Over the last decade, there has been a deliberate effort on the part of clinicians to encourage heart failure patients to monitor their own conditions. “Heart failure is a chronic condition, characterised by phases of stability interrupted by phases of 'decompensation' (worsening),” says Professor Iain Squire, Professor of Cardiovascular Medicine at the University of Leicester and Honorary Consultant Physician, University Hospitals of Leicester. “Unfortunately, a decompensation phase is often associated with the need for hospital admission, so it's important to empower patients and/or their carers to identify the signs of deterioration before things get to the admission stage.”


Be aware of changes


In this age of tech-driven innovation, are devices routinely available to help do this effectively? No, says Squire: it's not quite that simple. For example, you may think that standard ECG (electrocardiogram) monitors — such as Holter monitors and loop monitors — keep check on heart failure stability, but they don't.

“Individuals who are asked to wear ECG monitors by health professionals will include those with heart failure,” says Squire. “But this type of monitor only records abnormal heart rhythm activity which indicates that a further intervention may be necessary.” There are implanted devices that do monitor heart failure stability, called pulmonary artery pressure monitors, but, as these are for patients with chronic heart failure, it's technology which is not cheap and therefore not routinely available.

The best way to monitor heart failure is simply to be alert to any changes in your health —these are easy to spot. The main symptoms include breathlessness and fatigue and fluid retention – usually in the ankles – which can quickly cause weight gain.


Importance of early intervention


If a friend or someone in your family has been diagnosed with heart failure, it's important to notice changes on their behalf, because they might not. “Many patients with heart failure are elderly and may have impaired faculties,” says Squire. “Their eyesight and hearing may not be good and they may have a degree of cognitive impairment.” And, of course, the earlier you make their GP or cardiac specialist aware of any changes, the better.

In the UK, the vast majority of heart failure patients have access to a community-based specialist heart failure nurse who will regularly monitor weight, blood pressure and pulse. For some, a trip to see the nurse may head off a trip to see their consultant — or, in worse case scenarios, a stay in hospital. “Community heart failure nurses can encourage patients who are showing signs of fluid retention to increase their diuretics — and so reduce fluid — before they make contact with their own health care professional,” says Squire.

And while heart failure remains incurable, its treatment has improved markedly in recent years, which means that patients are living longer and better lives. “We're lucky to have a large number of leading research scientists in this area in NHS institutions and UK universities,” says Squire. “Plus, we're fortunate to be able to prescribe heart failure patients with medication and devices whose benefits have been proven in large, well-run clinical trials.”