Many people who need in-home care services are living with heart failure and need caregiving tailored to their specific needs.
Heart disease remains the leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC) with one person dying every 36 seconds from cardiovascular disease.
February is National Heart Month and includes National Wear Red Day, which is intended to highlight the risk for heart disease in women.
How to Care for Your Heart
Whether you are a caregiver for someone who is living with heart disease and want to keep yourself from developing high blood pressure and associated illnesses, experts have tips for well-being.
Cholesterol is one way to measure heart health and risks to the heart.
When it comes to trying to lower levels of bad (LDL) cholesterol, the advice remains consistent.
"Lifestyle changes are usually the first step for reducing blood cholesterol, and are continued if drug therapy is added," said Kathryn McMurry, Nutrition Coordinator at the National Heart Blood and Lung Institute. "Recommended lifestyle changes include increasing physical activity, losing weight if overweight, reducing dietary saturated and trans fats and increasing fiber-rich foods."
The goal of lowering LDL cholesterol is often to lower one's risk for heart disease and heart attacks. When cholesterol levels go up, so does the risk for heart disease. Check the National Heart Blood and Lung Institute's online 10-year calculator to assess your own risk score to determine your own heart attack risk. Based on that score, you will be in one of four categories which require different treatments and goals that will include dietary and lifestyle changes and possibly medications. Always check with your doctor for ongoing care as you address how to lower your cholesterol safely.
Experts believe regulating cholesterol levels is about balance. There are good (HDL) cholesterol levels and good and bad fats to consider. However, making lifestyle changes to achieve better cholesterol levels does not need to be overwhelming, especially for family caregivers with other concerns.
McMurry offers a few tips:
- Become more physically active. Adults should aim to build up to at least two hours and 30 minutes of aerobic physical activity that requires moderate effort each week. Walking is one simple way to add physical activity provided you do it for at least 10 minutes at a time.
- Eat smaller portions of foods and beverages high in fats and added sugars to reduce calories, especially if you are overweight.
- Eat more fish, choose lean cuts of meat, and eat chicken without the skin to reduce your intake of saturated fats.
- Eat more whole grains, vegetables and fruits rich in fiber.
- Check the Nutrition Facts labels and choose foods with lower amounts of saturated and trans fat and more dietary fiber.
- Experts say even people who did not previously have high cholesterol levels should get regular screenings. Levels of cholesterol increase with age, which means you should get a test at least once every five years.
If the results come with a higher cholesterol number, following McMurry’s tips can lead to fairly quick results depending on risk factors such as a family history of heart disease, smoking, obesity, diabetes, and high blood pressure.
Diet can play a critical role in heart health.
Why does it matter what you eat when it comes to keeping your heart healthy? Simply, the heart is pumping blood to the rest of the body and when it is compromised, overall good health is challenged.
The foods you choose to eat can affect weight, blood pressure and cholesterol levels and therefore impact the heart’s ability to keep doing its job. The healthiness of the heart is related to the healthiness of other organs, including the brain, and therefore how likely you are to develop serious illnesses such as dementia, diabetes, cancer and more.
It’s not just what you eat, but how much you eat. A person’s appropriate caloric intake depends on their age, gender, and typical amount of physical activity. Experts offer a variety of tips for controlling portions or calories so as to avoid obesity.
One way to regulate how much you eat is through portion control. The Mayo Clinic suggests using smaller plates or bowls or measuring food by cups or ounces in order to manage meal size. The American Heart Association advocates education on the right amount of calories for each individual.
Regardless of the method that you choose, in general it is recommended that you fill up on nutrient-dense meals and limit fast foods that can be full of sodium, sugars and bad fats.
Vegetables and fruits are packed with vitamins and minerals and fiber, but lower in calories than high-fat foods. When eating vegetables and fruits, go for a variety and eat them fresh, frozen or if canned, only those packed in juice or water and not heavy syrup or with any added sugars. Aim for five or more servings per day of vegetables and fruits.
Round out your plate with whole grains such as whole wheat bread, brown rice or whole grain pasta and a low-fat protein such as poultry or fish. Not all fish are the same and you want those high in omega-3’s, like salmon and herring. Don’t forget that legumes such as beans, peas and lentils can also provide protein. Use healthy fats like olive oil and vegetable oils to prepare these dishes.
And what not to eat...
Be aware of how much sodium is in your food because it’s not just the salt you sprinkled on your food that matters, but the salt that is found in many processed foods from canned soup to soy sauce. Excess sodium can be a factor in high blood pressure which is a risk factor for cardiovascular disease.
All of this is not to say that you can’t have some sweets in your diet. Studies have shown that eating dark chocolate (70% or higher cocoa content) a couple of times weekly might be good for the heart. Eating a heart-healthy diet should be enjoyable too.
Caregiving After Surgery for Heart Disease
Undergoing heart surgery is a traumatic endeavor, and with as much planning and preparing as it takes going into the surgery, it is equally important to have a well-prepared game plan for coming home.
