By J. Lorin G., OTR/ L

Congestive Heart Failure (CHF) is one of those diagnoses that I have frequently encountered in many environments as an occupational therapist, adult day health care, outpatient hand therapy, and now working at a SNF.  What is CHF and what can we do about it in occupational therapy or other healthcare fields?   Phyllis Ehrlich, OTR/L states that CHF is a “physiologic state in which the heart is unable to pump enough blood to meet the metabolic demands of the body at rest or during exercise” (1).  It’s a complicated condition, called by different names, congestive heart failure (CHF), chronic heart failure (CHF) and heart failure (HF). CHF can be caused by many different factors including hypertension, ischemic heart disease, or cardiomyopathy (2).  Obesity and aging are both big contributions to CHF, because of the difficulty of the heart muscle getting blood to all of the body’s tissues,

There are many different categories of CHF, including systolic or diastolic, right-sided or left-sided heart failure.   Systolic HF is when there is not a regular ejection fraction from the heart and often occurs with weakness of the left ventricle.   People with diastolic heart failure have normal systolic heart function and have difficulty refilling the heart with blood due to left ventricular stiffness or other factors.  Right-sided heart failure results in systemic edema, often resulting in edema in the legs or feet, and left-sided heart failure results in pulmonary edema (2).  Pulmonary edema is one of the leading complications of heart failure (3). CHF or HF can be caused by smoking, by a diet high in salt, both activities that can be influenced by occupational therapy through lifestyle change.  CHF is a condition that OTs or other health professionals can help by communicating with the RN, the dietician and all of the other members of the Rehab Team and IDT.

CHF is one of those co-morbidities that can fall by the side next to more acute diagnoses like a hip replacement, stroke or COPD.  As occupational therapists or other health care professionals, we can make a big difference in an individual with CHF’s life through encouraging exercise, healthier diet choices and healthier lifestyle choices.

One long-term study indicated that the top five cases of CHF are: ischemic heart disease (62%), cigarette smoking (16%), hypertension (10%), obesity (8%, and diabetes (3%) (2).   Heart failure affects 6-12% of people over the age of 65.  There are several pharmacological treatments available to the person with CHF including ACE inhibitors and vasodilators.  The most important treatments for those with CHF from a therapy point of view are lifestyle changes like helping people to stop smoking and increasing an individual’s exercise routine and activity tolerance.

Keeping track of a patient’s vital signs is very important.  Ehrlich says to take the person’s sitting and standing BP, HR and oxygen saturation level before and after exercise (1).  Keeping track of a person’s exertion level and teaching energy conservation and relaxation techniques can help maximize activities of daily living and activity tolerance levels.  As with all therapy and most health care, educating the patient about what’s going on with their body and how to best treat it is vital.

Exercise is important to people with CHF for several reasons.  It helps improve cardiac muscle contractility, it can help patients lose weight and it can lower the impetus to stay in bed and be inactive for so much of the day (2).  Exercises for a cardiac patient may include brisk walking or wheelchair-pushing (about ten minutes then rest) five minutes forward then five minutes backwards on the upper body and light weight-lifting to challenge the biceps and shoulder muscles.  My favorite exercise for a patient to do with light dumb-bells (2-3 pounds or more depending on the individual’s strength and ability) is to have the person start with outstretched elbows, then to bend their elbows as much as possible, then to straighten the elbows and lift the shoulders to about 90 degrees and then to lower the shoulders to resting positions with the elbows outstretched as in the starting position.  A person can do 3 sets of 10 repetitions or more or less as preferred.  Our patients’ comfort is always our top concern of course, but more exercise with an individual with CHF is usually better.

Congestive heart failure is different from myocardial infarction, an acute “heart attack” where heart muscle actually dies (2).  MI can be a contributing causal factor for CHF because of the heart’s inability to deliver enough blood and oxygen to the body’s tissues.  Our role with CHF as therapists is to promote independence in daily activities and to encourage establishment of a daily exercise routine.  One’s level of exercise tolerance should be graded according to a person’s age and previous activity level.  We can help to teach relaxation and spirituality (6) as a means for coping with the onset of CHF and its subsequent lifestyle changes. CHF is a disease and basic treatments and lifestyle changes can prevent it from becoming more acute (2).

References:

1. Phyllis L. Ehrlich, MS, OTR/L, CHES, “What Can We Do About CHF?” http://occupational-therapy.advanceweb.com/Article/What-Can-We-Do-About-CHF.aspx
2. “Congestive Heart Failure” http://en.wikipedia.org/wiki/Congestive_heart_failure
3. Jill Glomstad, “Heart Helpers” http://occupational-therapy.advanceweb.com/Article/Heart-Helpers.aspx
4. Clarissa F. Smith, PhD, Secondary Diagnoses in Geriatrics http://occupational-therapy.advanceweb.com/Article/Secondary-Diagnoses-in-Geriatrics-1.aspx
5. Elizabeth Remo, NP, ”Heart Failure Management” http://occupational-therapy.advanceweb.com/Article/Heart-Failure-Management-2.aspx
6. “Spirituality” on CHF Patients site http://www.chfpatients.com/rel/spirituality.htm