Derek: [begins mid sentence] . . . series webinar titled “Older Adults and Heart Disease: Getting to the Heart of the Matter.” The Griswold Home Care Solution Series webinar program is a monthly workshop, designed to provide practical solutions at the fingertips of family caregivers, families dealing with these conditions, and healthcare professionals.An exciting core component of the Solution Series webinar program is learning from you, the audience. Throughout the webinar, you will have several opportunities to share your thoughts, experiences, and insights on the topic of heart disease via an exercise we call “brainwriting,” which can further promote today’s topic to support your peers and healthcare professionals. First, a couple housekeeping items. All lines are currently muted. The audience will have several opportunities again to interact with the panelists, and we will also have a formal 10 to 15 minute question and answer session at the end of the webinar. The powerful components of the Solution Series workshop are not only the content, but the presented tools to help address the topic of heart disease, heart disease symptoms, heart disease risk factors, and treating and living with heart disease.
The presentation, recording, and all the tools that will be presented today will be made available and sent out to all registrants within 48 hours, along with the complete transcript of the webinar. Let’s dive right in. About today’s topic, February is American Heart Month, and also is the 50 year anniversary of the American Heart Proclamation. The American Heart Proclamation was originally proclaimed by President Lyndon Johnson in 1964 under Proclamation 35-66. On January 31st of this year, President Obama also commented and made a commitment to proclaiming this particular month. President Obama commented, “maintaining a strong heart is key to a long and healthy life. The number one killer of American men and women, cardio-vascular disease, is responsible for one out of every four deaths in the United States. “During American Heart Month, we renew our fight, both as a nation and in each of our own lives, against the devastating epidemic of heart disease.” Obviously this is a 50 year proclamation, was a big deal 50 years ago, and still is today. We also want to recognize that given the audience today and given the background and legacy of Griswold Home Care, particularly serving the older adult population, that not only is American heart disease prevalent in one of four, but also the American Heart Association reports that the number of Americans with heart disease has increased to 16.3 million, more than half of whom are 65 or older. Let’s get started with our goals today. By the end of the webinar, we’re hoping that you as the audience will learn about the nature and impact of heart disease in older adults. Understand how to understand and diagnose and treat heart disease in older adults. Through our brain writing exercise and through our panelists, we hope you’ll learn through the stories and experiences of an experienced cardiac nurse who we have here at our office in Philadelphia. Really most importantly, here are the tools that you can take away at the end of the webinar. We’ll provide a “fight heart disease” toolkit, and many examples of links and tools that you can access after the webinar. Okay. Joining us today is our first panelist, Dianne Kelly. Dianne is an RN, cardiac-cath lab assistant manager and has a really impressive background to support the agenda today. Dianne Kelly is a seasoned cardiac nurse with more than 23 years of direct care experience with patients who are living with various forms of heart disease. Dianne earned her registered nurse license from Our Lady of Lourdes [SP] School of Nursing, and currently works as the assistant care manager on the Our Lady of Lourdes Medical Center cardiac cath lab.
Impressively, Dianne was honored with the Lady of Lourdes’ “Nurse Excellence Award” two times during her career, and is known for her great skill, leadership, and dedication to patients and their families. Welcome to the webinar, Dianne.
Dianne: Thank you so much. It’s great to be here.
Derek: Our second panelist is Chris Kelly, director of learning and development at Griswold Home Care. Chris is the architect of the Solution Series workshop, in addition to leading all learning and education at Griswold Home Care. Previously a VP of health education at Health Ed, Chris was also a director of education at the Alzheimer’s Association, and managed multiple functions within assisted living facilities. We’ll give a hearty welcome to Chris. Chris, if I’m not mistaken, is it ironic that both of our presenters today have the last name “Kelly”?
Chris: [laughs] That was supposed to be a secret. Yeah, very excited to have my wife, Dianne Kelly, join us for the webinar. I really appreciate Dianne’s attendance, and also want to thank Lady of Lourdes Medical Center for supporting the webinar. Again, thanks Derek, great introduction. Really, really excited to be part of this webinar. Over the years, working with older adults, I just noticed a lot of anxiety, fear, confusion, particularly around heart disease. It’s great to share best practices during such an important month.
We’d like to recognize our audience. One of the great things about our webinar is we have, rather than segmenting the audience by professional and non-professional, we really want everyone on so we can learn from each other. We want to thank the healthcare providers, particularly the cardiologists, cardiac nurses, technicians that are working every day with older adults that have heart disease. As well as our franchisees around the country who are supporting clients with heart disease. Professional caregivers, CNAs, home health aides that are providing direct care, personal care especially for people with heart disease. Family caregivers, who are providing a lot of dedication and support for their loved ones with heart disease. Probably most importantly, the older adults out there on the webinar living with heart disease. Tremendous amount of courage to deal with the anxiety and the physical debilitation that can come from heart disease. We want to appreciate you as well. I want to mention that everyone experiences heart disease differently. You may hear about symptoms and forms and conditions that you never deal with. We want to make sure that you understand that.
We have a great activity, as Derek mentioned, called “brainwriting.” We want to make sure that this is not a one way learning experience. We want to make sure that we’re learning from you as well. Once we get to certain portions of the webinar, we will ask you questions, and if you look at the top right hand of your screen you’ll see an orange button with a white arrow. When you click that orange button, the toolbar will come out, and you’ll notice toward the bottom that there is a chat bar. That is where you will type your answers, your stories, anything you can share that we can learn from. At the end of the webinar we will repeat all of those statements and stories back so we can learn from each other. Again, we really appreciate your participation in the brainwriting exercise.
