Management of CHD and Other Chronic Illnesses - Essay Example

? Management of CHD and other chronic illnesses Management of CHD and other chronic illnesses This report presents Coronary Heart Disease (CHD) also known as Coronary Artery Disease, a condition that affects a large number of people and which causes a lot death as it affect a most vital organ in the body – the heart. Once we have looked its definition, diagnosis and treatment options we shall also look at factors that influence the occurrence and growth of this disease as well as its prevention. We will also look at the psycho-social impact if dealing with this disease as well as the impact of treating and management of such a chronic condition. The paper also looks at the future of the spread of CHD and other such so-called “lifestyle” illness and the impact this will have on the healthcare systems of the less developed world. The paper also looks at the social determinants of cardiovascular diseases, including CHD. The other thing that is examined in this document is the place for self care and self management of chronic illnesses especially in the homes and in the communities where a lot of such illnesses need to be managed, with the intention of reducing the need for making too many trips to the hospital for the patient and also ensuring that his or her psychosocial needs are met right at the place where they live. The report uses the case study of a CHD patient to ensure that the lessons learned and best practices in self management of chronic illnesses can be utilised and used as teaching tools not just for the patient but also for those members of their families and their community that are charged with the task of taking care of them and following up on their needs as patients and family members. Coronary heart disease is a condition caused by the build up of fat and cholesterol deposits in the walls of the arteries of the heart. These deposits result in the constriction of the arteries which leads to a reduction of the flow of blood to the heart. This build up of deposits happens gradually over time and usually the first signs that this manifests itself in are in breathlessness and chest pains. The first symptoms of CHD include chest pain or angina. Coronary heart disease can often lead to heart attacks, irregular heartbeat and heart failure. Coronary heart disease kills more people in the United Kingdom than any other disease, with about 82,000 deaths reported annually. A further 2.7 million are estimated to be living with the condition (NHS(b), 2012). In the United States there are over 7 million people living with CHD and every year more than 600,000 die of CHD and related illnesses (Surgical Associates of Texas, 2005). The prevalence of CHD is highest among those over 65 years of age (19.8%) while the prevalence among the men in the population is much higher than that in women, at 7.8% and 4.6% respectively (CDC, 2011). There are certain factors that increase the risk of contracting CHD. These include smoking, being overweight, a sedentary lifestyle with lack of exercise, excessive intake of alcohol, family history of heart disease, high blood pressure and diabetes (Canvin, 2012). CHD is diagnosed by various tests that are conducted which include blood tests to see the amount of fat and cholesterol in the blood, an electrocardiogram (ECG), chest x-ray, CT and MRI scans (Canvin, 2012; Heart Foundation, n.d.). Other tests include the angiogram, also called cardiac catheterization, where a dye is injected into the body via a thin tube known as a catheter. The images taken showing how the dye flows through the body are used to determine how effective blood flows through the body. Another test is the stress test where typically a client is placed on a treadmill at changing inclines and speeds and any abnormalities in the rate and rhythm of the heartbeat is measured. Additionally a dye can be introduced into the body intravenously and then x-rayed to show how effectively blood is being pumped through the body (Milano, 2013). CHD has no cure once diagnosed. It thus often becomes a life-long and life-changing chronic condition and the mitigation of its symptoms depends on various tools that have been developed to combat it. Its chronic nature also presents various challenges and implications. There are various treatments that can be given to manage the symptoms and prevent worsening of the condition and possible heart attacks and heart failure. These treatments all depend on how early the condition is diagnosed. Treatments can also include medication used to make the blood clot less, nitrates that relax the coronary arteries and make blood flow through them easier, ace inhibitors that lower blood pressure and beta-blockers that reduce the heart rate and many others. Most treatments also include lifestyle changes such as stopping smoking, exercising more frequently and losing excess weight (NHS(a), 2012). Other lifestyle changes that not only prevent but also play a role in the treatment of CHD include eating a healthy diet that has reduced animal and processed fat, eating more fish, lean meat and poultry as well as eating more fibre rich food and avoiding pies, sausages and burgers. Decreasing alcohol intake is also being encouraged as is reducing daily fluid intake (Houghton, 2008). These are effective in not only treating CHD when diagnosed early but are also key to preventing the occurrence of CHD. Patients are also advised to keep high blood pressure and diabetes under control. Patients are also advised to ensure that they adhere to all medications that are prescribed to ensure their efficacy and that they achieve the intended purpose. CHD is a condition that has to be attacked from different fronts – from ensuring the blood pressure is not too high, to ensuring that the blood vessels are relaxed and ensure that there is constant and uninterrupted flow of blood to and from the heart. Since treating CHD uses such a multi-pronged approach, skipping some of the medications results in serious problems as it means that some of the medications may not work as they should. Adherence to prescribed medication regimes is therefore key to managing this chronic condition. The medications use for CHD are also a complex mix, with some having contradictory and conflicting side effects. For example some of the medications for diabetes also result in side effects such as weight gain and heart problems associated with CHD (ThirdAge.com, 2011). There are also surgical interventions that could be used to treat CHD. Angioplasty is a non-surgical procedure which can be used to treat CHD. In this procedure a thin flexible tube is threaded through a vessel to the narrowed or locked artery. This ensures the continued and uninterrupted flow of blood through the vessel. A small mesh called a stent is also inserted to prevent future blockage. Coronary bypass grafting is surgery in which arteries of veins harvested from other parts of the body are grafted to bypass the narrowed arteries thus preventing heart attacks and relieving the pain of angina (National Heart Blood & Lung Institute, 2012). Mrs Cox is hypertensive, her pulse and respirations are both very high. Her BMI is at 45 which means that she is not just overweight but morbidly obese. She has been given medication to reduce her heart rate – Bisoprolol (Datapharm Communications Ltd, n.d. (a) but she not to be taking it. She has also been given Ramipril (Datapharm Communications Ltd, n.d.(b) which is supposed to reduce her high blood pressure but she appears not to have been taking it either. The other drug Furosemede (Datapharm Communications Ltd., 2013) is to ensure she does not retain fluids but she appears not to be taking that as well as she has oedematous ankles. She has also been taking aspirin daily and that is beneficial to her since Aspirin helps in preventing blood clotting which is useful for people with coronary heart disease as it prevents heart attacks and reduces the pain of angina (Hennekens, 2008). Mrs Cox has been relying on the Aspirin as her only medication and because it eases her pain she may feel that she does not need the rest of the medication. She needs to be given empowering advice on all the medication that she has been prescribed and the importance of taking them all and continuing to take them in order for her condition to be managed effectively. Mrs. Cox needs to be advised as follows: She needs to lose weight and reduce her BMI by changing her diet to a healthier one. Her weight puts her in grave danger of getting a heart attack and she does need to not only lose a lot of weight but also keep the weight off and improve the quality of the food that she eats. She also needs to take all her medication regularly otherwise her blood pressure and heart rate will not go down. Her daughter needs to take a more active role in her mother’s care. She needs to very carefully and meticulously ensure that she takes her medication and also advise her on her diet to ensure that she reduces her BMI. Mrs. Cox and her daughter need to be advised on the best way to ensure that Mrs Cox gets the kind of home-based health care that she needs, since she is fortunate enough to have a professional on the premises. There is a need for the self care that she needs at home be approached in a more formal and specialized way. The daughter may need some training in how to take care of her mother in the home setting and Mrs Cox also needs to be trained in how to accept and take care of her daughter in a way that is beneficial to her and to make sure that she able to make the necessary lifestyle changes that she needs to change in order to help her lose weight and take more control of her chronic condition. Mrs. Cox needs training on how to manage the psychological impacts of her illness. She needs to be taught how to cope with the feelings of frustration, isolation. She needs to learn the necessity and usefulness of exercising and the need for her to continue taking her medication as instructed by the doctor. Mrs Cox needs to learn how her diet affects her weight and why she needs to ensure that she eats healthier in order to manage her condition effectively. She needs to learn how to communicate effectively with her daughter so they can both work together to ensure that she stays as healthy as possible and that they both manage her condition in a positive, mutually beneficial manner (Nolte & McKee, 2008).  Mrs. Cox would also benefit from a visit and assistance from a social worker. This is necessary so as to ensure that she is able to access all the regular screening and assessment she needs not just for her medical and health needs but also to ensure that basic psychosocial needs are also met in a way that affects her treatment positively. This is also another area where she and her daughter can combine forces in order to first map out what her psychosocial needs are and then to go ahead and making plan that as many of them as possible are met especially in the home and community setting (Christ & Diwan, 2008).  Some of the drug treatments available for CHD include aspirin and other anti-platelet medicine that prevents blood from clotting. Beta blockers slow down the heart rate and also lower the blood pressure to try and ease the strain on the heart. Stations lower the amount of cholesterol and thus prevent further build-up of cholesterol in the arteries. Nitrates are types of drugs that are used in reducing the pain of angina. Calcium channel blockers are used to slow down the heart rate and lower blood pressure thus also helping reduce the workload of the heart. Angiotensin converting enzyme (ACE) inhibitors are also used to lower the blood pressure. All these and more drugs are all used with the purpose of relieving the pressure on the heart and thus preventing the possibility of a heart attack (WebMD, 2011). Coronary Heart Disease has various psychosocial impact and implications in the lives of those who have it, their relatives, friends and the general society at large. The patient firstly has issues of anxiety due to worrying about the effect of the disease in their life, guilt due to the fact that they feel society blames them for getting the lifestyle disease because of the way they have lived their life, lifestyle changes, and depression. The CHD patient also suffers from social isolation and feelings of hostility against him since he also seems and sometimes feels like he is utilizing the meagre resources of health care available due to diseases that are more or less of his choosing (Ogojiofo, 2012). As a result of CHD being a chronic disease that has no cure and is therefore one that has to be lived with for a long time, the patient goes through a series of psychological issues that range from uncertainty to conflict and social isolation that also change over time and affect the lives of those near them in family and society (Winters, 1997). CHD