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Cardiology Masterclass: Heart Failure

Posted in: Cardiology

What measures would you consider to implement in your county to improve the management of heart failure?

Dr. Ivy Barasa

Patient education on the risk factors of heart failure. Especially for patients with the HTN, DM or thyroid diseases. Screening so as to identify heart failure patients before progression through the NYHA classes. Availability of laboratory tests that will enable one to rule in or rule out possible causes of heart failure. Early initiation of antifailure drugs. Availability of ECG and echo machines within the county. Availability of cardiologist who will offer specialist care

Dr. Maureen Maleche

1. Community education to create awareness of heart failure, on measures to identify and prevent risk factors of heart failure and to mitigate complications in those who are already suffering from heart failure. These includes; -Explaining/teaching people what heart failure is, risk factors, causes and complications - community surveillance for early identification of those at risk and those with un-diagnosed heart failure for early intervention -emphasize on healthy lifestyle( low sodium diet, unsaturated fats, cessation of smoking and alcohol intake, regular physical exercise) -training of more healthcare worker from community level to medical experts/scientists at top referral facilities for better management of heart failure conditions -allocation of enough funds for setting up functioning cardiology departments with experts at every county referral hospital

Dr. Khuweillah Rudainy

To improve management of heart failure in Kilifi County, frequent screening of those at risk, follow-up of the newly diagnosed Heart Failure patients, and monitoring the effectiveness of the prescribed drugs is necessary. Laboratory and imaging tests should be made at a subsidized prices to encourage precise and timely diagnosis.

Dr. Ngugi Wamuyu

Preventive measures like physical activity, reduction of alcohol intake, smoking cessation, managing hypercholestrolemia which are risk factors for eventual heart failure. Early diagnosis and treatment of the underlying conditions like rheumatic fever and rheumatic heart disease, hypertension. This will prevent the numbers of people who end up with heart failure. Early diagnosis of heart failure through CMEs on heart failure, provision of Echocardiography and ECG, BNP so that we can prevent the progression and worsening of the heart failure which would result in frequent admissions. Patient education on their condition which would improve adherence and compliance to treatment. Hiring of the right staffing like physicians, cardiologists who are needed for optimal management of heart failure cases.

Dr. Michelle Wangui Getao

1. Prevention by managing modifiable risk factors - Community based screening for heart failure risk factors - DM, HTN, dyslipidemia, stable angina, cigarette smoking, depression, anxiety, excessive alcohol use, thyroid disorders etc. Enroll people found to have these disorders in the appropriate clinic and treat them. - Educate the community and health workers on rapid response to suspected ACS since myocardial infarction is a major cause of heart failure. - Enhanced, continuous education of doctors, clinical officers, nurses, nutritionists and other health workers on heart failure prevention and treatment. - Advocate for housing with adequate ventilation to reduce household spread of group A streptococcal infection and viral infections that may result in cardiac damage. - Advocate for green spaces in neighbourhoods where people can enjoy outdoor recreation and exercise. - Provide free or affordable psychosocial support services to help people constructively manage stress. - Encourage couples to plan their pregnancies so that the mum can receive preconception care to avoid preventable congenital cardiac anomalies. 2. Treatment - Avail affordable basic diagnostic facilities for confident diagnosis and monitoring of heart failure - ECG, echo, CXR, NT-proBNP, cardiac troponins, blood culture, thyroid function tests, lipid profile etc. - Avail affordable basic drugs for heart failure management - Oxygen, loop diuretics, ACEI, ARBs, ARB/Neprilysin inhibitor, SGLT2 inhibitors, Beta Blockers, MRAs, nitrates, hydralazine. The county can negotiate lower prices for drugs due to the large quantities needed to supply the whole county. - Continuous education of health care professionals on heart failure management. - Educate heart failure patients on low salt diet and healthy lifestyle.

Zainab Bagha

Educating the population on basics of heart failure... like which conditions predispose them to heart failure so they know to watch out for it... the initial signs and symptoms so as to present to a medical facility for management as soon as possible. Also educate on importance of adhering to the appropriate treatment. Importance of lifestyle n diet change. Make treatment more affordable and readily available for the population.

Dr. Flora Kithikii

Capacity building to ensure proper management of patients and timely referrals for the nxt level of care.