We also like to start our webinars with a basic overview, particularly for those of you who are new to heart disease. One of the challenges with heart disease is really understanding all the different terms and forms. One of our first goals for this project is really to describe what is heart disease. Heart disease can also be called cardiovascular disease. It’s really an umbrella term that we use to describe several conditions, one of which is coronary artery disease. Dianne, just based on your experience, what is the most common cause of heart disease?
Dianne: The most common cause of heart disease is a build up of plaque and cholesterol inside of the arteries. They adhere to the wall of the arteries and can cause blockages, as you can see in the pictures on the slide.
Chris: What are some of the most common forms of heart disease?
Dianne: Other forms of heart disease besides coronary artery disease are heart failure, which may also be called CHF, or congestive heart failure, arrhythmia, or irregular heartbeats-for example, the most common would be atrial fibrillation-and heart valve problems. You could have reguritation, which is like a leaky valve, or you can have a very tight valve which needs to be repaired surgically.
Chris: Great. You can see, when we say “heart disease,” a lot of different words, terms. We want to make sure that when we finish this webinar, that you have much more clarity than you’ve had in the past. I’d like to have our first brainwriting exercise. For those of you who have been diagnosed with heart disease, living with heart disease, if you could go into your chat bar and let us know what type or form of heart disease that you’re living with, and how it’s impacted your life. Again, we’ll read some of these statements back after the webinar. Let’s shift down and discuss some of the common risk factors for heart disease. We’ll start from the top left. Some of the most common risk factors are high blood pressure, having a diet that is high in cholesterol, having a co-morbid or related diabetes condition, smoking, being overweight, being physically inactive or sedate, having a family history of early heart disease. And also age, particularly women that are 55 and older. Dianne, as I look through these risk factors, a couple questions. For people that are physically inactive, how much of that is related to the fact that people have had heart disease, or had a heart attack, and they’re just anxious about what they can do physically?
Dianne: I think a good amount of that can be attributed to that. People are worried; they don’t want to cause another heart attack by doing too much. They really have to join with their doctor and find out how much activity that they can partake in.
Chris: In terms of family history, it must be really frustrating for the people that are really taking care of themselves, doing everything that their doctor is asking them to, but because of genetic history still develop heart disease. Does that come up a lot in your practice?
Dianne: Definitely. Patients come through the cath lab who have stents put in, and they’re very stressed about the fact that they take good care of themselves. We’ve had marathon runners who’ve had to have some arteries fixed. They’re in excellent physical shape, but I tell them you can’t fight genetics. They have high cholesterol because it’s familial, and all the more reason that these people have to follow these, take care of their blood pressure, try to maintain a low cholesterol diet, don’t smoke, control their weight. They have to really be on top of those things.
Chris: Great. You’ll notice throughout the webinar that towards the bottom of the slides, we will share some tools. Some of these we’ll actually open up and dive into. For this tool we won’t, but we just want to make sure that you know, as Derek mentioned, after the presentation is sent out following the webinar, the National Institute of Health has an entire web page dedicated towards risk factors, if you wanted to learn more about that.
As an educational designer, I was really thrilled when we were doing our research to find two great animated videos on the American Heart Association website. We really want to leverage these tools as well as Dianne’s expertise to help to remove the confusion around the difference between a heart attack and heart failure. Let’s start with a heart attack. Dianne, what is a heart attack? Using this visual, what happens to the heart when a person’s experiencing that attack?
Dianne: As you can see on this slide, the coronary arteries sit on the outside of the heart, and they feed the heart muscle much needed oxygen. You have three major arteries, and they all have many branches that come off of them. During a heart attack, what we talked about earlier, this plaque builds up inside the walls of the arteries. That starts in childhood. That’s why we always are talking about childhood obesity and trying to have a good diet as early on as possible, because this plaque starts to build up very early on in life. As the plaque builds up, they can start to become [inaudible 13:04]. There’s a collection of gunky cholesterol, fat, and when they become unstable they can rupture. When they rupture, your body rushes white blood cells and platelets to that area, because it’s an injury and your body is looking at it as an injury. When these things rush to that area, they will start to form a clot. As you see, as the slide progresses, the clot can get larger and larger. It eventually can block off flow completely. When the blood flow is blocked off completely, as we see in this slide, you can see that area on the actual heart, the model of the heart, where it looks like it’s black and blue. That’s heart muscle that’s dying because it’s not getting oxygenated blood.
Chris: Great. Great description. Just shows the power of combining an educator with some great interactive tools. This is again from the American Heart Association website. Let’s walk through the same process with heart failure. Dianne, again, what is heart failure, and what happens to a heart when someone is experiencing heart failure?
Dianne: Heart failure’s a chronic condition. Your heart is actually just a pump, and as we see in this picture, on the right side of the heart as shown on this picture, that’s actually your left ventricle. The left ventricle is very important, because that’s what pumps blood out to the rest of your body and feeds all your organs. When that pump becomes weak for many various reasons, you have heart failure. When we look at the next slide, we can see this is a normal heart pumping. That’s the left ventricle, that’s red, and it pumps very well. It has a nice, tight squeeze. When you have heart failure, the ventricles enlarge, blood sloshes around in there. It isn’t pumped out as well. A normal heart will pump out about 70% of its blood volume from the ventricle. When you have heart failure, you have diminished volume. You could have anywhere from 30% on down being pumped out of there. That can cause problems. You could have fluid backing up into your lungs, and then you start to get the symptoms of heart failure.
Chris: Again, great description. We’re hoping that both the visual and Dianne’s education help to really clarify. I know, working for years with older adults and families, there’s a lot of confusion around the terms. Hopefully that will help. Let’s shift now and talk about recognizing heart disease. Dianne, could you walk through some of the most common symptoms of heart failure first?
