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Health heart failure

Brian Henry, 55, of Sioux City talks about living with heart failure during an interview at UnityPoint Health -- St. Luke's in Sioux City. Listening at right is cardiac care coordinator Shelly Sturgill.

SIOUX CITY -- Brian Henry was uninsured and hadn't seen a doctor in 20 years when he arrived at UnityPoint Health -- St. Luke's with breathing problems.

During his hospital stay, the 55-year-old Sioux City man was diagnosed with influenza, pneumonia and a "laundry list" of other health problems, including heart failure (HF).

"I really didn't know that I had this syndrome until I was diagnosed with it. Then they started treating it and the actual disease caught up with me," Henry said of HF. "When it hits you. It hits you pretty good."

HF is a chronic condition in which the heart is unable to pump enough blood to meet the body's demands. Nearly 6 million U.S. adults have HF, according to the Centers for Disease Control and Prevention. It's one of the most common reasons patients over age 65 are hospitalized.

"One variation of heart failure is much more common as you get older. As the population ages and the Baby Boomers move up, the rate of heart failure is increasing," said Dr. Jeffrey Sykes, a cardiologist with Cardiovascular Associates. "As a consequence of this high prevalence of heart failure, it's placing a huge economic burden on the health care system."

HF costs are expected to double from $555 billion in 2016 to $1.1 trillion in 2035, according to a new American Heart Association report. Medicare is investing resources to help hospitals curb their 30-day readmission rates, thereby reducing health care costs. HF patients are a focus, because many of them are readmitted to the hospital soon after being discharged.

St. Luke's cardiac care coordinator Shelly Sturgill said HF patients who are hospitalized receive 60 minutes of education about their condition, meet with a dietitian and receive a packet of information before going home. She said the goal is to have patients seen by their cardiologist within a week of discharge.

"We regulate their medication then," she said. "How often do they come back? Some are here every week. Some are here maybe every three to four days. We're giving them IV Lasix, because the main thing is we want to keep them out of the hospital."

Patients in the early stages of HF may have no symptoms. As the disease progresses, they may present with fatigue, weight gain, shortness of breath and leg swelling. Besides age, risk factors for heart failure include high blood pressure, diabetes, coronary artery disease, smoking and obesity.

Studies suggest that up to 30 days before a patient displays symptoms, the pressure in their lungs and the pulmonary arteries starts to increase.

Historically, Sykes said doctors have had HF patients monitor their symptoms and weigh themselves on a regular basis to determine whether they're stable or getting into trouble with fluid retention. He said abnormal fluid retention can cause congestion of a number of organs, including the lungs.

"The problem with all of those standard approaches that have been used, is that they're not precise," he said. "The CardioMEMs is designed to try to help us prevent (Henry) from slipping into a decompensated state and helping us maintain what we call a compensated state." 

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Health heart failure

Dr. Jeffrey Sykes of Cardiovascular Associates talks about treating heart failure as cardiac care coordinator Shelly Sturgill, center, and patient Brian Henry listen during an interview at UnityPoint Health -- St. Luke's.

CardioMEMs, a small device implanted in Henry's chest, allows his medical team to analyze blood pressure readings from inside his pulmonary artery. Based his readings, his medications can be adjusted accordingly to improve his heart function. Since he's had the device, Henry hasn't been hospitalized.

"CardioMEMS is just one tool in our toolbox to help manage this disease process," Sykes said. "We do see people that have very weakened heart function that get put on appropriate medications and they don't generally have problems with decompensation, but some people do. People with more advanced or more severe symptoms, there's several various options that you can choose, not just medication and not just the device that he has."

Every morning, Henry said he lies on a special pad equipped with a receiver. His readings are transmitted in real time to a secure database for Sturgill to review.

"If it's too high, she calls me and lets me know or if it's low, she tells me I'm doing good," said Henry, who is now covered by Medicaid. "Shelly's the main key. If I need something outside of her realm, she'll still look into it."

Since Sturgill came on board, St. Luke's has seen its 30-day readmission rate plummet. Sturgill not only monitors patients' readings, she also coordinates their care with a variety of providers who make up the care team and educates them about their condition. HF patients like Henry are encouraged to make lifestyle changes such as eating less salt and limiting fluid intake to prevent the condition from worsening.

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