Journal of the Practice of Cardiovascular Sciences

REVIEW ARTICLE
Year
: 2020  |  Volume : 6  |  Issue : 2  |  Page : 102--104

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


Santoshi Kumari, Pallavi Rai, PD Subeen 
 Department of Cardiology, AIIMS, New Delhi, India

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

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.



How to cite this article:
Kumari S, Rai P, Subeen P D. Heart failure and self-care during the COVID-19 pandemic.J Pract Cardiovasc Sci 2020;6:102-104


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 [serial online] 2020 [cited 2020 Sep 23 ];6:102-104
Available from: http://www.j-pcs.org/text.asp?2020/6/2/102/283852


Full Text



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 cardiologistThey 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 programThey should told not to skip or double dose the medicine if missedWe reinforce the use of teleconferencing and a telephonic helpline help for HF patients to decrease the risk of exposure with COVID-19.{Figure 1}

They are taught social distancing and personal distancing

Follow strict social distancing by avoiding crowds, market, and officeMaintain at least 2 m distance from another individualMaintain 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 homeIt is advised to use virtual methods of socialization, i.e., Skype, WhatsApp, or make a call.

Personal and environmental hygiene

Wash hand thoroughly for 20 s with soap frequentlyAvoid touching mouth, nose, and eyesCover nose and mouth when coughing, sneezing, or use the inside of the elbowGargle with warm water frequentlyTake steam inhalation and saline gargles twice a day if there is a coughAdvised to keep frequently touched surfaces such as doorknobs, handles. or light switches, clean with disinfectantDamp dusting of room walls, table, and other things should be done regularly with disinfectantClean toilet regularlyAnything coming from outside should be washed properly before handling or dried under sunlight if possible.

Masks management

Use a mask or cloth to cover mouth whenever needed, as mask may cause breathing discomfort in patients with heart conditionsMask must be worn if coming in contact with othersCloth 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 useAppropriate 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 environmentThe mask should be placed carefully so that it covers the mouth and nose properlyAvoid touching the mask, if touched use an alcohol-based hand rubRemove the mask using lace or tie from behind.

Psychosocial well-being

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 limitationPractice yoga, walking, meditation, and simple breathing exercise, etc.

Diet

Advised to include whole grain vitamins, minerals, fruits, and vegetables. Fruits are low in sodium. Wash and peel off skin of fruits and vegetablesDrink warm water frequently, but keep fluid limitation as advisedAvoid chewing tobacco, alcohol, and smoking which can further more worsen disease conditionAvoid 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

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