Dianne: Sure. Heart failure, one of the most common symptoms would be shortness of breath. It’s also called [inaudible 15:53]. Especially why lying flat. Many of my patients will say they need two or three pillows at night to sleep on. Because they’re not sleeping well at night and they’re not getting enough oxygenated blood, they’re waking up feeling tired. You can feel anxious or restless. You may have persistent coughing or wheezing, and that could be from fluid backing up into the lungs. One of the hallmark symptoms is swelling of the legs. It’s also called peripheral edema.
Chris: Dianne, when you look at all these symptoms, are there any that you would say require more immediate medical attention, people who are experiencing them?
Dianne: Sure, yeah. We all can wake up feeling tired or occasionally feel anxious or restless. The shortness of breath and the swelling of the legs, they’re very important symptoms. Most people who have a history of heart failure will be working with their cardiologist.
They’re usually on a routine where the cardiologist will make sure that they’re weighing themselves every day. If they have any weight gain, if they notice any increased swelling of their legs or they’ve become short of breath, they’ll call their cardiologist. Because he may tell them to increase their dose of diuretic to help prevent re-admission to the hospital.
Chris: Is it common that someone would experience all these symptoms collectively at one time, or does it happen over time?
Dianne: Not necessarily. The shortness of breath and swelling of the legs can happen at the same time. The other things may or may not happen. It depends on the patient.
Chris: Again, another brainwriting activity. For those on the webinar who have experienced heart failure, it would be great to hear what the first symptoms were that you noticed and what you did in terms of working with your healthcare provider in getting treatment.
Dianne, let’s shift now and talk about the symptoms of a heart attack.
Dianne: Okay. [inaudible 17:53] chest pain is probably the hallmark symptom, the one that everybody knows about. Clutching of the chest. It’s also called angina. You may also have pain in your jaw, arm, back, and/or neck. Especially women. Women, it’s been come to known that they have atypical signs of a heart attack. They’re often not treated as quickly as men. Very often, women have those atypical signs, the jaw, the arm, the back, and neck. Shortness of breath as well. People may get a funny skin color. They may get very pale or gray. I’ve seen people coming in, having a heart attack, and they are a very unhealthy shade of gray. After we open their arteries, they pink up and they look fantastic. We like to see that. People can break out into a cold sweat. They’re not really doing anything, and they just start sweating profusely. Indigestion or nausea, that may be one of the symptoms accompanying one of these other symptoms. You may not just have that particular symptom alone. You may have some of these symptoms together, but generally people do have some kind of chest pain or tightness.
Chris: The other term that I hear frequently with heart attack is, you’ll hear people say “MI.” Could you talk about, are they the same thing?
Dianne: It’s the same thing, it’s just MI is short for myocardial infarction, which is just the technical term for a heart attack.
Chris: From a brainwriting standpoint, if there are people in the webinar that have had a heart attack in the past, similar question as before. What were the first symptoms that you noticed, and what did you do when you noticed those symptoms? Dianne, when we talk about diagnosis, we’ve gone through risk factors, symptoms-what are the steps that a person would need to go through to get a firm diagnosis of heart disease?
Dianne: Most likely your general physician will send you to a cardiologist. You’ll get a physical exam. They’ll probably do an EKG. An EKG, everybody’s probably had one. It basically just shows your heart rate and rhythm, and it can show if part of your heart muscle isn’t receiving enough blood. You’ll have what’s called EKG changes [SP]. Your cardiologist may order an exercise stress test, which is done on a treadmill. It basically measures your exercise tolerance and looks at what your heart’s doing while you’re exercising.
If you’re unable to exercise for any reason, you can have a medicated stress test where they inject some medication that mimics exercise, so that you don’t have to get up on the treadmill and actually do it.We’ll probably do some blood tests, check your cholesterol and electrolytes. You may have a chest x-ray if you’re experiencing any signs of congestive heart failure. They’re looking for fluid in your lungs. If you do have a stress test and the doctor doesn’t like the looks of it, he may send you for a cardiac catheterization [SP].
Chris: I know any time you talk about testing, one of the common questions is pain. Would you say as you go around the horn here and look at all these different tests, that most of these tests don’t really cause pain, it’s more of a time commitment and the test itself? None of these are really invasive or painful procedures.
Dianne: Well, the cardiac cath is invasive, and giving blood isn’t all that fun. The cath is an invasive test. The rest of them are non-invasive. I did skip echo cardiogram, which is just an ultrasound of the heart. That’s just looking at how well your heart pumps, and looking at your valves and making sure they’re functioning properly. Besides the cath and the blood tests, the rest of those are all non- invasive tests.
Chris: Okay, thank you. Let’s move on, and we’ll talk about the area of treating heart disease. A couple important points. I want to make sure that we note that we will not be recommending any specific treatments or brands. Even with our Q&A session, I think it’s very common when people join our webinar that they ask about a specific medication, or they ask for treatment advice. It’s very important that you work with your healthcare provider to find out what treatments are best for you. Our main goal with this slide is really to talk about all the treatment options that someone may have available if they have different forms of heart disease. We’ll start with medication. Dianne, could you just walk through the commonly prescribed medications for heart disease and why they might be prescribed?