Dr. Kenty Isabella

Prompt diagnosis, management,consultations as well as follow up for patients with hypertension and other preexisting conditions.Patient education on the importance of follow up and adherence to medications for the preexisting illnesses. Accessibility to a consultant to review patients.

Dr. Magdalene Randa

Early Diagnosis, Patient education, Follow up, access to medicines

Naomi Munywoki

Preventive measures to ensure they don’t get the heart disease to begin with. Early diagnosis and proper f/up. Lobby for availability of drugs for management.

Mbarak Mbarak

1. Propose to avail diagnostic equipment like ECG&Echo together with continuous training of staff on the same 2. Set up a cardiac diagnostic unit which will be linked by Telemedicine, with established cardiac centres like The Aga khan cardiac unit Mombasa 3. Community sensitisation and education programs via radio, social media clips and Barazas 4. Organize periodic visits by Cardiologists to the county, who will review already screened patients to guide on their management eg once every 2 months

Mbarak Mbarak

1. Propose to avail diagnostic equipment like ECG&Echo together with continuous training of staff on the same 2. Set up a cardiac diagnostic unit which will be linked by Telemedicine, with established cardiac centres like The Aga khan cardiac unit Mombasa 3. Community sensitisation and education programs via radio, social media clips and Barazas 4. Organize periodic visits by Cardiologists to the county, who will review already screened patients to guide on their management eg once every 2 months

Uzma Bagha

Education for patients and health care providers at all levels so that it is managed appropriately instead of being misdiagnosed. availabilityof basic drugs, and echo

Wyclif Odira Odhiambo

1. Training community health workers on identification of common signs and symptoms and prompt referral to health facilities 2. Early recognition through the symptomatology approach. 3. Early treatment initiation and follow up of all at risk patients. 4. Availing better diagnostic tools, and teaching frontline health care workers(nurses and clinical officers). 5. ECG and echocardiogram services at all level four hospitals

Effat Abdulwahab

I would 1) have a setup for free screening. 2) patient education 3) availability of diagnostic equipment and tests that are important These include ECG ECHO and important blood tests 4) availability of a cardiologist for consultation 5) regular CME for the young doctors on these topics 6) availability of drugs that are affordable and available 7) sensitive the community on importance of early detection and treatment of heart failure 8) appropriate method of data collection and follow up for the high risk and those with heart failure already

Caroline Bichii

1. Train community health care workers on screening and identification of risk factors, and appropriate referral of at risk patients. 2. Conduct community awareness programs aimed at educating the public on the spectrum of the illness, risk factors, healthy lifestyle adoption and linkage with the health facility. 3. Ensure availability of anti-failure medication. 4. Encourage patient follow up at clinics. Provide continuous counseling on adherence to medication, progression and prognosis of illness.

Charles Ndirangu

Sensitizing patients,relatives and the entire community on heart failure,the causes,the comorbidities and other risk factors. Regular CMEs for healthcare workers so as to minimize missing ACS and improve management. Lobby for availability of heart failure medication in the public hospitals. Lobby for availability of ECH/ECHO services at affordable prices. Most hospitals lack adequate lab support which hinders proper care giving especially in the management of comorbidities

Robert Ngasa

Increase awareness of the community on heart failure and its predisposing factors through outreach to the community as well as availing continuous training of health care workers in prevention, diagnosis and proper management.

Robert Ngasa

Increase community awareness of heart failure through outreach and avail training modalities for health care workers to continuously learn on early diagnosis and management of heart failure. Availing the right expertise and equipment would go hand in hand with preventive measures to allow better patient outcome

Dr. Haji Musuko

Patients with heartfailure present with medical and socioeconomic challenges. Measures to consider to improve management of heartfailure should be at all levels of health care. Level 1(community level) Strengthening Community sensitization by community health volunteers on the risk factors of heart failure. Community education to address risk factors to cardiovascular diseases. Level 2&3 - Most patients with heart failure are attended by primary health care workers in the dispensary and health centers. Training of such primary health care workers on the cardiovascular disease guidelines would improve on patient care in early referral to higher levels of care . Availability of essential medicines at this level of care would improve on patient outcomes. Most patients appreciate being treated at the nearest facility. Level 4 &5 -Avail more heart specialists who can mentor medical officersto treat patients with heart failure. Avail ECG and ECHO machines at the accident and emergency department so that patients access these diagnostics. Training on ECG and ECHO skills to medical officers and radiographers. Most ultrasound machines do not have an ECHO probe and even if available nobody is trained on the same. Avail the essential medications at these level of care. Avail laboratory reagents and equipment to carry out the required tests. There is need to link heart failure management to palliative care services. Heart failure is achronicc condition and patients would benefit from palliative care services. To address the socioeconomic burden , patients should enroll with NHIF so that they avoid out of pocket payments. Finally County governments should make deliberate efforts to increase the other staff cadres eg nutritionist ,counsellors, nurses social workers so that patients with heart failure get a holisitc approach.

