Heart & Lung 42 (2013) 397e398
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
AAHFN Leadership Message
It’s that time of year again, increased risk for heart failure patients
Lisa Rathman, MSN, CRNP, CHFN, CCRN
It is that time of year again. The holiday season is upon us. For some people, the holiday season is merry and bright, a time to spend with family and friends. It can be a whirlwind of buying gifts, cooking, parties and activities galore. However, the holidays can be stressful and for some it can be a very difficult time of year. It is a time of sadness and loneliness, a time of self-evaluation and reflecting about the past and anxiety about what the future may bring. Those who have lost loved ones or who are separated from loved ones at the holidays can find it to be a very sad time. The holiday season can also be a risk factor for increased hospitalization and death. Phillips and colleagues examined cardiac mortality around Christmas and New Year’s Day compared with daily cardiac mortality throughout the year.1 They found a 4.65% increase in cardiac mortality during the Christmas/ New Year holiday period. The investigators hypothesized that this increase was due in part to changes in behavior during the holidays with changes in diet and alcohol consumption, activity and delays in seeking medical care. Redman and colleagues examined whether there was a specific increase in heart failure hospitalizations during the Christmas/New Year holiday period.2 They conducted a retrospective review of heart failure visits to 18 different emergency rooms in New Jersey and New York from 1996 through 2004. The investigators found a 23% increase in daily visits for December 25 through January 7 and 30% increase in the 4 days following Christmas and New Year’s Day. Redman and colleagues proposed that the increases in HF visits to the emergency room during the holiday season were due to dietary indiscretion, delays in seeking medical care, increased stress and anxiety. As heart failure providers it is important to recognize that our patients may be at increased risk during the holiday season. We know our patients may choose not to live within their everyday diet, opting to partake in holiday overindulgences instead. Heavy meals, too much salt, skipping medications and excess alcohol can
0147-9563/$ e see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2013.08.010
all exacerbate heart failure. During the holiday season, it is important for providers to reinforce heart failure self-care behaviors. Providers should proactively discuss with patients how to manage their diet, medications, and stress level during the holiday season. For patients, recognition and prompt reporting of worsening symptoms of heart failure is paramount. Providers should plan for increased surveillance with telephone follow-up or outpatient visits for patients at high risk for readmission or with poor self-care. Anxiety and depression loom around the holiday season. For many patients, this time of year only worsens their feelings of isolation, depression and loneliness, and for others the struggle to cope with the pressures associated with the holidays, managing finances, family and all of the associated stressors creates a tremendous feeling of anxiety.3 Both depression and anxiety are barriers to patients being able to engage in self-care behaviors.4 In addition to reinforcing self-care behaviors, providers should incorporate screening and clinical management of depression. Despite the stressors and flurry of activity, the holiday season can be a wonderful time of year filled with celebration. For patients with heart failure, some common sense strategies can help make a big difference in keeping a person at home for the holidays, instead of in an emergency room or a hospital bed or worse. Take medications as prescribed e both at home and when traveling. It is common for individuals to miss medications over the holidays especially when they are traveling. Keep health care provider appointments e the holidays can be a very busy time of year. Many individuals will reschedule appointments or delay seeking care during the holiday season. Make good choices e try and avoid excess salt and alcohol. It may be difficult to make healthy food choices during the holiday season, but try to include as many nutritional dishes as possible. Maintain usual exercise routine e because of time pressures over the holidays, many individuals stop exercising. Exercise is a stress management activity. Sleep e not enough sleep can be harmful to the body anytime of the year. Avoid stressors e such as shoveling snow, overspending for gifts. Vaccinations e consider getting a flu vaccination. Infection and fever put extra stress on the heart. Take time to relax e do less, enjoy more. The holiday season is a busy time of year. Don’t forget to take time to take care of yourself and enjoy the season. Ask for professional help e depression and anxiety have adverse effects on your heart. Talk to your health care provider.
398
AAHFN Leadership Message / Heart & Lung 42 (2013) 397e398
The common sense strategies listed above not only benefit our patients but ourselves. I wish you and your family a safe and happy holiday season! References 1. Phillips DP, Jarvinen JR, Abramson IS, et al. Cardiac mortality is higher around Christmas and New year’s than any other time. Circulation. 2004;110: 3781e3788. 2. Reedman LA, Allegra JR, Cochrane DG. Increases in heart failure visits after Christmas and New year’s day. Congest Heart Fail. 2008;14:307e309. 3. Sansone RA, Sansone LA. The Christmas effect on psychopathology. Innov Clin Neurosci. 2011;8(12):10e13. 4. Riegel B, Moser DK, Anker SD, et al. State of the science: promoting self-care in persons with heart failure. Circulation. 2009;120:1141e1163.
Author Descriptions Lisa Rathman is the lead nurse practitioner of The Heart Group of Lancaster General Health Heart Failure Program in Lancaster, PA. Ms. Rathman developed an outpatient heart failure program at The Heart Group in 1998. In 2001, she was a member of the core team that developed the inpatient heart failure program at Lancaster General Hospital. She is a clinical associate faculty at the University of Pennsylvania. She is one of the founding members of the American Association of Heart Failure Nurses and currently serves as treasurer for the organization.
