Living with a long-term condition has become a common occurrence in modern society and the focus has sensibly shifted from survival to achieving an optimal quality of life. Although research and guidance has often emphasised how to help patients to ‘live’, efforts are increasingly being made to discover how healthcare and lifestyle interventions can help people with long-term conditions to ‘live well’.
The first column in this series explored ways to support people with heart failure at the end of their lives (Mendes, 2019). However, many patients with a heart or circulatory condition are not at the end of their lives, and probably not even close. So how can this growing population be supported to live their best life despite their diagnosis?
Emotional support
One of the first aspects that should be mentioned is the psychological effect that a life-changing diagnosis can have. Diagnosis comes with its own grief stages and research shows that almost all patients experience symptoms of emotional distress when they suffer an acute cardiac event, or shortly thereafter (Murphy et al, 2016). There will also be changes to a person's day-to-day life, such as possible effects on relationships, sexual activities, working life, finances and travel.
This information is important for nurses in acute care who find themselves caring for someone who has just been admitted to hospital after a myocardial infarction for example, because it may help not only to explain the behaviour of the patient, but also offer some insight into the compassion, empathy, support and resources that may be required as part of a person's individualised care.
Patient empowerment
In addition to offering support for the range of emotions patients may experience such as anxiety, fear, anger, frustration, distress, sadness and depression (Murphy et al, 2016), patients should be armed with clear and accessible information at their own pace, supported with answers to their potential questions in hospital and, importantly, post discharge (when these questions are more likely to arise). They should be empowered to care for themselves, manage their symptoms on a day-to-day basis, and feel encouraged that they can indeed live a full life with and beyond their disease.
Cardiac rehabilitation
One of the most worrying trends is the lack of cardiac rehabilitation uptake. Half of eligible patients in England are taking up cardiac rehabilitation services; this falls short of national recommendations (British Heart Foundation, 2018). This means that the 78 000 people in the UK who are not taking advantage of this service, which offers physical, emotional and lifestyle support such as exercise and dietary advice, are at an increased risk of a further cardiac event (British Heart Foundation, 2018). These individuals are missing out not only on potentially life-saving services, but on life-enhancing services as well.
Cardiac rehabilitation services are offered to help people live and live well with heart and circulatory diseases. The newest National Audit of Cardiac Rehabilitation (NACR) data provide an opportunity for nurses on acute wards to encourage patients to take up these services, as well as possibly joining a relevant support group, and signpost them to appropriate local contacts and resources.
Risk factors
Many patients seen in hospital by secondary care nurses may not yet have heart disease but could be at risk. Nurses will know that the lifestyle advice offered to patients for most long-term conditions overlaps and is important for every single person who is admitted to hospital, if not for rehabilitation purposes, for prevention.
Some of the factors that have an impact on heart disease are blood pressure, smoking, overweight and obesity, physical inactivity/sedentary behaviour, diabetes, diet and alcohol, stress, sleep apnoea and hormone therapy (Sandmaier, 2005). These factors can both contribute to heart and circulatory diseases and worsen existing disease.
Lifestyle support
It is important that patients are advised not only how to improve various lifestyle habits such as quitting smoking, taking regular exercise and eating nutritious meals, but also that they understand that doing one thing on the list isn't enough; swimming doesn't cancel out those chicken and chips. Furthermore, it is important for patients to prioritise their personal enjoyment by continuing to engage in hobbies and passions, spending time with friends and family, and discovering new healthy interests such as fun physical activities or trying new healthy recipes.
Patients should be equipped with information and resources, both regarding what is available in the community and hopefully technology and useful smartphone applications (apps) as well. Furthermore, they should be encouraged to be open with their nurses and doctors, feel comfortable with asking questions and be committed to understanding their condition and how to confidently manage it so they can live full and well lives.