Abdikadir A. Adow

To start with CHW to carry out community awareness regarding risk factors for heart failure e.g. encouraging/senitizing community on matters weight control. Sinking and exercise. To enlighten people on diabetes . To randomly check BP and sugars esp above 40yrs old.. To treat rheumatic fever patients thoroughly to avoid vulvular heart diseases. Secondly once a patient is diagnosed with HF. Clinicians be able to manage well using updated protocols.. proper and timely referrals made ..finally hospitals to invest in investigative equipment on heart disease.

Pauline Kamau

Creating awareness of the risk factors,preventive measures ,ways to curb further progress of already existing factors ie obesity &hyperlipidemia encourage exercise,minimizing smoking and alcohol use and encourage early health seeking behaviors for screening.Early identification and prompt management of already existing modifiable factors predisposing to heart failure ie DM,HTN,CAS,,Endocrine disorders ,in addition to considering pregnant women with underlying hearts diseases that may result to heart failure or exacerbate HF during pregnancy.Followup of patient with risk factors should be emphasized by avoiding long duration TCAs.Lobby for diagnostic equipments ieImaging(xrays),ECHO & ECG machines and availability of key laboratory tests ensuring they are readily available in A$E.Availability of cardiologists for consultations and referrals.Avail essential drugs in management of the underlying conditions that predispose to heart failure and HF itself.Health workers education on Riskfactors and timely identification of signs and symptoms of heart failure by holding regular CMEs.Eventually most patients with HF have underlying conditions that requires a multidisciplinary approach,should encourage employment of more specialist ie nephrologist,nutritionist etc

Alfred Bikeri Manduku

1 Health education and awareness on the risk factors 2 Regular screening 3 Availability of testing tools and cardiologists

Amal Almas

Screening for common diseases like hypertension and diabetes. Prompt follow up of hypertensive patients and other heart conditions. Proper education to cardiac patients regarding their condition,drug adherence and warning signs for heart failure. Encourage patients to eat a healthy diet and do regular moderate exercise. Discourage cardiac patients from strenous exercise and other factors which might tip a patient into heart failure. Reassess patients medications and always watch out for drug to drug interactions. Train doctors and nurses on the use of already available diagnostic tools like ECG machine Pin up a chart on the steps in management of heart failure so that all patients get standard and prompt care. Timely referrals.

Dr. Cedric Tumbo

i have been lobbying for an ECG and i think i will continue doing that together with an ECHO since i can't/don't have an access to a physician. Patient education has been ongoing and i will also continue doing the same.

Geoffrey Sangany

At the county level its is important to screen patients for heart failure at any opportunity presented especially at the outpatient department more so for patients who have risk factors (age, diabetes, thyroid disease, rheumatic fever, kidney disease, patients with edema, patients with difficulty in breathing). This will have to involve capacity building across cadres such as comunity health workers, clinical officers, nurses and medical officers. Having diagnostic tools such as ECG, Ecjocardiography and the relevant lab tests available at the county level. Having a cardiologist available for referral and management of cases. Social support for patients who may not be able to afford the more costly interventions. Counseling of the patients on the importance of keeping a healthy lifestyle, adherence to therapy and close follow up through the clinics.

Florence Karanja

Generally, it's necessary to sensitize the community through education in terms of understanding and preventing the risk factors of heart failure, need for socioeconomic support and importance of screening for DM/HTN. This can be achieved through support groups. To emphasize on the need for health care workers at primary health centers to make timely referrals. To equip the hospital with the necessary diagnostic tools including; laboratory investigations, echo.