used to be considered a disease of affluence but unfortunately it now affects other strata of society as well. In the developing world, because of the “modernisation” which has seen the creeping in of unhealthy eating habits associated with the more “developed” world, these diseases are now becoming more common. In some of the wealthier nations, CHD is now starting to decrease among the more affluent, who have access to better healthcare, while it is increasing in the less well-off societies who do not have similar access to quality health care. One of the psychosocial factors fueling the increase in CHD in some of the hitherto non-affected or little-affected population groups in the developed world has been the change in diets with more unhealthy eating in these poorer, less well-off communities, such as the African Americans in the United States (Anyadubal, 2010). Another factor that pre-disposes the less well off to lifestyle diseases such as CHD is the much lower educational standards and achievement in this population. Another factor that predisposes the middle and lower income groups to CHD is stress. Anxiety, insecurity and the struggle to make ends meet continue to take a toll on these populations and again predispose them to diseases such as CHD. Research – and the impact of work related stress has been one of the most researched areas of CHD – has shown a direct correlation between work-based stress and incidences of CHD. Unemployment and addiction are the other issues that act as accelerants of CHD and other such diseases in the low income groups. All this means that an even larger part of society is coming to be at risk of diseases such as CHD, hypertension and diabetes and it is increasing even more in countries and societies where there has been little improvement and in many cases even decline in both the quality and quantity of healthcare (Gupta, Kler and Gupta, 2012). Especially where the disease progression has gotten to the much higher level, the costs of managing CHD patients get higher, especially when included with the costs and the impact of an ageing population. All these effects have implications on the quality of life and the general well-being of not only the CHD sufferer but also those of his or her immediate and extended family. The interaction of genetics, biology and the social environment has also been known to be a special social determinant of CHD and other cardio-vascular diseases. A study done in Italy involving some nuns and the villagers living in a nearby monastery. The nuns spent their entire life in isolation and silence. It was noted that although the amount of urinary salt extracted was about the same, the incidence of high blood pressure was far lower among the nuns. Thus, despite both groups having a similarly high salt diet, for the nuns the lack of stress, silence and isolation had an effect on their health outcomes (Lang, Lepage, Schieber, Lamy, and Kelly-Irving, n.d.). CHD management is also a very expensive affair. Not only is it a disease that has no cure, and therefore depends on lifetime of medication and healthcare needs that far surpass those of other diseases. Even the equipment and the tools required to adequately diagnose CHD are very expensive, making it and even greater burden for especially impoverished third world countries. Chronic illnesses such as CHD have had a significant impact on healthcare costs throughout the world. On average, it is estimated that chronic illnesses account for between 70 and 80 % of all health care expenditure. Patients with chronic conditions are more likely to visit their health practitioners. On average 80% of consultations are due to chronic illnesses. 66% of admissions through the Emergency Departments have an elevation of their chronic illnesses. Despite being a small proportion of the patients (5%) they occupy 40% of inpatient days (Hennekens, 2008). In the hierarchy of illnesses, chronic illnesses which only account for about 5% of all patients in the health facilities are at the top of the disease pyramid where they take up a lot more resources than all the rest of the other levels of the hierarchy (HSE Transformation Programme, n.d.). Care of patients who have chronic long term illnesses such as CHD is an issue that is fraught with many social, ethical and legal issues that all need to be addressed and addressed adequately in order that the patients, their families, their communities and all at large are able to deal with them tackle them. The WHO defines long-term or chronic care as a comprehensive range of services based in the homes, in the communities, in health facilities and elsewhere then ensure and allow individuals to lead dignified lives with independence and without undue burdens being placed on them or their families. This is the key ethical and justice goal of long term chronic care. It recognises the fact that all citizens need to be offered services, irrespective of their birth or race or sex or disability decent life chances including but not limited to health, education, employment and political participation. This covers not only patients, caregivers but also other members of society and the nations at large. This is seen as a sort of social contract that needs to be entered into and embraced whether in the third world or in the first world with the key purpose being to give all dignified life and health care options (World Health Organization., 2002). There are also key basic ethical rights that do need to be adhered to when looking at care of chronic long term patients. These include beneficence – doing what is good for the patient and as a health provider, non-malfeasance or doing no harm, treatment that is consistent with the patient’s goals, confidentiality, autonomy and informed consent, physician-patient relationship, truth-telling, justice and non-abandonment (Feinsod, 2008). In conclusion therefore CHD and other such chronic illnesses, whose prevalence appears to be on the rise is a complex and complicated matter and has many facets to it that all need to be addressed. References Anyadubal, C. C. 2010. The Experiences of Coronary Heart Disease Patients: Biopsychosocial Perspective. International Journal of Human and Social Sciences, 5 (10), 614-621. Canvin, R. 2012. In Coronary heart disease. Available at; CDC. (2011, October 4). In Prevalence of Coronary Heart Disease --- United States, 2006--2010. 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