the stop hf screening programme elaine tallon rgn, rm, pg dip clinical specialist nurse

The STOP HF Screening Programme

Elaine Tallon RGN, RM, PG Dip

Clinical Specialist Nurse


The dreaded blood testing and cholesterol


The terrifying weighing scales


The ever so lovable blood pressure!!!!!


• Look back at where The STOP HF programme has evolved from

• Where we are today

• Tips for keeping healthy

Discuss


Definitions:

• BNP: B-type natriuretic peptide- which is a protein that is released from the heart muscle when it is under stress or strain.

• ECHO: Echocardiogram – scan of the heart.

• ECG: Electrocardiogram – looks at the electrical activity of the heart.

• Heart Failure: Where the muscle of the heart does not work as well as it should


• The STOP HF research programme started in 2004

• Main aim of seeing if the BNP blood test could be used to identify early signs of stress or strain on the heart muscle.

Where we started:


• 2005 began recruiting• From GPs surgeries-Dublin, Wicklow, Wexford• >40yrs of age• Risk factors-hypertension, cholesterol, diabetes, prior

heart attack• Randomisation-control and treatment arm• Reviewed yearly in GPs surgery• If BNP > 50pg/ml treatment arm – had echocardiogram

& seen by Prof McDonald to assess and ensure all risks under tight control

• Education re healthy lifestyle


• In 2011 – all participants were reviewed in SMH and had ECG and ECHO done

• In 2012 – reviewed all participants data including events / admissions to hospital


Showed that the BNP is a good subtle indicator together with

• Collaborative care between hospital and GP

• Managing your risk factors tightly• Good lifestyle choices resulted in less strain on the heart muscle,

less incidents of heart failure and other serious cardiovascular events.

Outcome of analysis / research:


Hence, we could not continue as a research

programme but we are now a

SCREENING programme where everyone gets the same

care / follow up.• Only reason we are consenting - so that we can

use your blood for medical research including genetic testing and that it can be sent to facilities outside Ireland for testing.


• Take history of risk factors, up to date medical & surgical history, medications prescribed, any symptoms

• Check your weight, height, BMI, abdominal girth, blood pressure, heart rate

• Blood sampling for BNP, Cholesterol, Glucose and medical research

• ECG and ECHO

Assessment has not been changed:


Dependent on BNP result:– BNP <20pg/ml – every 3 years– BNP 20 – 50pg/ml – every 2 years– BNP >50pg/ml – every year

IMPORTANT: • Do NOT worry about BNP result • Subtle indicator & guide to your treatment• What really matters is how you are feeling and

results of other tests

Frequency of assessment


• Nurse & doctor review your visit and all test results

• If we have any concerns we will ask you to come in and be seen by doctor / have further investigations if necessary

• Automatically whether you are seen by a doctor or not a letter with all investigation results will be sent to your GP

After your assessment


Good blood pressure control• Aim for <140/85mmHg

How you can prevent stress / strain on the heart muscle


Good cholesterol control

More happy:>1.0mmols/L -Exercise

-Oily fish-Porridge

Less lousy:-Low saturate fats

<3.0mmols/L -Grill or bake food<2.5mmols/L – diabetes -Lean meat<1.8mmols/L-known heart disease


Good diabetic control


• Keep your weight down - BMI < 24.9

• Through what you eat, drink and exercise• Weigh yourself weekly• Aim to lose a pound a week

Weight


Present weight statistics of those attending STOP HF:

• BMI < 24.9 (normal weight) = 25.1%– Male = 18.2% Female = 31.1%

• BMI 25 – 29.9 (overweight) = 40.9%– Male = 43.7% Female = 38.5%

• BMI >30 (obese) = 34%– Male = 38.1% Female = 30.4%


• Half hour brisk walk/cycle/swim 5-6 times per week to keep healthy and well

• Up to an hour 5-6 times per week if you need to lose weight

Exercise


Exercise

If problems with joints / back walk in the pool


DIET

• Aim for a well balanced healthy diet plan that you can maintain for life

• Avoid fad diets• Little and often of the right foods


DIET

Suggest if you need to lose weight• Breakfast- oat based cereals –porridge or

unsweetened muesli with low fat milk or yogurt• Mid morning – piece of fruit• Lunch – 2 slices brown bread with your protein-

oily fish or lean meat or low fat cheese or egg• Mid afternoon – piece of fruit• Dinner – 2 medium sized potatoes or ¼ plate

wholemeal pasta or brown rice, ½ plate of vegetables, fish, chicken or lean red meat

• Avoid eating after 6.30pm


DIET

• Aim for 5 portions fruit / vegetables per day• Watch sugary foods – cakes, chocolates,

biscuits, sweets – have as treat only 1-2 times/week

• Watch the sugary drinks• Avoid salt – use pepper, herbs, spices• Watch the sauces, salad dressings• Avoid processed foods, ready made meals, take

aways - best make your own


Diet

Remember:

Watch what you bring into the house – if it’s not there you

can’t have it!


ALCOHOL

Women = 11units/week maxMen = 17 units/week max (HSE guidelines – low risk drinking)

One standard unit =


NO Smoking

• Never too late to stop • Not easy to stop but well worthwhile for a good

quality of life• Smoking Cessation courses St. Vincent’s

University Hospital


Reduce STRESS levels

--->


Reduce STRESS levels

• Accept there are events you can’t control• Good work / life balance• If carer, make sure to take time for yourself• Do pleasurable things -Walking, reading, gardening• Try to keep positive• Get enough sleep• Eat well• Avoid alcohol and smoking• Seek social support• Get help if you feel you are not coping


Take your medications as prescribed

• They are usually for life• Don’t stop them unless doctor tells you to• Know your medications• Keep list of names, doses and

how often you take them in your wallet / purse• Try not to miss doses• Be honest with your doctor if you

are not taking your medications


Have regular medical check ups


Conclusion

• STOP HF SCREENING programme

• Frequency of visit as per your BNP results

• Your doctor will be informed of all your test results


Attempt to keep your risk factors under control through healthy lifestyle choices

that you can maintain for life


Thank you all

And I hope

to

the stop hf screening programme elaine tallon rgn, rm, pg dip clinical specialist nurse

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