Because HF is a chronic condition that is incurable, it can cause significant impairment in patient quality of life. Social isolation, lack of social support, and a diminishing ability to carry out the activities of daily living independently all negatively affect the patient’s psychological well-being. The incidence of depression in this population is four- to fivefold higher than that in the general population.19 Depression contributes to medication nonadherence, reduces patient compliance with any lifestyle modification strategy, increases the utilization of healthcare services, increases healthcare costs, and further reduces patient quality of life.20-22 The need to screen and treat depression in the community setting is of paramount importance if HF is to be managed adequately. Patients who have a diagnosis of HF or who are identified as at high risk for the development of HF should be screened and treated early for depression.
Patient education and follow-up
To increase compliance with therapy, it is important to educate patients and reinforce teaching points at each encounter. Discussing the benefits of prescribed treatments will increase patient compliance with the regimen. Emphasis should be placed on symptom control and quality-of-life issues. Patients should understand that treatment with medication alone is not optimal. It is important to stress proper diet and daily exercise and to manage depression. The clinician should always reinforce the fact that medications will decrease the symptoms of heart failure, prevent hospitalization, improve the quality of life, and prolong survival.
Although death rates from heart disease have declined, the effects of cardiovascular disease remain high, and the burden of treating it continues to grow. The primary care provider can significantly improve the control of symptom exacerbation. Guided by the evidence, the busy practitioner can effectively and confidently manage patients with HF and prevent rehospitalization.1
Shenaz Georgilis, MSN, FNP-BC, is Assistant Professor at Queensborough Community College of the City University of New York in Bayside, Queens, New York.
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