13 Feb, 14 | by Toby Hillman
“Doctoring her seemed to her as absurd as putting together the pieces of a broken vase. Her heart was broken. Why would they try to cure her with pills and powders?”
So, it is Valentine’s day – and what better than a bit of medical education about broken hearts. As it happens, Leo Tolstoy may have been onto something when he wrote Anna Karenina. Why would one try to cure a patient with a broken heart?
Well, helpfully, this paper examines the question of what non-pharmacological treatments are available for end stage heart failure.
The paper explores the major recent advances in devices for heart failure, and is a great primer for the general physician, or generally interested on the recent advances in medical technology available for those with end stage heart failure.
The devices which grab my attention are those which have the potential to inform patients, and their treating physicians even before symptoms of an exacerbation of their condition occur.
This paper describes three existing systems which can allow patients to monitor their own condition. The devices use surrogates for fluid overload, or impaired LV function (intrathoracic impedance, left atrial pressure, or right ventricular pressure) and can be used to provide feedback to decision makers to allow adjustment of therapy, pre-emptively arrange admission, or intervene in other ways to avoid an exacerbation.
These advances may represent something of a watershed in the management of this particular long term condition, and in the involvement of patients in management of their own diseases.
For years patients have sought help, relief, and advice from their physicians. The traditional model is that patients attend clinic with their physician, have an assessment which lasts a few minutes, and then a plan is made to last for the next few weeks / months or years. This doesn’t, however, reflect the lived experience of long-term conditions when seen from the patient perspective.
Patients with LTCs actually live with the condition impacting on their every day life. Indeed, the condition ultimately can become part of their personal identity.
Recognising that patients live with a particular condition, and yet, are often subject to the decisions made by physicians, and live with the consequences of these decisions until their next visit is vital if we are to understand how to assist patients in taking back control of their disease, developing greater health literacy.
Technology can provide the answers in some cases, but only if we trust patients by giving them back some control. In the case of heart failure, it seems that providing patients with the ability to monitor various indices can lead to improvement in symptoms, and even lead to an overall reduction in drug treatments. People with diabetes have been entrusted to control their own blood sugars through self-administration of insulins for many years now, and the provision of action plans for patients with respiratory conditions like asthma, bronchiectasis and COPD have resulted in improvements in overall symptom and disease management. The blending of technology and self-management is gathering pace, and the opening up of clinical information to patients through systems like Renal PatientView are transforming the way some clinicians and patients approach long-term condition management.
So, on this feast of St Valentine, why not take a look at the options for patients of yours who may have broken hearts, but also think about how utilising advances in technology can help to transform not only disease management, but also change the relationships we have with our patients, and they have with their diseases.