Lisa Rathman, MSN, CRNP, CHFN, CCRN Treasurer, AAHFN Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health Heart Failure Program, Lancaster, PA, USA E-mail address: [email protected]
Contents lists available at ScienceDirect
Heart & Lung journal homepage: www.heartandlung.org
AAHFN Leadership Message
It’s that time of year again, increased risk for heart failure patients
Lisa Rathman, MSN, CRNP, CHFN, CCRN
It is that time of year again. The holiday season is upon us. For some people, the holiday season is merry and bright, a time to spend with family and friends. It can be a whirlwind of buying gifts, cooking, parties and activities galore. However, the holidays can be stressful and for some it can be a very difficult time of year. It is a time of sadness and loneliness, a time of self-evaluation and reflecting about the past and anxiety about what the future may bring. Those who have lost loved ones or who are separated from loved ones at the holidays can find it to be a very sad time. The holiday season can also be a risk factor for increased hospitalization and death. Phillips and colleagues examined cardiac mortality around Christmas and New Year’s Day compared with daily cardiac mortality throughout the year.1 They found a 4.65% increase in cardiac mortality during the Christmas/ New Year holiday period. The investigators hypothesized that this increase was due in part to changes in behavior during the holidays with changes in diet and alcohol consumption, activity and delays in seeking medical care. Redman and colleagues examined whether there was a specific increase in heart failure hospitalizations during the Christmas/New Year holiday period.2 They conducted a retrospective review of heart failure visits to 18 different emergency rooms in New Jersey and New York from 1996 through 2004. The investigators found a 23% increase in daily visits for December 25 through January 7 and 30% increase in the 4 days following Christmas and New Year’s Day. Redman and colleagues proposed that the increases in HF visits to the emergency room during the holiday season were due to dietary indiscretion, delays in seeking medical care, increased stress and anxiety. As heart failure providers it is important to recognize that our patients may be at increased risk during the holiday season. We know our patients may choose not to live within their everyday diet, opting to partake in holiday overindulgences instead. Heavy meals, too much salt, skipping medications and excess alcohol can
0147-9563/$ e see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hrtlng.2013.08.010
all exacerbate heart failure. During the holiday season, it is important for providers to reinforce heart failure self-care behaviors. Providers should proactively discuss with patients how to manage their diet, medications, and stress level during the holiday season. For patients, recognition and prompt reporting of worsening symptoms of heart failure is paramount. Providers should plan for increased surveillance with telephone follow-up or outpatient visits for patients at high risk for readmission or with poor self-care. Anxiety and depression loom around the holiday season. For many patients, this time of year only worsens their feelings of isolation, depression and loneliness, and for others the struggle to cope with the pressures associated with the holidays, managing finances, family and all of the associated stressors creates a tremendous feeling of anxiety.3 Both depression and anxiety are barriers to patients being able to engage in self-care behaviors.4 In addition to reinforcing self-care behaviors, providers should incorporate screening and clinical management of depression. Despite the stressors and flurry of activity, the holiday season can be a wonderful time of year filled with celebration. For patients with heart failure, some common sense strategies can help make a big difference in keeping a person at home for the holidays, instead of in an emergency room or a hospital bed or worse. Take medications as prescribed e both at home and when traveling. It is common for individuals to miss medications over the holidays especially when they are traveling. Keep health care provider appointments e the holidays can be a very busy time of year. Many individuals will reschedule appointments or delay seeking care during the holiday season. Make good choices e try and avoid excess salt and alcohol. It may be difficult to make healthy food choices during the holiday season, but try to include as many nutritional dishes as possible. Maintain usual exercise routine e because of time pressures over the holidays, many individuals stop exercising. Exercise is a stress management activity. Sleep e not enough sleep can be harmful to the body anytime of the year. Avoid stressors e such as shoveling snow, overspending for gifts. Vaccinations e consider getting a flu vaccination. Infection and fever put extra stress on the heart. Take time to relax e do less, enjoy more. The holiday season is a busy time of year. Don’t forget to take time to take care of yourself and enjoy the season. Ask for professional help e depression and anxiety have adverse effects on your heart. Talk to your health care provider.
398
AAHFN Leadership Message / Heart & Lung 42 (2013) 397e398
The common sense strategies listed above not only benefit our patients but ourselves. I wish you and your family a safe and happy holiday season! References 1. Phillips DP, Jarvinen JR, Abramson IS, et al. Cardiac mortality is higher around Christmas and New year’s than any other time. Circulation. 2004;110: 3781e3788. 2. Reedman LA, Allegra JR, Cochrane DG. Increases in heart failure visits after Christmas and New year’s day. Congest Heart Fail. 2008;14:307e309. 3. Sansone RA, Sansone LA. The Christmas effect on psychopathology. Innov Clin Neurosci. 2011;8(12):10e13. 4. Riegel B, Moser DK, Anker SD, et al. State of the science: promoting self-care in persons with heart failure. Circulation. 2009;120:1141e1163.
Author Descriptions Lisa Rathman is the lead nurse practitioner of The Heart Group of Lancaster General Health Heart Failure Program in Lancaster, PA. Ms. Rathman developed an outpatient heart failure program at The Heart Group in 1998. In 2001, she was a member of the core team that developed the inpatient heart failure program at Lancaster General Hospital. She is a clinical associate faculty at the University of Pennsylvania. She is one of the founding members of the American Association of Heart Failure Nurses and currently serves as treasurer for the organization.
Lisa Rathman, MSN, CRNP, CHFN, CCRN Treasurer, AAHFN Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health Heart Failure Program, Lancaster, PA, USA E-mail address: [email protected]
