Heart Failure Management with Entresto

Beth Davidson, DNP, ACNP, CHFN, CCRN, a nurse practitioner who specializes in heart failure management in Nashville, TN, and heart failure patient Michele N, discuss the problem of heart failure, providing insight into the impact on African Americans specifically,  the symptoms, and managing the condition.

Beth Towery Davidson

Beth is the Director of the Heart Failure Disease Management Program at TriStar Centennial Medical Center in Nashville, TN, a charter member of the American Association of Heart Failure Nurses (AAHFN), and is currently serving her second term on the Board of Directors as President Elect.

Beth has authored and co-authored several publications, and most recently, was a contributing author for the AAHFN Advanced Heart Failure textbook. She is a frequent speaker at many local and national venues.

In addition, Beth is a member of the Middle Tennessee Advanced Practice Nurses, American Association of Critical Care Nurses, Sigma Theta Tau International, Heart Failure Society of America and a founding member of the Middle Tennessee Heart Failure Journal Club.  Beth received the 2014 March of Dimes Nurse of the Year award for Advanced Practice and the Vanderbilt University School of Nursing Alumni Award for Clinical Achievement in 2007.

She earned her BSN from Western Kentucky University, her MSN from Vanderbilt University, and in 2007 completed her DNP from the University of Tennessee Health Sciences Center.

Michelle N. (Heart failure patient)

Michele, 63, leads a busy life as a business manager, a recovery support group leader and an active member of her church. In 2016, she started experiencing swelling in her legs and shortness of breath. She went to a physician for what she thought were allergies and asthma. But the symptoms worsened, and soon Michele wasn’t able to walk to her car after work without help from a coworker or taking breaks. Her physician referred her to a cardiologist, and, after an echocardiogram, Michele was diagnosed with a chronic type of heart failure. Having lost her mother 12 years earlier to heart failure, she was terrified to hear her diagnosis. But Michele’s cardiologist prescribed a medication for heart failure, and, while treatment impacts everyone differently, she is back to her activities and has not been hospitalized for the condition, which drives approximately 900,000 to the hospital each year. In addition to medications, Michele altered her lifestyle to manage her condition by walking more often and reducing her salt intake.

Transcript

Neal Howard: Hello and welcome to the program. I’m your host Neal Howard here on Health Professional Radio, glad that you could join us once again. Every minute in this country, two people are hospitalized for heart failure and millions of Americans live with the condition every day. Now here during American Heart Month to explain what heart failure is and what to do about it, is Beth Davidson. Beth is a nurse practitioner specializing in heart failure management and heart failure patient Michelle. Welcome to the program both Beth and Michelle, how are you both?

Beth Davidson: We’re great, thank you for having us during Heart Month. It’s a very timely conversation.

Neal: Beth, a bit of video background if you would for our listeners.

Beth: Absolutely. So I’m a heart failure nurse practitioner in Nashville, Tennessee and I’ve been taking care of heart failure patients for at least 20 years so this is sort of my passion. I love taking care of these patients.

Neal: Great. Well what exactly is heart failure? We hear a lot about it and what are the symptoms, what are the most common symptoms? Who’s at risk?

Beth: To start, heart failure is a chronic progressive condition where the heart muscle becomes weak and it’s unable to pump enough blood to your tissues and organs. So it’s a muscle weakness because of the poor pumping action of the heart, the most common symptoms are shortness of breath, fatigue and swelling so you can get this accumulation of fluid especially in your feet, your legs and your abdomen. Now heart failure can really occur to anyone but there are some risk factors for heart failure. Number one, it is actually African American History Month so just to just to say that African Americans are at increased risk for heart failure. Patients who have long-standing high blood pressure at increased risk. If you have blockages in your coronary arteries, you can also be at increased risk. And then things like obesity, being overweight, living a sedentary, an active lifestyle – all those can predispose you to developing heart failure.

Neal: Well some of us when we hear heart failure, it’s automatic hospital visit. Is this something that you can actually live with day to day and manage it and still live a productive life apparently so?