Dianne: Sure. The first one we have listed is probably the most important one, and one of the most important ones, and the cheapest one that you can buy for pennies at the drug store is aspirin. Aspirin basically thins your blood. Usually the doctor will prescribe either one of two doses. You’ll be on a baby aspirin or a full adult aspirin. It is one of the most important drugs you can take that’s prescribed. A few of the others, beta blockers and ace inhibitors and [inaudible 23:07] channel blockers are basically just medications that help control your heart rate and your blood pressure, your heart rhythm. Just things to help your heart so that it doesn’t have to work as hard. One we have listed there are statins, which lower your cholesterol. They are extremely important to keep your cholesterol at a normal level, and have also been found to have an anti-inflammatory effect. They’re very good for the health of your arteries. Diuretics are really important for those people who suffer from congestive heart failure to prevent excess fluid build-up in their bodies. Like I said, if people do notice that they’re having some swelling or increased weight gain, your doctor may tell you to ramp up your diuretics for a bit, just to keep you from being re-admitted to the hospital. That’s very important. Nitrates are basically, like nitroglycerin is an example of something that you’ll put under your tongue if you were having any chest pain or angina symptoms. It also comes in a long acting form that you would just have to take once a day. Nitrates basically just dilate your arteries. Our next one are anti-platelet medications; you’ve probably seen many commercials for them on TV. They prevent your platelets from clumping together. Platelets normally want to stick together or stick to anything that’s inside the body, like a stent. These make your platelets very slippery so they won’t adhere to the struts of the stent and cause the stent to be blocked off.
Chris: Awesome. We tend to see these medications listed, and I think the assumption is that people know what they are and what they’re for. It’s great to hear you talk about why these treatments were being prescribed. Let’s talk now about something that you do every day and have a lot of experience in, the angioplasty and stenting procedures. If you could, walk through what would the process be that a person would through from beginning to end?
Dianne: Okay. Your doctor wants you to have an angioplasty. You come to the hospital for your cardiac catheterization. Actually it’s the cath first before angioplasty. The cath is what’s going to diagnose what your problem is, and if there’s a blockage that needs to be fixed.
You come in in the morning, you haven’t eaten since midnight the night before. You come in and have an IV put in. we take you to the cardiac catheterization lab, where we give you some mild sedation to make you feel comfortable. We don’t knock you out completely, because we want to be able to talk to you and know if you’re having any symptoms. The doctor puts an IV-it’s basically a large IV, larger than the one that would go in your arm for the procedure. There’s two ways they can get up to your heart. They can go through the groin, which is the usual way, but one of the new ways we’re going is through the radial artery, which is in the wrist. Either way, they both lead up to the heart.
Through that IV, he or she will insert catheters and guide them up to the heart to inject dye into your coronary arteries. When we do that, we can see on x-ray whether or not there’s any blockages that need to be fixed. If you do need something fixed and we’re able to do it right then and there, the physician will choose to do so. They will thread a wire down through that artery, and over that wire, like a railway, we will have a catheter that has a balloon on it. On that balloon is crimped a stent. It’s a metal stent. The stent goes down, he puts it right where the blockage is, blows up the balloon, deflates the balloon, and the stent stays in the artery and acts like a scaffold to keep it open.
There’s a couple kinds of stents that we can put in. One is a drug coated stent, and the metal is impregnated with medication that helps prevent scar tissue from building up in that artery. 99% of the time, we’ll put a drug coated stent in. There are some times where we’ll use just a bare metal stent that does not have the drug coating. That’ll be up to the physician, whether or not that that’s appropriate. The patient then goes out to the recovery area. It’s a pretty easy recovery, and usually you go home the next day, barring any complications.
Chris: Then we also know in addition to medication, angioplasty [inaudible 27:34], there’s also surgery. Could you talk about the coronary artery [inaudible 27:38]?
Dianne: Sure. Sometimes when we do the catheterization, it’ll show that you have numerous blockages. You have three major arteries, and like I said, those arteries have several branches. Some people may have four or five blockages, which is really too many blockages for us to put stents in. They may consult cardiocerasic [SP] surgeons to come see you and offer a coronary artery bypass. Basically what they do, they take some veins from your legs and use that to make a bypass around the blockage in your main arteries, sort of like a detour. Blood can go around that blockage and get past that blockage, so it can feed your heart muscle the oxygenated blood that it needs.
Chris: Awesome. Again, great overview. We’ll shift now and talk about the non-medical treatments. I think there’s a tendency to play down non-medical approaches. When it comes to heart disease, if you review the most recent AHA guidelines and a lot of the peer reviewed literature, there’s a new emphasis on the fact that non-medical treatments are just as important, if not more important in some cases than medical treatments. Particularly when we talk about prevention and maintaining the long term outcomes from all the different treatment approaches, as Dianne just discussed. The other thing I want to mention before I go through these, if you think about eating healthy foods, staying active, you hear these things every day. As a health educator, I think it’s important to validate that all of these things are easier said than done. Just saying “eat healthy foods,” there are behavior changes, attitudinal changes, there are people that can’t access things like organic foods due to financial barriers, or they may not have geographical access to some of these. As we go through these, we really want to separate ourselves and emphasize that we know that all of these changes are difficult to start and also difficult to maintain. Some of the primary, non-medical treatments that have been proven to impact heart disease outcomes are eating healthy foods-and we’ll show you a great tool in a second from the American Heart Association that gives you a great path to take. Staying active, and again, I don’t think we can repeat enough that any time you start a new physical activity, you definitely want to work with your healthcare provider to make sure it’s the right activity and that there’s the right amount of vigor, and that you’re not putting yourself at risk and it will provide the best outcomes. Stress reduction. Just given particularly the anxiety and the fear that comes with heart disease, and as Dianne mentioned a number of times, smoking cessation. Which again sounds easier said than done, but there are some great tools and programs to support that. What we’d like to do now is jump into-the American Heart Association has a great, great website called the Nutrition Center. You’ll notice on the very top it segments nutrition, physical activity. There is information for children or grandchildren. Weight management, stress management. A lot of great information. If you look at the Nutrition Center, great five goals to healthy eating. What I like about this page is we often say “eat healthy foods,” but we don’t tell people which foods to eat. It’s outlined very clearly here to eat more fruits and vegetables, to eat more whole grain foods. You’re given some examples here.