A caregiver can help make a checklist of the things you will need and schedule help in the weeks prior to your surgery.
When you get home after being discharged, it is likely that the first thing you will want to do is bathe.
Be Prepared
Be prepared that you will need assistance with bathing and getting dressed afterward. Have all your bathing items ready to go, as well as comfortable pair of clothing (button up tops are best) loose enough to put over your bandages. While it might seem better to have someone you know help with this intimate task, hiring a professional in-home caregiver to assist with safely getting in and out of the bathtub or shower can be a way to preserve family and friend relationship. In addition, a caregiver is trained to safely do these tasks, but a family member can risk serious injury and then need their own caregiver.
Set aside blankets and pillows to prop yourself up and alleviate any stress to your chest. Also consider having a friend, or an in-home caregiver around to help you travel home safely, pick up any prescriptions, and help set you up for comfort once you’re home.
Having an extra pair of hands can smooth your transition after surgery and alleviate extra stress.
Heart Health and Medication Reminders
Caregivers can be on hand to give medication reminders, which can be the difference between remaining comfortably at home and being readmitted to the hospital and even life and death.
A study published by the American Geriatrics Society found that older people who have suffered from a heart attack often do not stick with the drugs prescribed by their doctor. For instance, on average, seniors filled prescriptions for the blood thinner clopidogrel (Plavix) less than half the time. Researchers say the worse they are at filling those prescriptions, the more likely they are to have health problems and die earlier.
This news is especially troubling during the winter. Another study published by the American Heart Association found that heart attacks are more deadly during the winter months. It’s unclear why, but experts speculate that it could be because people are less inclined to exercise when it’s colder.
What's Your Heart Health?
Knowing the health of your heart can be as easy as looking in the mirror. The American Heart Association says people who look old, with receding hairlines, bald heads, creases near their ear lobes, or bumpy deposits on their eyelids, have a greater chance of developing of heart disease than younger-looking people the same age. Doctors say this is the difference between biological and chronological age.
Whatever the problems with your heart, you do not need to confront them alone. The American Heart Association has a wide range of resources at www.heart.org. Homewatch CareGivers can also provide help in monitoring medications, making sure you or your loved one eat the proper diet, and make sure there is guidance from a doctor when needed.
Hospital readmission rates for people with heart failure are a major concern in the healthcare continuum. There are currently penalties and fines against hospitals for exceeding certain readmission percentages and experts are looking at ways to keep people from returning to the hospital within 30 days of being released.
“It’s a changing playing field,” said Robert Bonow, MD, past president of the American Heart Association and national spokesman and the Goldberg Distinguished Professor of Cardiology, Director, Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine Northwestern Memorial Hospital. “We used to see 28 percent readmission rate, and a lot of hospitals now are reporting declining numbers because of penalties.” Dr. Bonow is quick to point out that statistics on readmission rates can be misleading as the readmission may be due to something unrelated to the patient’s heart failure. Many of the reasons for readmissions are avoidable with proper follow up care, he noted.
“People may be readmitted because of an unrelated chronic condition, a fall in the home, it’s difficult to predict,” he said. “It’s really multifactorial. A patient can be sent home with the right medications and on the outpatient side there is not an understanding of the medications.”
Not understanding medications could be anything from not being able to read or speak English, Dr. Bonow said, to not understanding dietary restrictions that come along with the medications.
For example, Warafin (which sold under the brand names Coumadin and Jantoven) is a common medication for people who have had a heart attack and it can prolong their life. The American Heart Association describes the benefits on their website. “Warafin is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a heart attack, stroke, deep vein thrombosis or pulmonary embolism. Because Warfarin interferes with the formation of blood clots, it is called an anticoagulant. Many people refer to anticoagulants as “blood thinners”; however, Warfarin does not thin the blood but instead causes the blood to take longer to form a clot.”
Keeping in mind this is just one of the important medications a patient returns home to self-administer, this one small pill has an array of possible side effects and the AHA notes, “Many medications can alter the effectiveness of Warfarin, resulting in an INR that is either too high or too low. Some of the most common over-the-counter pain relievers, such as: ibuprofen (brand name Advil) and naproxen (brand name Aleve), enhance the anticoagulant effects of warfarin and increase the likelihood of harmful bleeding.” Furthermore, foods high in vitamin K—such as green and leafy vegetables like spinach and broccoli—can make Warafin less effective and potentially increase the risk of blood clots. Yet, the AHA also tells people it is not necessary to avoid these foods while taking Warafin. An INR, or international normalized ratio, is a way to test coagulation.
“There are lots of things in play here,” said Dr. Bonow of the many reasons that heart failure patients might be readmitted to the hospital within 30 days.
A caregiver may able to observe sudden bruising or bleeding that could indicate issues with a blood thinner.
Family caregivers and professional in-home caregivers can help people with heart failure reduce the possibility of a hospital readmission within 30 days of being released from the hospital—whether in the form of medication reminders, doing a fall risk assessment of the home and subsequently removing fall hazards, managing diet or driving someone to the doctor for follow up appointments.