Fredrick Otieno

Education Conduct frequent CMES to the HCWs laying emphasis on prevention, early diagnosis and appropriate treatment (drugs with morbidity/mortality benefit). Community awareness on heart failure discussing the risks as far as gender and age is concerned. Continuous patient education and counselling on the benefits of regular follow up, adherence and how to avoid the risk that can predispose to decompensating.

Ms. amina noor

patient education at the community level on the risk factors and early detection of the signs and symptoms of heart failure, screening of high risk factor patients(DM,HTN,obese) and close follow up for already diagnosed patients. making diagnostic tools(ECG/ECHO) and lab investigations easily available and affordable for proper management(HefRef/HefPef). counselling of patients on compliance of their meds and the possible complications that could arise, linking them to nutrionists for proper dietary guidance. familarizing with guidelines available and upcoming ones, working/consulting /referring to a cardiologist for proper care of the patient.

Dr. Rajab Idris

Patient and family education.CMEs for health workers to enhance early diagnosis and management of heart failure.

James Mugo

1. Set up elaborate protocols for managing heart failure 2. Sensitize relevant health care workers on the above protocols 3. Engage health care managers to provide necessary resources (e.g. ECH, Echo) to different medical facilities

Dr. Mohamed Arif

Measures to improve management of heart failure at county: 1. Patient education on importance of early detection and contributory factors. 2. Screening at every opportunity of patients at risk of heart failure or those with comorbidities. 3. Making ECG/ ECHO and lab investigations available at subsidized prices for patients who cannot afford. 4. Having personnel fully trained on management of heart failure and frequent CME'S. 5. Making anti failure medications available at subsidized costs to patients who can't afford. 6. Follow up of diagnosed patients. 7. Keeping a health record with patient information and current status. 5. Having med

mutwiri rarama

The management of heart failure in our County currently is in need of reconfiguration because we have very high numbers of hypertension patients who are not well managed and most end up with Heart failure as the most common complications. 1. The first thing I would consider doing is educating the CHVs and the community at large on the risk factors of Heart failure and the importance of how to manage the most common risk factor (Hypertension). 2. Avail the necessary equipment for diagnosis of Heart failure in the early stages and start the appropriate treatment at the earliest possible for the best possible outcomes. 3. Stocking up the level 4 and 5 facilities with the correct medicines according to Evidence based outcomes to ensure patients enjoy the greatest mortality and morbidity benefit from the drugs. 4. Setting up of Specialized Cardiac Units on the level 5 Hospitals that have well trained consultants in Cardiology and the relevant multidisciplinary departments. This should be accompanied by running of regular Heart Failure clinics.

Gamar Bajaber

I would educate patients diagnosed with heart failure,on what it means to have heart failure,advise them on factors that they can control to reduce decompensation like fluid intake limit ,compliance to meds,and dietary restrictions like reducing salt intake among others.To the county officials,i would lobby for more ecg,echo machines to aid in diagnosing nderlying causes of heart failure and providing adequate flow of hf meds.Also organising cme or webinars so as to uptodate clinicians on hf treatment to keep clinicians updated on recent hf guidelines.Having a ccu with inotropes in counties will also help manage patients in cardiogenic shock with heart failure,hence help prolong survival and quality of lifr of some of these patients.

Dr. Tendwa Ongas

Patient and relative education (especially in those with comorbids/ pre existing cardiac conditions ) it should be standard practice for patients to be seen with atleast one caregiver/relative. 2. Capacity building of health and community workers to be able to confidently pick up signs and symptms of cardiac disease including heart failure so as to be able to adequately treat/refer said patients. 3 improvement of infrastructure at basic levels e.g. providing echo/ecg machines at several facilities. Also train healthcare workers on use of the equipment in form of CMEs and short training courses.

Dr. Moenga Masese

1. Aggressive screening of at risk patients, early diagnosis adequate follow up. 2. Mass education to sensitise public on symptoms, precipitants of ccf as a preventive measure. 3. Adequate resource mobilization- necessary personnel, lab works, radiological investigations .

Ruth Komu

1. Provision of the ECG and Echocardiography services in the county facilities. 2. Stocking up on the necessary medication to ensure access in all the level 4 and 5 facilities 3. Proper training of the staff handling the patients with heart failure particularly in the outpatient setting to ensure early diagnosis and proper followup. 4. Hiring a cardiologist.
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