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Pharmacy Health and Behavior Section 301, Group #6 November 8, 2011 Artecia Barefield Sabrina Ferguson Deatra Johnson Stephen Okon Robert Smith Lauren Wood Malphurs Heart Failure Lenz Ch. 11 1 Slide 2 Definition of Heart Failure Heart failure is the inability of the heart to adequately deliver oxygen to the body 2 Slide 3 Prevalence of Heart Failure (HF) HF has become a significant public health concern in the United States in recent decades Approximately 550,000 new cases of HF are diagnosed for the first time each year An estimated 5 million Americans currently have HF HF accounts for 12 to 15 million physician office visits each year, with an incidence level that is approaching 10 per 1,000 people older than 65 years of age HF has become the most common Medicare diagnosis 3 Slide 4 Prevalence of HF (continued) HF is primarily a condition of the elderly, and therefore, as patients get older, they are more likely to have HF. Many patients are diagnosed with HF after they have had a heart attack. Because treatments for heart attacks have improved, more patients are surviving the event, which is most likely the reason for the increased incidence of HF. 4 Slide 5 Pathophysiology of HF HF is the inability of the heart to adequately deliver oxygen to the appropriate tissues of the body, which is caused by an inability of the ventricles of the heart to fill with or eject blood. The left ventricle is the chamber of the heart primarily responsible pumping blood through the aorta in order to supply the blood and oxygen to all the tissues of body. Failure of the left ventricle usually results in a decrease of cardiac output which is the amount of blood being pumped by the heart per minute. (CO = stroke volume x heart rate stroke volume) Classic signs and symptoms resulting from HF include shortness of breath, fatigue, pulmonary edema, and peripheral edema. 5 Slide 6 Four Stages of HF 6 Stage Apatients are at risk for HF because they possess risk factors for HF such as hypertension, atherosclerotic disease, diabetes, obesity, and metabolic syndrome. Patients do not have structural heart disease Stage Bpatients have structural heart disease (e.g. post MI) but do not have symptoms of HF Stage Cpatients with structural heart disease who have prior or current symptoms of HF Stage Dpatients are refractory to HF treatments and require specialized interventions Slide 7 Environmental Risk Factors for HF Coronary heart disease Myocardial infarction Hypertension Pulmonary hypertension Dilated cardiomyopathy Genetic causes Valvular heart disease 7 Slide 8 Preventing HF The primary goal in the prevention of HF is to adequately control the causes of myocardial injury. This can then decrease the risks for obtaining HF symptoms. Several diseases and lifestyle habits can lead to myocardial injury. It is important to follow the recommended guidelines of the following diseases as an important first step in HF disease prevention: Atherosclerotic disease Hyperlipidemia Hypertension Diabetes mellitus Obesity Metabolic Syndome Adequately controlling blood glucose levels, body weight, as well as blood pressure, and cholesterol levels, are important disease-prevention strategies for HF. 8 Slide 9 Behavior Changes Discontinue Use of: Cigarettes Alcohol Illicit Drugs Low sodium diet (DASH Eating Plan) Increased consumption of fiber, potassium, magnesium, and calcium Decreased consumption of saturated fat, cholesterol, and sodium Engage in physical exercise 20-40 minutes per day of light to moderate exercise, such as walking or bicycling 9 Note: There is no direct evidence that controlling dietary sodium or participation in regular exercise can prevent the development of HF, however, it is well known that specific dietary changes and regular exercise control and decrease the risk for developing many diseases leading to heart disease. Slide 10 Dietary Recommendations for Patients with HF NutrientsNutrient Target Fat (% of total kcal)27% Saturated6% Monounsaturated13% Polyunsaturated8% Carbohydrates (% of total kcal)55% Protein (% of total kcal)18% Cholesterol150 mg/day Fiber31 g/day Potassium4,700 mg/day Magnesium500 mg/day Calcium1,240 mg/day Sodium1,500 mg/day 10 Slide 11 Medications Used to Treat HF Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARB) Aldosterone blockers Beta blockers Digoxin Diuretics 11 Slide 12 Consequences of Uncontrolled HF 12 Signs and symptoms resulting for HF include: Shortness of breath Fatigue Pulmonary edema Peripheral edema Uncontrolled HF will have a negative impact on quality of life and can eventually lead to death. Slide 13 Theory of Planned Behavior 13 Slide 14 Theory of Planned Behavior Explores the relationship between behavior and beliefs, attitudes, and intentions It is a value-expectancy theory The main constructs of the theory are behavioral intention, attitude, subjective norm, and perceived behavioral control. Behavioral intention is the most important determinant of behavior 14 Slide 15 Theory of Planned Behavior 15 ConceptDefinitionMeasurement Approach Behavioral IntentionPerceived likelihood of performing behavior Are you likely or unlikely to perform the behavior? AttitudePersonal evaluation of the behavior Do you see the behavior as good, neutral, or bad? Subjective NormBeliefs about whether key people approve of disapprove of the behavior; motivation to behave in a way that gains their approval Do you agree or disagree that most people approve or disapprove of the behavior? Perceived behavioral control Belief that one has, and can exercise, control over performing the behavior Do you believe performing the behavior is up to you, or not up to you? Slide 16 Case Study A.B. is a 45-year-old female who has been a patron of your pharmacy for 3 months. She has a past medical history of hypertension for 1 year and dyslipidemia for 4 years. She is sedentary with a BMI of 34 kg/m2 (54 tall, 199 lb), follows no specific eating plan, and does not drink alcohol or smoke tobacco. She does admit to eating on the go frequently owing to the busy schedules of her five children and full time job. Her current medications include hydrochlorothiazide 12.5 mg/day, and rosuvastatin 10 mg/day. Her most recent cholesterol panel was taken 6 months ago and revealed total cholesterol 167, LDL 115, HDL 56 and triglycerides 145. Her current blood pressure, which you measured in the pharmacy, averaged 128/82 mm Hg with a resting heart rate of 82 beats per minute. A.B. has been reading some literature displayed in the pharmacy about disease- prevention pharmacy services. She expresses interest in adopting lifestyle modifications such as exercise and weight loss. On average, A.B. consumes a total of 2,687 calories per day, and her diet is extremely high in sodium. 16 Slide 17 Questions: 17 True or False: The primary goal in the prevention of heart failure is to adequately control the causes of myocardial injury. What are the classic signs and symptoms resulting from heart failure? True or False: The most common causes of HF include coronary artery disease and hypertension.