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Heart Healthy: New approach at CMC compiles resources for patients with heart failure

Catholic Medical Center

January 28. 2017 5:53PM

Congestive heart failure (CHF) has recently surpassed heart attacks as the leading cause of cardiac deaths in the United States. Because of success in treating people with heart attacks, there are now more survivors.

"Many of us are familiar with friends and family members who have survived a heart attack but unfortunately are left with shortness of breath with exertion, swollen ankles and shins, and are unable to lay flat on their backs," said Dr. Louis Fink, executive medical director of the New England Heart & Vascular Institute at Catholic Medical Center. "This is a classic description of someone suffering from CHF, with a weakened heart muscle that doesn't effectively pump blood."

CHF patients typically require hospitalization to manage their condition. A new program at Catholic Medical Center focuses the resources necessary to optimally manage patients with CHF at home and keep them out of the hospital. The New England Heart & Vascular Institute (NEHVI) is nationally recognized for its cardiac care. A team of its experts, along with other talented caregivers from CMC, is piloting a system in which all the services that impact a patient with CHF efficiently and seamlessly work together. The goal of this initiative is to improve the health and wellbeing of CHF patients so that they can maintain their lifestyle while staying out of the hospital.

Multidisciplinary team

Congestive heart failure is a complex disease process that requires a comprehensive treatment plan - yet it can be challenging to ensure patients get that full range of care. CMC's multidisciplinary team is made up of nutritionists, exercise physiologists, pharmacists, nurses, nurse practitioners, physicians and providers of home care services working together to monitor a patient's status and progress in a coordinated way.

"Sometimes, the simplest answer is the right one," said Dr. Robert Capodilupo, cardiologist at NEHVI. "In this case, NEHVI and CMC already had all the resources and expertise to address our CHF patients' needs. It was just a matter of bringing them all together so that our patients can access the services without having to do extra legwork."

A person may be able to recite the low-fat, low-sodium characteristics of a heart healthy diet, but knowing what foods to eat and how to be successful is no easy task. CMC nutritionists are available to help patients take a new approach to their heart-healthy way of eating. CMC pharmacists speak directly with patients, making sure they understand their medications' purpose, potential side effects and interaction with other prescriptions. The pharmacy team also maintains office hours to answer phone calls from CHF patients.

Participation in a certified cardiac rehabilitation program helps patients feel and function better; representatives are here to handle to insurance paperwork for these programs. Close follow up in a doctor's office after hospital discharge has been identified as an effective way to keep a patient healthy and reduce short-term hospital readmission. NEHVI has daily clinic appointments reserved for patients who have been hospitalized at CMC with CHF and need a follow up visit to help them understand how they can reduce the likelihood that they will need to return to the hospital anytime soon.


For patients with difficult-to-manage advanced CHF, treatment options are available that further reduce the likelihood of a return to the hospital. The CardioMEMS device, for example, can help the care team continuously and remotely monitor the pressure inside a patient's lung, which alerts the cardiologist when extra fluid builds up around the heart.

"This allows us to adjust medications as necessary without an office visit," Capodilupo said. "Patients feel better and stay out of the hospital." NEHVI has the most advanced CardioMEMS program in New England and one of the most experienced in the country.

The United States is suffering from escalating health care expenditures and it is well recognized that the hospital is the most expensive site in the continuum of care. Fewer hospital admissions indicate successful and effective CHF care. In fact, this statistic is now being tracked by the Centers for Medicare and Medicaid Services to identify programs with the greatest success and value to patients.

CMC's congestive heart failure management program integrates existing services in a more efficient way to provide patients with the highest value care. Working together in a more coordinated fashion has taken some time and effort, but no investment in extra services, equipment or staff. This type of program is just what our patients and costly healthcare system need to help us achieve our shared goals of good health supported by the highest value services.

William Goodman, MD, MPH, FCCP, is the hospitalist medical director at Catholic Medical Center in Manchester.

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