Chronic Heart Failure (CHF) Program

Chronic Heart Failure (formally called Congestive Heart Failure) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.

As of 2008, cardiovascular disease (CVD) has been the #1 cause of death in the US for both men and women. It claims more lives than the next five leading causes of death combined (Cancer, Accidents, COPD, Diabetes, and Alzheimer’s Disease). 

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Presently, there are almost 5 million people with the diagnosis of CHF. Each year, there are 550,000 new cases of CHF.  At the age of 40, the lifetime risk of developing chronic heart failure is 1 in 5.
Congestive Heart Failure changed its name recently due to not all patients have signs of congestion.  Patients have more effective fluid volume control due to diet and medications.

The most common symptoms of Chronic Heart Failure are:

  • Dyspnea
  • Tachypnea
  • Paroxysmal Nocturnal Dyspnea (PND)
  • Orthopnea
  • Peripheral Edema
  • Skin appears Cold, Pale, possibly Cyanotic
  • Weight Gain
  • Hepatomegaly
  • Jugular Vein Distention
  • Rales (Crackles) in Lungs
  • S3 Heart Sounds
  • Sinus Tachycardia
  • Decreased Exercise Tolerance
  • Decreased Physical Work Capacity

Because heart failure is the most common reason for hospital admissions for people over the age of 65, it is important to utilize the benefits of a good home health agency.

Here at Advance Care LLC, we are committed to a unique and comprehensive Chronic Heart Failure program. Our program encompasses education for both the clinician and the patient.

Our first goal is to provide the most up to date training for our clinicians.  Our management team recognizes the importance of staying current with cardiac information.  Our managers go to annual symposiums on cardiac care.  In 2011, we invested in a 24 hour internet library for our clinicians to advance their skills and technical knowledge.  Our Advance Care LLC Learning Center provides education to our clinicians, as well as teaching guides for our clients. Each clinician on our CHF team has been personally selected by our President, Lisa Stroud, RN.  Lisa has an extensive background in Cardiac Care.  She has assisted with development and implementation of Cardiac Programs with other area home health agencies.  Lisa, along with the Directors of Education play a vital role in the education of our clinicians.  Each SN must complete our Advance Care LLC Learning Center Modules on Cardiac Care (Total of 4 hours). Each SN and Rehab member must complete a 3 hour CHF In-service and be deemed competent in the skills of theory, observation, assessment, and provisions of care.

Our second goal is to utilize technology in the home.  Each clinician works on a laptop with the most current information on drugs and their potential side effects.  The software allows the clinician to immediately detect a possible medication error.  The clinician contacts the MD with any serious drug interaction and drug duplication.  We are presently beginning a telehealth program. It prompts the patient to check their vital signs including weight at a specific time. The system allows us to individualize each case, weight and vital sign thresholds are set up for the patient by the Cardiac Case Manager.

Our final goal is to utilize the team approach to produce an excellent level of quality care.  The role of the SN is to assess and observe the medical status of the client.  Nursing is instrumental in all facets of medicine management. After an acute episode, we believe in seeing a patient in their homes with a high frequency of visits. For the first 6 weeks after a Myocardial Infarction, the heart is at risk for hypoxemia and re-infarction.  It is critical to monitor these clients closely to avoid further damage and/or re-hospitalization.

Our rehab team consists of PT, OT, and ST. Our physical therapist role is to encourage cardiopulmonary function.  A patient is placed on a therapeutic exercise program to increase total body strength. We score our clients using the current best practice and valid tests.  Our current program monitors vital signs and recovery throughout the treatment. We use the Rate of Perceived Exertion Scale, Dyspnea Assessment Scale, and Target Heart Rate ranges as guidelines for treating parameters. All patients are required to participate in the Functional Reach Test, Timed Up and Go Test on admit and discharge.  Our PTs also are required to perform additional Balance Tests to place clients in a high, medium, or low fall risk categories. Samples of these are the Tinetti Scale, Berg Scale, and Dynamic Gait Test. To perform progressive resistive exercises, our therapists provide resistive training bands to our clients.  Low weights may be  used as indicated during the certification period. Other physical therapy interventions include transfer and gait training.  To improve the ability of our clients to ambulate in their home and in their community, we strive to practice gait on both even and uneven surfaces.  We stress pulmonary function by instructing our clients in pursed lip breathing, diaphragmatic breathing, and/or deep breathing exercises and techniques. Each therapist has a pulse oximeter for their clients to monitor oxygen consumption and recovery.  To monitor improvement in aerobic capacity, our clients perform the 6 Minute Walk Test and/or the Gait Velocity Test.

Our Occupational Therapist works with improving the quality and safety with ADLs and IADLs. OT is responsible for recommending environmental adaptations and adaptive equipment for clients. An example of environmental adaptations would be to move items in cabinets to lower shelves, to decrease the stress on the heart. A reacher and a long handled shoe horn would be examples of adaptive equipment that is utilized after open heart surgery to decrease the pressure over the sterna sutures. OT instructs both the client and family in energy conservation and body mechanic techniques.

Our Speech Therapist would be used when a client was having difficulty with swallowing or with speaking.  In the near future, we will be announcing that we will be adding a Vital Stim program to our ST program. Many dyspnea patients have difficulty with speaking due to the loss of breath.  ST is vital in improving and/or restoring a patient’s ability to communicate to the world around them.
Many cardiac clients go through a time of depression.  At Advance Care LLC, we have a full time Medical Social Worker that sits on our CHF team.  The MSW works to help the patient and family cope with the current loss of function and mobility.  The MSW works in conjuction with the RN and MD to identify and screen for depression utilizing the Geriatric Depression Scale, PHQ-2, and PHQ-9 scales.  Coping skills and strategies are frequently used during treatment sessions. Our MSW also provides counseling and financial planning information to the patient and family.

In conclusion, our CHF program is a comprehensive approach to the treatment of chronic heart failure. We pride ourselves on the quality care provided to our clients using the latest wireless telehealth technology.  As a recent member of the Top 25% Elite Home Care Companies in the United States, our outcomes meet or exceed the national averages. We hope you allow us to be a provider of choice to your clients.