4-6 weeks post statin commencement Check kidney and liver function Maybe INR

37 Smoking - Cold turkey didn t work Motivated while in hospital to Quit Started again few days/weeks later Suggest strategies, resources Referral to Quitline? My quit buddy App NRT, champix? Remember smoking promotes clots = blocked stents!

38 Help with weight loss & dietary advice? Ensure referral to CR Long term goals Use waist circumference Dietician /diabetes educator/ Ex physiol at GP practice? Refer patient to Heartline/ Heart Foundation website Refer to Heart Foundation walking group?

39 Other??? Depression common: screen and monitor Stress: lifestyle changes, relaxation Often only see cardiologist once (GP can refer back) Return to work advice? Retraining? Sex? Driving? Individual assessment Min 4 weeks commercial driving Min 2 weeks private vehicle Min 2 days PTCA & stent Inform Dept of Transport & Insurance company

40 Communication Deficit Healthcare providers think 80% patients understand what they have said BUT Of these patients, only 37% patients reported they actually understood

41 Teach-back technique Ensure patients know your goal is to check how well you explained the info - not to test their knowledge Universal precautions - Taking specific actions to minimise risk when you don t know who is affected Take universal precautions using teach back Can t tell by looking if someone will understand Communicate clearly with everyone Confirm understanding with everyone

42 Avoid yes/no questions like - Do you understand?

43 The spirit of MI: change talk 1. Collaboration (vs Coercion) dual expertise between patient and the clinician 2. Evocation (vs Education) elicit reasons, abilities and methods for change 3. Autonomy (vs Authority) emphasis that the individual is ultimately responsible for making his or her own choice for change

44 TRACS MI Resources