July 10, 2013

Patient role vital in managing congestive heart failure


---- — PLATTSBURGH — A diagnosis of congestive heart failure need not be a life sentence if a person is determined to manage the condition properly.

Congestive heart failure occurs when the heart has been damaged or is weak. It is a chronic condition that cannot be cured, but doctors have many treatments at their disposal to keep it from worsening.

“Heart failure is not a disease in itself but a syndrome that can be caused by disease,” said Anne Laramee, a clinical nurse specialist and nurse practitioner for Cardiology and Palliative Care Services at Fletcher Allen Health Care in Burlington.

“It occurs when a heart problem causes the heart not to pump the way it should or it doesn’t fill as well as it should.”


The heart is an intricate muscle with many working parts that have to mesh for it to operate properly. Electrical impulses controlling the heartbeat may misfire, causing problems with how blood is pumped through the body, or the heart itself can hold too little or too much blood, which can impact its ability to pump.

“Heart failure is a common problem, and it is increasing,” said Laramee, who spoke in Plattsburgh recently as part of the CVPH Medical Center Community Lecture Series. 

“For people over 40, there’s a one-in-four chance for developing heart failure.”

Congestive heart failure is the leading cause of hospitalization for people older than 65, Laramee told the several dozen people in attendance at the Warren Ballroom on the SUNY Plattsburgh campus.

Also, up to 44 percent of those people admitted to the hospital with heart failure are readmitted within six months of the first hospital stay.

“There are a lot of things we are learning today that can help prevent (those kinds of hospital statistics),” she said. 


Two-thirds of heart-failure cases are caused by coronary heart disease, she added. 

Heart disease can be inherited through genes, and it can develop over a person’s lifetime.

Fletcher Allen’s Cardiology Unit, which now works collaboratively with CVPH Medical Center, has developed a program called FACES that addresses many of the symptoms of congestive heart failure and how to combat them.

Fatigue, activities becoming more reduced, chest congestion, edema or ankle swelling and shortness of breath are the five focal points of FACES, Laramee explained.


“Your heart is not giving your body what it needs,” she said of the origin of these symptoms. “We spend a lot of time and money finding ways to reduce and prevent these symptoms.

“Early recognition of symptoms is important,” she stressed. “The number one thing that causes hospital admissions is that patients are not telling their providers about having these symptoms. We’d rather have patients call us, so we can treat the symptoms and prevent a return to the hospital.”


There are several kinds of medications that can alter the heart rate or reduce blood pressure and thus affect the increased severity of symptoms, Laramee said.

There are also many other options that can help alleviate symptoms, including the use of diuretics to reduce fluids and the use of pacemakers and other technologies to support a proper heartbeat.

Patients with congestive heart failure can remain active if they have control of these symptoms, she stressed.

“Exercise is important and will help you live longer,” she said. “Let your body be your guide (in determining how much exercise is appropriate). When you’re active, you should be able to talk normally. 

“If you can’t, slow down or stop.”


She also recommends anyone who has had heart failure to work closely with cardiac rehab facilities, which help educate patients on the best options for exercise and nutrition.

Another important self-help tool is to check weight daily. When problems start to develop, the body holds onto fluids longer, and that means a sudden increase in weight, which should signal a call to the doctor.

Reducing stress and anger are important in long-term treatment, as well. Also, having a solid support group can help a patient get through some of the more difficult times.

“How long do I have?” Laramee said of the number one question that is on people’s minds when they’re diagnosed with heart disease. 

“That’s difficult to answer, difficult for practitioners. People want to know that, but it’s a discussion that is not always happening.”

Patients need to be proactive in asking those questions to allow for advanced-care planning, she added.

“Be an active participant in your health care, contact your practitioner (when symptoms arise), limit your salt, weigh yourself daily, exercise,” she said.

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