Beth: Absolutely. I agree that the term ‘heart failure’ is really hard and patients don’t want to hear that they have heart failure – that scares you right out of the beginning. But the thing is if you’re an active participant and you make some dietary changes and some lifestyle modifications and take medications as prescribed, you can live a long productive active life much like Michelle is doing now.

Michelle: Absolutely.

Neal: But when hospitalization is needed, that’s a really bad sign. Your condition has worsened or you’re out of your management phase. Is that what sends people to hospital?

Beth: That is exactly right so when you have the weakened muscles and I talked about that fluid accumulation, if you think about that and you get fluid accumulating in your lungs, you’re going to be very short of breath, very winded, can’t lie flat. That’s very scary for patients so we end up bringing them in the hospital to give them some medications to get rid of the fluid and then they’re discharged home and their symptoms feel much better but Neal just like you said, the thing to note is “Gosh, my condition has changed. My condition has worsened. Now I’ve had to have a heart failure hospitalization.” And that’s a key moment to think about “Gosh, am I doing everything that I can do? Am I on the right therapy?” So it’s definitely worth a conversation with your provider if you’ve had a heart failure hospitalization.

Neal: Michelle, did you go to the hospital immediately or were there long-standing symptoms that you were confused about before you finally had to go?

Michelle: There was a confusion or maybe even a denial on my part. I was dealing with shortness of breath and swelling in my feet and legs and I thought it was allergies or asthma or anything like that and so I had gone to my family doctor to discuss these things with her and she referred me over to a cardiologist who ran some tests and discovered that I did indeed have heart failure.

Neal: What was your initial reaction? Hearing something like heart failure, cancer or anything like that – what was your initial reaction and had you had any experience with heart failure before?

Michelle: Okay, you’re touching on a very sensitive topic because my mother had passed away back in 2004 from the very same thing that I’m dealing with today. So when he told me I had heart failure, I thought it was the end for me as well. I’m sorry, but after he allowed me to get it all out, he said “Okay, let’s get down to business and get you feeling better.” And that was two and a half years of years ago and I’m doing so much better now.

Neal: What are you doing to manage – lifestyle change medications – how are you managing?

Michelle: My sodium is at an all-time low. I don’t cook with sodium. When I go out to restaurants, I talk to the server about the sodium in the food. I’m very proactive when it comes to eating a diet with low sodium. I have increased my physical activity. I spend in front of a computer all day so I get up I walk around the building or just get up and just move around a little bit more, walk my dog a little bit more and I take my medication. The doctor recommended Entresto for me which was right for me. It might not be right for everybody but it was right for me and I’m doing great.

Neal: Now Entresto, is that Novartis Pharmaceuticals?

Beth: Yes. So Michelle and I are here today actually on behalf of Novartis to talk about in Entresto which is a therapy option for heart failure. In fact, it was proven in a large clinical trial to keep patients alive and out of hospital longer than another leading heart failure medication. There was new research recently that showed Entresto can be started in the hospital and although there are limitations to this data we know that in stabilized patients, it is appropriate for hospital use as well. Entreso isn’t right for everyone. I’m grateful that Michelle has had a great response but for example, if you have angioedema which is an allergic reaction or pregnancy or ASIs or ARB therapy, then those make you not a candidate for Entresto. So I know that’s a lot of information, some of that’s complicated, that’s circling back sort of to that’s a complicated discussion to have with your healthcare team to try to determine “Is this therapy right for me?”

Neal: Well where can our listeners go and get some more information about Entresto and about heart failure management in general?

Beth: Absolutely a great website for your listeners would be entresto.com  

Neal: Well I thank you both for joining us this morning during National Heart Month and African American History Month. It’s been a pleasure talking to you both Beth and Michelle, thank you for joining us this morning.

Michelle: Thank you for having us.

Beth: Thank you very much Neal, have a good day.

Neal:  You as well. You’ve been listening to Health Professional Radio, I’m your host Neil Howard. Transcripts and audio of this program are available at hpr.fm and healthprofessionalradio.com.au. You can also subscribe to the podcast on iTunes, listen in and download at SoundCloud and be sure and visit our Affiliate Page at hpr.fm and healthprofessionalradio.com.au

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