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Heart failure and self-care during the COVID-19 pandemic


 Department of Cardiology, AIIMS, New Delhi, India

Date of Submission23-Apr-2020
Date of Decision23-Apr-2020
Date of Acceptance25-Apr-2020
Date of Web Publication06-May-2020

Correspondence Address:
Santoshi Kumari,
Nursing Officer, Heart Failure Service, Department of Cardiology, AIIMS, New Delhi, India

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcs.jpcs_33_20

  Abstract 

India and many other countries are facing the challenge and threat posed by the growing pandemic of COVID-19. Patients with chronic conditions such as heart failure (HF) are at greater risk of getting the infection. Since the HF patients are at greater risk and hospital outpatient department facilities have also stopped temporarily, patients need to be prepared for self-care for HF. The objective of this article is to integrate practices and recommendations for self-care, in order to maintain well-being and prevent patients from getting infected. HF patients are encouraged to practice preventive and protective measures to limit the risk of COVID-19. HF nurses should focus on self-care education teaching also about medications, personal and environmental hygiene, mask management, social and personal distancing, psychosocial aspect, and diet in HF. All the patients are advised and encouraged to use teleconferencing, virtual, and other means of electronic communications to avoid direct contacts with others. All HF patients should be advised to stay at home and follow the government advisories.

Keywords: COVID-19, heart failure, self-care



How to cite this URL:
Kumari S, Rai P, Subeen P D. Heart failure and self-care during the COVID-19 pandemic. J Pract Cardiovasc Sci [Epub ahead of print] [cited 2020 Aug 13]. Available from: http://www.j-pcs.org/preprintarticle.asp?id=283852

The outbreak of SARS-CoV-2, a strain of corona virus, is a pandemic, which has affected six countries with >100,000 cases, 17 countries with 1000–10,000 confirmed cases, and 52 countries with between 1000 and 10000 confirmed cases as of April 17, 2020.[1]

Individuals with heart diseases, such as heart failure (HF), coronary artery disease, advanced cardiomyopathy, and congenital heart disease, are at greater risk of contracting and succumbing to the effects of the virus. Infections are an important cause of decompensation of heart in HF patients. Infections may be acquired in the community or can be the result of frequent hospitalization.[2]

The study by Cardoso et al. reported high hospital infection rate (45.8%) and mortality (21.5%) among patients with decompensated HF.[3]

Chronic diseases are the main causes of mortality worldwide, and HF is one of the leading causes of hospitalization and high rates of morbidity and mortality in many countries.[4]

Inflammatory effects of the viral infection can worsen cardiac and kidney function. Once the virus enters, it causes damage to lungs and triggers inflammatory response which places stress on cardiovascular system. By affecting the lungs, it brings a drop in blood oxygen saturations. Inflammatory effects of the virus cause a drop in blood pressure and stimulate the heart to beat faster and harder to meet oxygen needs of major organs. The acute inflammatory response due to COVID-19 infection may worsen cardiac function and exacerbate symptoms in HF patients. Vaccines against pneumonia such as pneumonia vaccine and flu vaccine do not provide protection against the new corona virus.

Data from China show that a significant proportion of patients who had comorbidities such as diabetes and hypertension and heart disease, particularly in the age group over 70 years, had higher mortality from COVID-19.

HF patients are vulnerable to infection, which could be hospital or community acquired. Patients with preexisting cardiovascular disease and hypertension in addition to age and diabetes have emerged as fairly strong associates of a poor outcome if they come in contact with COVID-19. Patients with cardiac problems should be more careful and should follow basic preventive measures such as social distancing, hand washing, and prudent use of upper respiratory protection to prevent contracting the disease and avoiding any adverse outcome.[5]

Preventive and protective measures will help limit the risk of COVID-19 infection in HF. Furthermore, since the outpatient services have been interrupted due to COVID-19 outbreak, more focus is oriented toward home-based self-care. It is the responsibility of HF nurses to teach the patients' self-care.

The Steps taught are as follows:

Self-care and medication: Patients are encouraged to check and maintain records of body temperature, blood pressure, weight, and abdominal girth daily, which helps the cardiologist with baseline information about his/her patient when giving suggestions.





  • Patients are advised to take medication as advised by the cardiologist
  • They are advised to put medicines in A (an ACE inhibitor/Angiotensin II Receptor Blockers (ARB) or Angiotensin Receptor-Neprilysin Inhibitors (ARNI), B (beta-blockers), C (complementary, i.e., other drugs), and D (diuretic) labeled pouches to avoid confusion [Figure 1]
  • Patients are told not to manipulate the medication dose on their own, except the diuretics, which they can self-titrate or modify if advised by the doctor. Most patients are taught self-titration of diuretics as part of the HF program
  • They should told not to skip or double dose the medicine if missed
  • We reinforce the use of teleconferencing and a telephonic helpline help for HF patients to decrease the risk of exposure with COVID-19.
Figure 1: Zip locks to store medicines.