Use liquid vegetable oils such as olive oil, canola oil, corn oil. Eat more chicken, fish, and beans than other meats. Also make sure that you read food labels. I know when I was working with Dianne on this presentation, one of the first things you said was the importance of reading food labels.
Dianne: Yes. We don’t realize, we eat so much packaged foods, and how much sodium is in the packaged food that we eat. Especially for people that have congestive heart failure, it’s very important that you monitor your sodium intake. Generally, a cardiac patient is going to be allowed 2,000 to 3,000 milligrams of sodium a day, and if you eat one can of soup, you could be eating 1,000 milligrams right there in just that one can of soup. This just has a nice thing, it’s called the Salty Six, and it tells you some of the six things that we eat on a daily basis that are very high in sodium. Breads and rolls, if you read the package, even whole wheat breads-we’re trying to eat healthy, we pick up a package of whole wheat breads, and there’s a lot of sodium in it. You have to do some comparison shopping when you’re in the supermarket. I’m going to pick this whole wheat bread versus that whole wheat bread because it’s lower in sodium. Cold cuts, anything towards hotdogs, lunch meat, they’re all very high in sodium. Pizza, obviously. Poultry. If you’re getting chicken breasts from the meat department, that’s not going to be too high in sodium because it’s just chicken breasts. If you’re getting rotisserie chicken or anything that has any type of marinade on it, that’s going to be very high in sodium. Soup like we talked about, and sandwiches, obviously, the bread and cold cuts put together. The other things that we don’t think about are condiments. Soy sauce, ketchup, salad dressing. They’re all extremely high in sodium. I can’t stress enough, not just for heart failure patients, but for all cardiac patients, because we’re trying to keep control of our blood pressure, you have to read labels.
Chris: If you scroll down a little bit, again, a real believer in actionable tools and the importance of goal setting. Any time someone needs to make a change in their lifestyle, it can really feel like an abyss. Where do you start? Great tool up top for setting healthy diet goals, healthy cooking, dining out. There’s actually a “cart smart” shopping list that you print and take with you to the supermarket. A lot of the enjoyment of food people feel is taken away when you follow some of the dietary recommendations that Dianne just went through, but there are some great recipes for maintaining the taste while eating healthy. Then also some cookbooks and health guides that you can look through.
Again, these links will be available after the webinar. I definitely recommend that you revisit them.
Dianne: We just want to say, you can have anything in moderation. It can be very depressing. I’ve dieted a thousand times, and when I have to cut my calories, I’m not in a good mood. You can ask my husband, it’s not a pleasure to be around me. We don’t want you to think that you can never have a cheesecake or never enjoy any type of food that’s bad for you. You can have anything in moderation.
Chris: Great point. We want to make sure we mentioned the Getting Active tool. We’re not going to open it, but it’s a very similar plan and goal setting tools related to getting and staying active. From a brainwriting standpoint, before we move onto the next slide, it would be great to hear from the audience what non-medical approaches have helped you the most. On that process of how difficult it is making some of these changes, what were the most difficult? What were the things you did to make these changes that we just talked about? We can’t emphasize enough with a condition like heart disease the importance of surrounding yourself with experts like Dianne. Dianne, could you walk through, particularly from a cardiac standpoint, we’ll go down the left side of this graphic. Who were the key members of the primary heart healthcare?
Dianne: If we start at the top, your doctor may refer you to a cardiologist. He or she would be the one who would do your cardiac catheterization and stress testing if you needed it. Hopefully you won’t have to meet the cardiothoracic [SP] surgeon, but they would be the ones who would do your bypass surgery, or if you needed any valve replacement or repair. Nurse practioners and physician assistants, they work very closely with your physician. They write prescriptions, they do examinations. They’re very high functioning professionals. Cardiac nurse, that would be me. You could meet me in the cath lab, or you could meet one of us on the cardiac [inaudible 36:09] if you were admitted to the hospital as a patient.
Chris: Just from an educational standpoint, we can see how valuable it is to have someone like you on a webinar. How much of your role on site, when someone’s having a procedure, is dedicated to education?
Dianne: I do it from the moment I meet someone until the end. Our patients come in, they’re absolutely scared to death. They’ve never had a cath. Even if they have had a cath, they’re scared to death because they don’t know what’s going to happen. I think it’s very important, from the moment I meet a patient until I say goodbye to them and they’re either discharged to home or they go to their bed on the floor, that the entire time is spent educating them. It just makes the process so much easier. Our patients come in, and they’re so scared. It’s because they’re having a cath. “My brother Tom told me it was the worst thing he ever experienced, and it was so painful.” I tell them 99% of the time, patients say it was nothing like they conjured up in their head. I just think it makes it easier for them to hear that from somebody else.
