Healthy living
Body matters
A day in the life of a heart nurse
Jane Feinmann looks at the work of a visiting British Heart Foundation nurse
It's a brisk winter's morning in a suburban house just north of London. An elderly Asian woman, perched on a chair, her feet resting on a stool in front of her, is having her blood pressure taken. She's breathing with difficulty but talking earnestly to the young woman with the stethescope.
The young woman is Deepa Patel, and she is a Heart Failure Specialist Nurse (HFSN). Her visit is part of something quite new. The old-fashioned district nurse visited homes, but was a generalist. The expert heart specialist's place was in hospital doing the rounds. Here is one woman performing both roles.
This apparently humdrum scene represents a medical breakthrough. It is cutting-edge management of an unpleasant incurable condition that has, too often, been neglected in the past.
There is nothing particularly new or wonderful about any one element of the medical treatment provided during Deepa Patel's home visit. It is the whole package that makes the difference.
The HFSN combines a specialist training in prescribing with a nurse's listening skills and empathy. Not least, she has the transport to visit and carry medical kit to patients for whom regular hospital visits are impractical.
First introduced in 2002, there are now 230 HFSNs. But they remain such a cutting-edge development that training and salaries are funded entirely by charitable donations via the British Heart Foundation - and are one of the objects of this month's BHF £1m Valentine's Appeal.
The charity's target is to make sure that all heart failure patients, as well as patients who have had heat attacks and children born with congenital heart disease, have access to a specialist nurse. BHF's Heart Information Line, which supports heart patients and their families, will also benefit.
Around 800,000 people in the UK live with heart failure, the vast majority of whom are over 60 and suffer from other serious health problems. The condition has many causes; but the consequence is an enlarged heart muscle that progressively prevents effective blood circulation. Symptoms can be frightening and debilitating - most notably, breathlessness and a build-up of fluid in the ankles, wrists and lungs, all of which hamper mobility and quality of life.
The syndrome can be stabilised with the right medication: diuretics to get rid of the fluid and cardiovascular medication to prevent further heart deterioration.
Too often, however, sufferers not only fail to get the right medication; they don't even get a proper diagnosis. Many only get to see a doctor during one of the frequent emergency admissions to hospital that make heart failure one of the costliest conditions to treat.
By keeping a close eye out for deterioration, the HFSN can adjust medication, keeping the syndrome stabilised, avoiding emergency admissions and improving the quality of life
Shardaben Patel (no relation) is a case in point.
In the last couple of years, the 82-year-old, who also suffers from diabetes, blood clots and lung problems, has been repeatedly admitted to hospital because of severe breathlessness - including a six-week-long stay last year.
She says that though she tried to get treatment for her puffy, painful legs, the symptom was pretty well ignored and she was discharged without any follow-up. Shardaben was lucky, however. She had a family that pushed for a proper diagnosis and she was also put on Deepa's list.
Deepa has been a BHF heart-failure specialist since 2004. She has a degree in nursing and a growing list of specialist postgraduate qualifications, giving her with the authority to prescribe for heart failure and the autonomy to make clinical judgements.
Since Deepa began to visit regularly, Shardaben has not been back to hospital. "I think she feels calmer about the future, less bogged down with negative things," says Deepa.
As well as checking blood pressure, puffiness and general health, Deepa uses the visit to talk to Shardaben about the possible benefits of reintroducing a heart failure drug known as an ACE inhibitor.
"She's on 19 different drugs at the moment so it can be a difficult balancing act to get the benefits of good heart failure drugs without causing problems with other medication," explains Deepa, as she sorts through Sharbden's drugs, stored in several carrier bags.
Lynne, the next patient, has multiple sclerosis as well as heart failure. She's had a couple of falls, causing worries that the medication might be lowering her blood pressure too far. After carrying out tests, Deepa can be reassuring as well as proactive. The drugs are fine and are not causing the problem, she explains, promising to refer Lynne back to an MS clinic for physiotherapy.
Lillian has severe arthritis and was diagnosed with heart failure just before she was about to have hip replacement surgery last year. She had a pacemaker inserted but then suffered a serious heart attack. Now she's in agony and virtually immobile from the arthritis but surgeons can't take the chance on doing the operation, despite Lillian's willingness. It's not a heart failure issue and Deepa can't promise that she can change the surgeons' minds. But she can arrange for a prescription for a much stronger painkiller to be delivered: "I'll love you forever for that," says Lillian.
The visits finished, Deepa goes back to her office to send emails and make telephone calls that result from her morning's calls. She never discharges patients - continuing to see them right until the end and telling them as truthfully as possible when that is going to be. "You can't do this kind of work without getting emotionally involved," she says. "I use the drive home to switch off. That way I'm ready to give my best the next morning."
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