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Cardiology Masterclass Discussion Question 2 : Module 3 - Heart Failure

Posted in: Cardiology

What successes/impact have you had in the last one year in the management of heart failure in your county?


Effat Abdulwahab

We have managed to get a physician in the hospital who was never there before We also have available tests now such as lipid profile, uec and hba1c too...which helps us alot with our hypertension and heart failure cases as well as diabetes

Dr. Aarif Varvani

1) availability of point of care test kits eg BNP, Troponins etc 2) availability of ecg and point of care echo/ultrasound 3) availability of new antifailure treatment via various access programs eg Uperio via Novartis access program, Ivabradin, Bisoprolol (concor), carvedilol and nebivolol etc 4) weekly CMEs for those in the department of Internal medicine 5) segregation of Cardiac outpatient follow up clinic from the general MOPC so that more time is allowed per patient to allow for patient education sessions as well 6) participation and presentations at various conferences eg KCS, Africa STEMI Live

Wyclif Odira Odhiambo

Many times in the ward round when people are treated for pneumonia and pumped with a wide range of antibiotics until I review them in MOPC and find a whole range of classical features of heart failure. And I've made it my priority to teach the nurses and clinical officers Framingham criteria on how to pick heart failure. I believe empowering clinical officers and nurses in the peripheral facilities in CME or ward rounds. The only downside is that there's no ECG or echocardiogram machine in our hospitals and so the patients have a be referred to Kisii or Kisumu counties for the tests. Clinically we still make big steps in heart failure management anyway.

Mbarak Mbarak

- Was able to do and help in interpretation of Echo&ECG hence saving patients time and money needed to travel to Mombasa for such investigations. - Separate cardiac patients from general clinics hence focussed care - Offer recommendations for setting up of a cardiac diagnostic centre which would be linked to other centres of excellence to help in diagnosis, care and referral as appropriate

Geoffrey Sangany

Just to reiterate what has been mentioned above, most success has been achieved in the clinical setting. Due to lack of diagnostic labs and ecg/echo we have adapted to teasing out heart failure through the outpatient department and clinics. This has led to sensitization in recognising the early signs and symptoms of heart failure. There is still a long way to go in diagnosis and treatment since we still have to refer patients to Mombasa or Nairobi for echo/ecg and further management since we lack a consultant at our facility.

Dr. Ngugi Wamuyu

In our facility, we have made little progress in the management of heart failure. We have no consultant physician who can provide mentorship on the same. The medical officers are very few thus its hard to conduct daily ward rounds on the medical patients and as well run the MOPC clinic effectively. We had acquired an ECG machine but it failed. We have to send out clients for ECHO in neighbouring town thus cost implications to poor patients we attend to. However we have been trying to ensure we as medical officers review the MOPC and sickly medical patients regularly when we can. We have also taught the clinical officers both registered and interns on how to diagnose and manage heart failure patients in CMEs and ward rounds

Naomi Munywoki

Being able to do bedside echos with point of care u/s. Having a proper set- up NCD program/ clinic.

Zainab Bagha

Availability of tests eg cardiac markers... Availability of ECG and Echocardiogram Specialized cardiac centre where cardiac patients can easily access services and reviews by the cardiologist.

Dr. Khuweillah Rudainy

Availability of portable ECG at Malindi Subcounty hospital, teaching of the interns and the clinical officers how to interpret decreased voltage indicative of dilated cardiomyopathy. Holding weekly CME after MOPC care. Availability of reliable affordable drugs by Norvatis has made follow-up on Heart Failure patients easier. The facility has its set-back by unavailability of key diagnostic modalities but we refer what we can't handle.

Dr. Mohamed Arif

1. Availability of ecg for point of care testing. However we still lack an echo machine and have to refer to mombasa for that. 2. Weekly CMEs for sensitization to pick out heart failure patients. 3. Liasing with a physician from an NGO facility in management of heart failure patients. 4. Availability of anti failure drugs at the facility.

Fredrick Otieno

conducting regular CMEs to educate on how to make diagnosis and appropriate management. Bedside ECHO and appropriate referral to cardiologist. Lobbied for an ECG machine.

Dennis Nanyingi

Availability of ECG machine at CDM clinic. The hospital has also started cardiac markers testing making it easy for the patients who initially travelled long distances to access the services.

Dr. Hassanfahad Adan

Made recommendations for the purchase of ecg, echo machines... Participated in weekly departmental CMEs which have enhanced our knowledge on heart failure, its causes n management.

Dr. Ivy Barasa

Heart failure management has improved after mass education on risk factors, need for screening, need for early initiation of medication and importance of adherence at the community level. At the hospital, there have been symposius on Heart failure, ways to mitigate it, patient focused treatments including medication, life style changes and intervention for the ones that require assist/ implantable devices. The presence of a readily available ECG and echocardiogram has also improved the management of heart failure. Specialists have also made it a goal to pass on the knowledge and skills on palliation for the heart failure patients.