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  1. They are taught social distancing and personal distancing


    • Follow strict social distancing by avoiding crowds, market, and office
    • Maintain at least 2 m distance from another individual
    • Maintain personal distancing or even better self-isolation if possible, to avoid contact with others as a risk of coming in contact with an asymptomatic “carrier of COVID-19”
    • Stay at home if possible, work from home
    • It is advised to use virtual methods of socialization, i.e., Skype, WhatsApp, or make a call.




  2. Personal and environmental hygiene


    • Wash hand thoroughly for 20 s with soap frequently
    • Avoid touching mouth, nose, and eyes
    • Cover nose and mouth when coughing, sneezing, or use the inside of the elbow
    • Gargle with warm water frequently
    • Take steam inhalation and saline gargles twice a day if there is a cough
    • Advised to keep frequently touched surfaces such as doorknobs, handles. or light switches, clean with disinfectant
    • Damp dusting of room walls, table, and other things should be done regularly with disinfectant
    • Clean toilet regularly
    • Anything coming from outside should be washed properly before handling or dried under sunlight if possible.




  3. Masks management


    • Use a mask or cloth to cover mouth whenever needed, as mask may cause breathing discomfort in patients with heart conditions
    • Mask must be worn if coming in contact with others
    • Cloth mask can be used. Have a pair of masks and use alternatively. Used mask should be cleaned regularly and dried properly in sunlight for 3–4 h before use
    • Appropriate use and disposal of mask is essential to avoid any increase in risk of transmission as the outer part of the mask comes in contact with the environment
    • The mask should be placed carefully so that it covers the mouth and nose properly
    • Avoid touching the mask, if touched use an alcohol-based hand rub
    • Remove the mask using lace or tie from behind.




  4. Psychosocial well-being


  5. Emotional well-being is important in patients with heart conditions. Stress and anxiety could be seen because of worsening symptoms of HF and pandemic of COVID-19.





    • Exercise to improve mental and physical health within limitation
    • Practice yoga, walking, meditation, and simple breathing exercise, etc.




  6. Diet


    • Advised to include whole grain vitamins, minerals, fruits, and vegetables. Fruits are low in sodium. Wash and peel off skin of fruits and vegetables
    • Drink warm water frequently, but keep fluid limitation as advised
    • Avoid chewing tobacco, alcohol, and smoking which can further more worsen disease condition
    • Avoid anything edible from outside. Cook hygienically at home.




HF patients are at increased risk for COVID-19, but if they take adequate precautions, they should be able to avoid getting infected with the virus.[6],[7],[8],[9],[10],[11] All patients with HF should be trained to take care of their illness by titrating their diuretics, using telemedicine to connect to their doctors, and visiting the hospital only if necessary. Once infected, they have a higher risk of morbidity, and adequate care should be given to them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
WHO. Director-General's Opening Remarks at the Media Briefing on COVID-19 – 11; March, 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. [Last accessed on 2020 Apr 25].  Back to cited text no. 1
    
2.
Mesquita ET. Infections in heart failure – Impact on mortality. Arq Bras Cardiol 2018;110:371-2.  Back to cited text no. 2
    
3.
Cardoso JN, Del Carlo CH, Oliveira Jr MT, Ochiai ME, Kalil Filho R, Pereira Barretto AC. Infecção em pacientes com insuficiência cardiac descompensada: mortalidade hospitalat e evolução. Arq Bras Cardiol. 2018;110:364–70.  Back to cited text no. 3
    
4.
Mission WC. Report of the who-China Joint Mission on Coronavirus Disease 2019 (Covid-19). World Health Organization; 2019. Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. [Last retrieved on 2020 Apr 08].  Back to cited text no. 4
    
5.
European Centre for Disease Prevention and Control. Information on COVID-19 for Specific Groups: The Elderly Patient with Chronic Disease Immunocompromising Condition and Pregnant Woman. Available from: https://www.ecdc.europa.eu/en/news-events/information-covid-19-specific-groups-elderly-patients-chronic-diseases-people. [Last accessed on 2020 Apr 25].  Back to cited text no. 5
    
6.
Kachroo V. Novel coronavirus (COVID-19) in India: Current scenario. Int J Res Rev 2020;7:435-47.  Back to cited text no. 6
    
7.
British Heart Foundation: Corona Virus: What it Means for You if you Have Heart or Circulatory Disease. Available from: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health. [Last accessed on 2020 Apr 25].  Back to cited text no. 7
    
8.
World Heart Federation: The Link between COVID-19 and CVD. Available from: https://www.world-heart-federation.org/covid-19-and-cvd/. [Last accessed on 2020 Apr 25].  Back to cited text no. 8
    
9.
World Health Organization. Infection Prevention and Control during Health Care when Novel Coronavirus (nCoV) Infection is Suspected. WHO/2019-nCoV/IPC/v2020. World Health Organization; 2019. Available from: https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125. [Last accessed on 2020 Apr 25].  Back to cited text no. 9
    
10.
Luscher TF, Infection, Infarction and Heart failure prevention and management, Eur Heart J 2015;36:3033-5.  Back to cited text no. 10
    
11.
Seth S, Vashista S, The Hriday card. A check list For Heart Failure, Dept of Cardiology Aiims, New Delhi, India. 2017;3:5-7.  Back to cited text no. 11
    


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