Chris: Great perspective. Starting from the right to top right, moving down towards the right, some other key team members that you might come in contact with are cardiovascular or radiological technologists. These are people you may interact with if you’re having any kind of imaging done, like CAT scans or chest x-rays. Both the exercise physiologists and cardiac rehab therapists will be really focused on how to help you stay active, while also monitoring your condition. A dietician can give you much more depth of information and recommendations related to meal planning, eating healthy foods. Then again, I can’t emphasize the importance enough of non-medical home care. Dianne talked through some of the symptoms to think about. Fatigue, shortness of breath, pain. We’re dealing with older adults that have other co-morbid conditions like diabetes. I think non-medical home care can play a key role, particularly when people are being discharged from the hospital after they’ve had a cardiac event. As a researcher, we’ve spent a good three or four weeks looking for, what are the articles that are out there related to key barriers for older adults. One article, actually a scientific statement that was released very recently, last year in 2013, entitled “The Secondary Prevention of [inaudible 38:37] Sclerotic Cardiovascular Disease in Older Adults,” a scientific statement from the American Heart Association. This statement was led by Jerome [inaudible 38:47] and Daniel E. Foreman, two knowledge leaders. We have a great quote here that really jumped out at me. “Despite clear benefits of cardiac rehab in older adults, the vast majority of older adults do not participate. The cumulative effect of these factors is a dismally poor cardiac rehab use rates among older adults.” I was really curious as to why-obviously providers wouldn’t intentionally provide a barrier to access. Why is this happening? First barrier we read about was lack of referrals. There are providers who are not referring older adults to cardiac rehab. Some of that may be due to stigma that an older adult maybe can’t benefit or wouldn’t want to participate in a cardiac rehab program. Some patient related factors, where maybe it was referred, but the older adult or family decided it wasn’t the best approach. Then there were also socio-economic barriers where some people were referred, but were not able to afford cardiac rehab programs. It would be great, particularly for providers on the webinar, from a brainwriting standpoint, if you could go into your chat bar and let us know why do you think cardiac rehab referrals are a barrier for older adults. Then in your practice, what has helped? Have you seen people benefit from cardiac rehab, and how have you helped older adults to access cardiac rehab programs? What is a cardiac rehab program? Basically, cardiac rehab helps people to recover from heart attacks, surgery, we talked about angina and other heart procedures such as the stenting and angioplasty we talked about. People often ask, how long is cardiac rehab, where does this happen? It can range anywhere from six weeks to six months or even longer in length. Cardiac rehab can be offered both in patient and out patient.The core pillars of a cardiac rehab program are providing education and counseling related to all the factors we discussed over the past hour. Helping people to stay active and fit safely, reducing cardiac symptoms, improving overall health and quality of life, and then also reducing the risk of future heart problems. Once again, the American Heart Association has developed a great tool that we’ll open up here. It’s a webpage dedicated directly to describing what cardiac rehab is. There’s links to finding a cardiac rehab program near you, who does cardiac rehab.
If you’re interested, if you’re either about to start cardiac rehab or you’re interested in learning more about it when you receive the presentation, definitely take the time to click on the tool and dig a little bit deeper to learn more. For those of you who have actually been in cardiac rehab programs as patients, if you could go into your chat bar and brainwrite what your experience was like, that way we can learn from your experiences as well. The last area that we’re going to dive into has really finally received much needed focus, and that is really understanding the impact of heart disease on quality of life. I think we touched on some of the emotional factors as we’ve gone throughout the webinar. We did a pretty exhaustive literature review to really understand, what are the key psycho-social barriers that people deal with with heart disease, particularly older adults. Some of the barriers that rose to the top were emotional challenge, Dianne mentioned anxiety and depression already. Fear of death.
I remember, I worked with a resident, this was an older adult who had had a heart attack and came back to the nursing home where I worked. I’ll never forget, the person said, “I feel like a walking time bomb. I never know when it’s going to happen again. It happened so suddenly last time, and it’s very hard to forget. It’s very hard to not think about my heart and take my pulse.” Fear and uncertainty are a common barrier. Physical pain, discomfort and fatigue, which again can impact a person’s ability to care for themselves and just enjoy life. Financial challenges due to the fact that medical bills pile up, and many people are not able to work if they’re younger adults. It follows that if somebody is depressed and physically in pain and struggling with mobility that they would also deal with isolation. Then finally important to note, especially with family caregivers on this webinar, that when someone has a heart attack or heart failure or afib, it causes great stress not just for the person dealing with it but also for all the family members. Dianne, I know you’re, again, working with people every day, patients and families. As you look through these barriers, which would you say rise to the top and are the ones that you see most commonly?
Dianne: I would definitely say the two on the top, the emotional challenges. They have to make a lot of lifestyle changes, which can cause anxiety and depression. You feel like you’re not living your life to the fullest, you have to eat a healthy diet and exercise and do things that are not necessarily things that they were doing prior to that. And the fear of death. People are very afraid. You come in having a full blown heart attack; I see these people that like I said, they’re gray and sweaty, and they just look awful. You can tell how bad they feel. That’s not something that leaves them quickly. That’s a very bad memory that sticks with them. I’d definitely say those two are the most common.
Chris: Great. Again, from a brainwriting standpoint, think about some of the factors we just went through-the emotional side, the physical pain, the fear. It would be great to hear how heart disease has impacted your daily lives, those of you that have dealt with heart disease, and also what has helped you. Again, if you cannot find the chat bar, just click on the orange button at the top right. You’ll see the chat bar towards the bottom. Again, we appreciate learning from your experiences as well. I mentioned earlier that recovering from heart disease and dealing with heart disease can feel like an abyss. You don’t have a path. We always like to include an action plan in our webinars and many of the tools that we develop, so you do have a path and have steps to take. We want you to work with your care team; we talked through some of the experts that you should have around you. If you don’t have those experts, definitely ask your primary care provider for referrals. Make sure you keep your appointments. Again, think about [inaudible 45:35] that you’re dealing with and the anxiety which can make you forgetful. There are some great organizers, and if you go on the American Heart Association website, they actually offer apps that you can use to stay more organized with your appointments.
Follow the treatment plan as prescribed, particularly when you start to feel better. That’s usually when people think “oh, I probably don’t need to take this anymore, because I feel better.” Remember why you feel better and stick with your plan as prescribed. Get involved from an advocacy standpoint. The American Heart Association is a great advocacy organization. They do walks, they do public policy events, work groups. Again, their website is www.heart.org. We talked about eating healthy foods, so you develop your meal plan, develop your plan to stay active with your healthcare provider.