Caroline Bichii

In the past year, initiation of open heart surgeries for patients with valvular heart disease at the hospital has reduced progression to heart failure.

Pauline Kamau

1.Availability of a portable ECG machine. 2.Being a teaching hospital we have cardiologist at par. 3.Having a different clinic set up and bookings ie MOPC and DCC and hence TCAs have a shorter duration. 4.Emphasis on patients health education during MOPC and DCC.

Dr. Timothy Kaleli

Establishing a proper outpatient clinic follow up for patients with hearfailure at my place of work. Advocacy to have a EKG machine and availability of drugs.

Robert Ngasa

The availability of echo/ecg coordinated through referral out and back has helped in clearing out the picture especially in hypertensive heart failure.

Dr. Maureen Maleche

The most important success in my county was sending our physician doctor to go and study cardiology in India this year. The county also bought a couple of ECG and Echo Echo machines, which prompted the county to send ane doctor to specialize in cardiology due to lack of expert in handling the machine.

Dr. Flora Kithikii

Regular MOPC clinics

Uzma Bagha

availability of ecg, knowledge on ecg reading, access to cardiologists and echos

Dr. Cedric Tumbo

We made a regression as the family physician who used to help with this causes was sent to county management. We are in no good place with investigations, diagnostic equipment (no echo/ecg).

Muthoni Maina-Luzing'a

Stabilised supply of oxygen, hence fewer instances of lack of oxygen CMEs, where everyone in the hospital is invited to attend

Dr. Kenty Isabella

By running the MOPC at the subcounty facility i am at,facilitating follow up as a preventive measure for patients who don't always make it to the county hospital to be seen by a physician.

Dr. Haji Musuko

I joined my County in January this year. My posting was to a remote subcounty as a subcounty medical officer of health. Together with the subcounty health management team members ,our role was to support 38 GOK primary care facilities ( 34 dispensaries and 4 health centres). The success /impact in the subcounty was to ensure supply of basic drugs to treat hypertension and diabetes. Through the UHC programmne , Clinical officers , nutritionist and health records officers were posted in the primary health care facilities to ensure proper treatment of patients with hypertension and diabetes. As a county ,5 health care workers ( Family physician, 2 medical officers, Pharmacist and Clinical officer) were trained by Kenya cardiac society as Trainer of Trainers on the Kenya National guidelines for cardiovascular diseases Management .The TOT are to train the primary care health care workers. As a county we had a Data quality Assesment from the Division of noncommunicable diseases where identified gaps were addressed to improve on patient care. 2 weeks ago, through Kenya red cross , 5 Trainer of Trainers were trained on NCD care during emrgencies like drought and floods. CHVs were also trained to do community screening on hypertension. There is a cardiologist at the Malindi subcounty hospital. Drugs are available for heart failure.

Ruth Komu

The successes we have had in management of heart failure in my centre in the past 1 year include: 1. Provision of echocardiography services For the first time, echocardiography services are available in our facility at an affordable fee. 2. Consistency in electrocardiography services There has been improvement in the provision of ECG services in that, the machine broke down less this year.

Gamar Bajaber

Introduction of the poc machine that aids in nt pro bnp levels and increasing echo machines in the facility has helped early diagnosis and management.Introduction of valve replacement surgeries has improved quality of life of patients.Formation of anticoagulation clinics for patients with heart failure and conditions like afib has helped in prevention of further complications.Booking patients 2 wks after discharge to cardiac clinic has helped reduce readmissions in heart failure .

Faith Mbuvi

Availability of lab tests - cbc /u/a, lipid , hba1c, uec lft tsh and ecg . though we still refer patients to physicians elsewhere

Charles Ndirangu

For the past few months I've worked as a medical officer,I am not aware of a lot of positive impact in terms of management of heart failure. We're still in lacking of adequate knowledge among health care workers,lack of diagnostic tests such as cardiac markers,no ECG or ECHO services that are readily available in the public hospitals. Inadequacy in the supply of drugs required in management of ACS or hypertensive crises and also in the management of heart failure.

Abdikadir A. Adow

The major step so far that works for our institution is basically clinical diagnosis by doing rounds with nurses and clinical officers and treat accordingly. Also early referral.. we also focused on monitoring patients on MOPC so that to pick those in danger... challenges are availability of imaging

mutwiri rarama

In our County we have had the following successes: 1. We have managed to train several doctors in Echocardiography and basic ECG interpretation therefore Echos are more readily available now. 2. There has been an increase in efforts towards education the general population on Hypertension and Diabetes diagnosis and importance of proper management and follow up to reduce the number of cases that develop heart failure as a complication. 3. Heart failure targeted CMEs have also been given more importance by the organizers of such forums.
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