Management of chronic disease - heart failure
Channel: York Cardiology
Date: 13/02/2022

I wanted to tell you a story about a patient who recently contacted me for advice. 

This particular lady was in her 50s in a very prestigious and high powered post and completely fit and well. She was married, had a daughter in Australia and had a wonderful social life with hiking with her girlfriends. Around Xmas time in 2020, she developed a flu-like illness and after that she started noticing that she was getting breathless on very modest levels of exertion.  So she contacted her GP but unfortunately couldn’t even get an appointment for 3 weeks. Eventually she saw her doctor who examined her and suggested that she may have asthma and gave her some inhalers. She was asked to go back in 4 weeks to see how she was feeling. Unfortunately she felt no better and actually felt much worse. So she went back in 4 weeks and this time saw another doctor who asked her to stop the inhalers and suggested that it could be her heart and organised a chest X-ray and blood tests. After a few days she was called back to the surgery and saw another doctor who told her that the chest X-ray and blood tests suggested that she may have heart failure and that she needed to see a cardiologist. 

This poor woman was completely stunned when she heard this and even before she could collect her thoughts and ask the doctor any questions, she was shown the door with the advice that she would hear from the cardiologists soon. This poor woman went home completely shell-shocked with her life turned upside down in an instant. As she hadn’t even had a chance to ask any questions, she went to the internet and looked up heart failure and her heart sank when she read about all the horrible things that could happen with heart failure. 

Finally she saw a cardiologist who confirmed that she did indeed have heart failure and needed to start some medications as soon as possible and he would arrange for a heart failure nurse to see her. This took another 4 weeks and the nurse (another new face) who came to see her, asked her how she was (and she was a little better), increased her medications and said she was going to review her again in 8 weeks.

In the meanwhile this poor woman continued to remain completely confused about why her medications were being increased. She started noticing that she was more tired and not sleeping well. She wasn’t sure whether this was her underlying condition or her medications or that she was developing anxiety. She went to see her GP who said that he was limited with what he could give her because he was worried about how they could affect her heart. So her anxiety progressed and it started affecting her relationship with her husband. She stopped going out with her friends because she was told that alcohol was bad for her. She stopped hiking because she had been told to avoid any undue exertion. As she started spiralling downwards, it started affecting her employment. She was desperate to see her daughter but because of her diagnosis, her travel insurance became unaffordable and she started comfort eating, piling on weight which knocked her confidence even more and made everything so much worse.

Eventually, she decided to go and to see a famous professor of cardiology privately. This chap who spent no more than 10 minutes with her, looked at her medications and told her that she was optimally managed and nothing else was needed and discharged her. It was after this, she contacted me to ask me my advice and in this video i will talk about what i advised her.

This lady’s heartbreaking story shows the problem with modern day medicine. This poor woman had seen a multitude of different nameless faces over the course of 18 months and was in a far worse position both physically and mentally than she was when she had started. SHe was on 7 or 8 new tablets everyday when she had never taken a tablet in her life before her life changed and unfortunately she did not even know what these medications were doing for her. Most disappointingly, despite all these encounters with healthcare professionals, the patient felt that she had been left to manage completely on her own,

This is far from optimal management. This is the kind of care that enslaves and enfeebles a patient and makes the patient worse rather than better. Today i wanted to chat to you about what i feel optimal care for heart failure should be and how care when properly administered can empower and liberate the patient rather than contribute to what happened with this poor woman. The principles that i am discussing here can be applied to all chronic disease.