A lot of the research we did identified tai chi, meditation, and massage therapy as some of the more effective approaches for people that are trying to reduce stress and relax from heart disease. Again, smoking cessation. Ask about cardiac rehab. If this raised awareness, hearing about cardiac rehab and you think you might be a candidate, definitely ask your cardiologist or your primary care provider. Then finally, nothing’s more powerful than joining a support group and being in a room or virtual room with other people that are going through the same thing as you. This is a great action plan to start from.
Derek: Fantastic. I thought I knew a little bit about this topic, and now I’ve been fully schooled on the topic. What great information not only from the educational but also from the practical standpoint from Dianne, of seeing hundreds if not thousands of clients and patients over the last 15 to 20 years. Thank you both. We now want to open up the webinar to questions and answers, and we do have quite a few comments to read out as well. For the question and answer session, really, nothing is off limits. If you want to share a story about anything we talked about, if you want to reference a tool that maybe has helped you deal with heart disease, if you want to share any prescriber or doctor experience.
If you want to provide insight of working with home care providers, patients, or healthcare providers on the topic, or if you just have general questions for our panelists, any questions, any comments, anything you want to share, please type those into the Go To Meeting panel. We first have a couple comments to go through. The first is from Patricia Potter, down in, I believe, North Carolina. Patricia just comments, “with elderly parents, both with a family history of heart disease but who are also pretty set in their ways, especially in their diet, I have been successful in getting them to take omega-3 supplements.”Dianne, can you address whether this is beneficial for prevention not only for them, but for myself and my siblings?”
Dianne: Yes. There’s a lot of literature out there about omega-3 fatty acids being beneficial. I would definitely tell you to address it with the primary care physicians and find out if that’s something that he or she would want them to take.
Chris: Really, Patricia, great question. An important component Dianne was recommending is when we think about nutra-cuticals [SP], some of the non- prescription approaches or alternative or complimentary approaches, I think there’s a tendency to think that because they’re not prescription, that there are no risks or no side effects. Even with the non-medical approaches, nutra-cuticals as Dianne said in literature have been shown to improve not just heart disease, but a lot of other conditions. We definitely, even with non-prescription approaches, recommend that you work specifically with your healthcare providers to get the appropriate guidance. Great question.
Derek: It’s interesting. One part of Patricia’s comment is “parents who are set in their ways,” and helping curtail maybe their habits. Especially Dianne and Chris as well, as Dianne, on discharge and as you’re helping patients go through and be referred to cardiac rehab, are there other tricks and tools of the trade of professionals that they use to try to get patients to adhere to the recommendations that professionals are making?
Dianne: I think the most important thing is trying to help people understand why it’s so important to do the things that we’re recommending. They hear it over and over again to eat healthy, but they have to understand just by going over the Salty Six, and we explain to people why it’s important to lower their sodium and to start to read labels. We explained to them what physically happens to their arteries when they smoke. Smoking can cause clotting, and it increases plaque production. If they understand what happens and why we’re telling them to do things, I think they’ll have an easier time adhering to some of these restrictions that we’re giving them. Some people are just stubborn. They are stubborn, they’re set in their ways, and I think it’s just a matter of repetition.
Chris: I think also with our audience, particularly people 65 and over, I think sometimes there are generational beliefs. People are thinking back to what they had done years ago, and they may not be aware of some of the advances. I think there are health literacy issues. I think when we say eat healthy and don’t smoke, I think one of the great things about offering these tools, especially if there are adult children out there that can share these tools with your parents, who may not have access to the computer, I think that could really help. Just the standpoint that if they understand it, then they may believe it, and that may drive the behavior change that we’re looking for.
Derek: Great recommendations. Hopefully that’s helpful, Patricia. We also have a comment from John Beretak [SP] it looks like, who comments, “other non-medical approaches to lowering cardiac stress. Unplugging from the multiple demands of the digital atmosphere. Simplifying your life. Reducing your sense or other need for perfectionism. Prayer and meditation and getting your sleeping habits in good order.” Chris and Dianne, any comments there?
Chris: I just love the idea of simplifying your life. I think we tend to focus on stress management techniques, but they all in a way, if you think about meditation, it’s really about getting out the clutter and focusing on what’s most important. I think in many cases, heart disease and when people have a heart attack, that in itself is a wake up call. It’s a great time for people to re- evaluate everything they’re doing and maybe simplify things a little bit. I don’t know if, Dianne, you have anything else to say.
Dianne: I agree with the digital age. Unfortunately, people can contact us every second of the day. It’s kind of a nice thing when I go somewhere and I don’t have good service. You’re tied to your phone and you’re constantly looking at things and checking your email and answering texts. That can be very stressful. It’s definitely something that I think is good for people to put the phone down and put the computer down . . .
Chris: Be active.
Derek: Absolutely. We also had a comment from William Springfield, when Chris asked the exercise, what type of heart condition were you diagnosed with or someone you love, and William commented, “arrhythmia. Irregular, episodic atrial fib.” Thanks for sharing that, William. We also have-all of these comments and questions are fantastic. Keep these coming in. We’ll continue doing the Q&A session until the top of the hour. We also have another comment, again, from William Springfield who wrote, “one of the greatest fears is repeating father’s death from heart attack. “The physician stated he had been having mini-heart attacks, and his heart muscle was 80% dead and coronary arteries were all 80% occluded. This info, combined with my own atrial fib, resulted in my upcoming appointment with my cardiologist.”
Chris: That’s speaking to the fear that when you have a family member that has dealt with a heart attack, you obviously grieve for your family member but also think about, what are the chances of something happening to me? What I love about what you’re saying, William, is that you were proactive. There are a lot of people that have the history and they have the signs, but are in denial and don’t honor that history and see a cardiologist.
