Posted by: Fatima Sabir19 JUL 2011
Unfortunately, just over a week ago, I had to see a family member undergo a heart attack. Those that have had experienced a similar situation will understand the ordeal one goes through and if they are living today I think we should take a minute to admire the strength it takes to come out fighting strong and take this as a second chance to spend more time with a loved one. If a loved one has been lost I cannot imagine your pain and can only offer you my deepest sympathies and hope you have the strength to come through this.
After these events I decided to create a blog to discuss how we can help patients dealing with coronary heart disease.
So firstly, let me startt off with some statistics* to put the disease into perspective:
- In 2009, over 180,000 people died from cardiovascular disease(CVD) in the UK- that’s one in three of all deaths.
- Around 1 million men and nearly 500,000 women have hada heart attack, giving a total of over 1.5 million people in the UK.
- In England around 11 per cent of men and 15 per cent of womenwho were admitted to hospital with a heart attack in 2006 died within 30days.
- The number of people in the UK living with coronary heartdisease (CHD) increases with age and is higher in men than in women. Thereare nearly 2.7 million people in the UK with CHD.
So, it is obvious then, that coronary heart disease is a major issue in the world we live in, but how can we as health professional help? Well, lets start with the simplest of things: understanding. I think sometimes as humans we forget how much of a difference abit of understanding can make. Dealing with any long term medical condition including CHD is quite daunting, and most often it greatly affects family members emotionally. For this reason I think we need to be familiar with different coping strategies. Some people face the problem and take steps to move on (i.e talk about their problems, good compliance with their medication) whilst others ignore the problem resulting in ‘ostrich symdrome’- burying their heads under the sand. What we have to remember is that we are all different. So the way one person deals with having a heart attack does not necessarily mean another person will cope in the same way. When a patient comes for their medication it should be a requirement of a health professional to ask how they are coping with their medical condition/treatment. This gives a chance to signpost the patient to a support group they may benefit from, or even recognise signs of depression.
As mentioned above, family members are also affected by a close one suffering from CHD, for this reason members of the family should be made part of the treatment process. This could be highly effective in ensuring lifestyle advice is followed through; as humans learn through observation. Seeing everyone taking steps to achieve a healthier lifestyle will encourage the pateint to follow the same healthy steps. More importantly, role models for younger audiences will be created, allowing the prevention of CHD to take place. Although developing CHD has genetic influences, risks can be kept low if healthy behaviours are followed. When giving lifestyle advice it is important to gain a feel of the patient’s current lifestyle, it is much easierto incorporate small changes into a current lifestyle than to try to change their lifestyle completely (e.g. swap full fat milk for low fat, white bread for wholemeal). By using a more holistic approach, lifestyle advice may be taken on board more effectively than a one size fits all approach.
If complaince is an issue, investigate if it is due to undesirable side-effects. If not, then the patient needs to be informed on how important it is to take their long term medication- even if they feel fine! Some people stop taking their medication indicated for hypertension as they feel they don’t make a difference- this outlook needs to be acknowledged and patients need to be educated on their medication. We also need to understand some pateints have cultural beliefs and feel taking their medication will effect the bodies balance/energy, again advice should be given on the importance of compliance but it is essential to take a sensitive approach so patients are not offended. Giving patients goals may encourage compliance especially if a reward incentive scheme is used (e.g. lose 4lbs in a month and a patient receives a voucher for a full day pass at their local gym).
The 2008 Pharmacy in England: building on strengths-delivering the future, stated that future aims expected from pharmacies are to provide better support to indivduals on long term conditions. I think one way of achieving this goal is to encourage pharmacist to go beyond MURs. I can understand time constraints prevent lenghty consultations but may be giving a patient one pieace of advice and a quick check of their current progress may be the right thing to achieve a pharmacist’s potentional in a community setting.
Of course, most of these points are not restricted to just CHD but can be applied to a multitude of medical conditions, however I believe these issues are most salient when discussing CHD. Now this blog has turned into a lengthy report and if you’ve made it this far you are a trooper! I just thought the MPharm programme has a great structure, we learn about drug interactions and how to spot prescription errors…yet, sometimes we fail to understand human psychology; and it may be this, the missing piece in making us truly successful pharmacists.
*All statistics were obtained from the British Heart Foundation website, the website has a very clear and simple layout. If you want to know more about heart disease, having a quick browse would be good starting point.