Dianne: Yeah, I think that’s very important. I’m not sure of your father’s medical history, but it’s important-I didn’t mention, for diabetics, you said your father had been having mini-heart attacks. Diabetics don’t often feel the same symptoms as non-diabetics. The chest pain, they may not feel that. It’s important for diabetics to not only stay on top of their blood sugars, but also to follow up with their doctors and have regular physical exams.
Derek: Fantastic. Thanks, Dianne. We have an additional question from William Springfield, who asks, “what is the experience of using statins? Have benefits been seen in patients using statins versus those not using them? Example, reduction in heart attack.”
Dianne: William, I would say almost every patient that comes through my cath lab and sees the cardiologist is put on a statin, if they can tolerate it. Some people can’t tolerate statins. They have some symptoms, some side effects from them. They can discuss that with their doctor if they are having those. I see most of the time that patients are put on them, because there are definite benefits from being on statins. You should really discuss it with your doctor in regards to the reduction in chance of having a heart attack, but like I said, it does decrease your cholesterol and it helps decrease inflammation, both of which are very important in helping prevent heart disease.
Chris: Again, we want to avoid-you can hear it in Dianne’s instructions there. We want to avoid giving any medical advice. We’re not physicians, and not knowing the entire case. Great question. I think Dianne answered it really well, but I think the best bet with specific recommendations for use of statins will come from your PTP [SP] or cardiologist.
Derek: Great; sounds good. We also have a comment from Jessica Panetta [SP]. I believe this was when we were asking what additional tools maybe have you come across and used when dealing or treating with heart disease? Jessica comments, “one of the tools is to find a directory of registered dieticians who provide nutritional counseling in your area. Visit via the website, www.eatright.org. The website of the Academy of Nutrition and Dietetics. Nutrition counseling is often a covered benefit through policies with health insurance companies. You can also call your insurance carriers for a list of participating registered dieticians in your area.” Great insight, Jessica. Thanks for the feedback.
I also have another question that we’ll throw to both of our panelists from John Beretak, who asks “what advice would you give people who are elderly, potentially 75 and up, who may be sexually active and have a history of poor heart health?”
Chris: I think this is a terrific question. I like the fact that we’re talking about this topic with older adults. I worked most of my career with people over 65, and there are sexuality and intimacy issues that aren’t discussed often times. As with any type of heart disease, I think when you’re talking about any physical activity that’s going to increase your heart rate, it’s worth a discussion with your health care provider. I think generationally, that might be a difficult discussion for the older adults themselves to have with their doctor unless they’ve had this doctor for a long time. That’s a time where an adult/child could talk to a doctor, or do some research and maybe help that adult take that discussion. I think it’s a great question and should definitely be discussed, so the older adult has some guidance.
Derek: Fantastic. Again, we want to thank our panelists. Key takeaways for today, Chris?
Chris: Yeah. These are some of the key elements we want to make sure that you take with you and remember. Number one, it’s important to recognize and treat heart disease in older adults. Try to surround yourself with experts. We gave you some tools to do that.
Emotional issues are common. We wanted to validate that, but also give you the tools and the confidence that you can overcome those through education, support, and advocacy. Lifestyle changes and treatment can prevent worsening symptoms.
Again, we validated that it’s difficult to make these changes, but we’ve given you tools to I think make it much easier. Then finally, fight back. Get involved. We’ve given you the link here to the American Heart Association. They have an entire page on things you can do. Volunteering, support groups, advocacy, so that you don’t feel like a victim. You can not only fight this disease yourself, but help other that are going through the same thing.
Derek: Fantastic. Thanks, Chris. Next, we want to allow Dianne to give us, again, first of all to thank Dianne for her time today, but also to let her tell us a little bit about Our Lady of Lourdes Medical Center.
Dianne: I work at Our Lady of Lourdes Medical Center. It’s located in Camden, New Jersey. I’ve been there for 23 years. I’m very proud to work there. We have an excellent cardiac program. We do thousands of procedures each year, including coronary stents, peripheral stenting. We do bypass surgery, valve repair, and I’m proud to say that we’ve started a new program called the taver [SP] program. That’s a minimally invasive valve replacement program. We’ve had excellent results. We serve a large portion of southern New Jersey and even into Philadelphia. It’s an excellent hospital, so I’d recommend that you come there.
Chris: I just want to add, in addition to the cardiac program, Lourdes has one of the best wellness centers in the country. As we talked about massage and tai chi and some of the non-medical approaches, another great resource for those services.
Derek: A question if you don’t mind, Dianne. For those obviously here in the northeast, traveling a distance or even a medium to long distance to get to the right center is critical. For those who may be midwest or west, if you were a family looking for the right treatment center or the right rehab area, what are one or two things you might advise families to look for as they’re evaluating options if they might not be in the northeast to be able to access Lourdes?
Dianne: Sure. If my family member needed to have a cardiac catheterization, I would make sure that the hospital they were going to had a surgical back- up. That’s one of the things that Our Lady of Lourdes has. Very rarely are there any complications from the procedure, but if there are, you want to be able to go into the operating room right away. There are many hospitals in the area that are doing these procedures that don’t have surgical back-up, so you would have to be loaded into an ambulance and brought to some place like Our Lady of Lourdes that performs surgery. If you’re being brought to our hospital having a heart attack, or brought to a hospital, say you’re having a heart attack and they do a cardiac catheterization and they don’t have a surgical team, then you’d have to be transferred to some place like Our Lady of Lourdes. I would definitely look into the hospital and make sure that they have surgical back-up.
Derek: Fantastic. Great information. We must be going but thanks to Chris and Dianne, our ppresenters and to all who listened!eat evening everyone. call will be disconnected. Goodbye.