|HONEY BEE SECTION - INNOVATIONS FOR THE HEART
|Year : 2017 | Volume
| Issue : 1 | Page : 5-7
The Hriday Card: A checklist for heart failure
Sandeep Seth1, Shivani Vashista2
1 Department of Cardiology, AIIMS, New Delhi, India
2 Senior Research Fellow, Department of Cardiology, AIIMS, New Delhi, India
|Date of Web Publication||17-Jul-2017|
Department of Cardiology, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
Use of a simple checklist can drastically lower the likelihood of heart failure patient readmission and improve quality of life. The Hriday Card is a simple 4 page booklet which combines patient education material teaching the patient about heart failure, how to tackle daily emergencies, how to look after their fluid balance with appropriate use of diuretics. It also contains medication and daily weight charts for the patient and a heart failure checklist for the heart failure nurse or doctor which covers points like vaccination, presence of LBBB or Atrial fibrillation and use or lack of use of ACE inhibitors and beta blockers and many other points related to heart failure. This checklist can be filled in less than a minute. It is a simple tool to enhance heart failure care and medication adherence.
Keywords: Heart failure checklist, Hriday Card, medication adherence
|How to cite this article:|
Seth S, Vashista S. The Hriday Card: A checklist for heart failure. J Pract Cardiovasc Sci 2017;3:5-7
| Introduction|| |
Heart failure mortality in India is very high with more than one-third of patients dying in hospital after being admitted for heart failure, and of the remaining, another one-third getting readmitted or dying in the next 3 months after discharge (rule of three). Health education, medication adherence, heart failure checklists, and disease management programs are all methods which have been tried successfully to improve mortality and morbidity of heart failure. We designed and validated a special card for the management of heart failure patients which combined health education, a heart failure checklist, an approach to self-management, a disease monitoring chart, prescription charts, and linked to a telelinked smartphone app “Dhadkan” which was described in the last issue of the journal. This card is named the Hriday Card™.
| The Hriday Card™|| |
The front of the Hriday Card [Figure 1] displays a personal information table, i.e., name, age, address, and phone number.
The next leaf (page 2) of the Hriday Card [Figure 2] contains a brief checklist, which contains the diagnosis, vitals, and other associated factors such as blood pressure, heart rate, weight, hypertension, diabetes mellitus, smoke, alcohol, and thyroid disorders. Specific aspects of the electrocardiogram (presence of atrial fibrillation or left bundle branch block) and echocardiographic parameters (only ejection fraction) are also recorded. Vaccination status is also marked.
The second page also has a pocket for the medications list [Figure 3] which can be filled by the doctor/heart failure nurse or a trained paramedic. It includes the complete prescription including the medicines and their doses. This medication chart helps the physicians go through the medication and easily alter the doses.
There is a separate leaflet for weight record which [Figure 4] is filled by the patient daily. The patient is advised to take their daily weight after urination and before breakfast. They are advised to use the same weighing machine for recording; the weight management plays an important role in their management and helps teach the patient to self-manage their fluid management by a judicious use of diuretics and fluid restriction.
The next leaf of the card [Figure 5] has its unique importance because it describes the patient's clinical status. The disease severity is described by different color zones, i.e., green, yellow, red. the green zone signifies that the symptoms of the patient are under control and there are no weight gain and no swelling of the feet, ankle, legs, or stomach, and the patient is advised to continue the medication prescribed, a low sodium diet, and keep the physician appointments. The yellow zone shows that some warning symptoms have started to appear like weight gain, i.e. 1 kg gain in 2–3 days or 2 kg in a week, problem in breathing such as shortness of breath, swelling of feet ankles and/or legs, tiredness, dry hacking cough, sleeping on more pillows or in reclining position. This condition calls for changes in medication. Finally, there is the red zone – as the color signifies, the patient in this condition is sick, having chest pain, a hard time breathing, shortness of breath and should call a physician as soon as possible.
The last page [Figure 6] contains nine points for patient's health education which describes how to control heart failure. it starts with checking the weight daily, taking medication on time, eating a low salt diet, calling a doctor if symptoms increase, taking the vaccinations of influenza (annually) pneumococcal (once in 5 years), regular checkups, regular exercise and meditation, prohibition of smoking as well as drinking.
The patients are advised to constrict low sodium diet and water intake by 1–1.5 L.
| Conclusion|| |
Many problems related to heart failure may be avoided by exercising good judgment. Good judgment may only be gained by experiencing the problems once. The Hriday Card is based on two decades of experience of combining checklists for heart failure and health education and teaching patients to control their disease and having faith in themselves and their doctor. We hope that this card will help improve the outcomes of heart failure in India. This card is available for all users and is already being used in many hospitals in Delhi. Anyone who wants a supply of the cards with instructions for use can contact the corresponding author at email@example.com.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Seth S, Khanal S, Ramakrishnan S, Gupta N, Bahl VK. Epidemiology of acute decompensated heart failure in India: The AFAR study (Acute failure registry study). J Pract Cardiovasc Sci 2015;1:35-8. [Full text]
Rai M, Sharma KK, Seth S, Pathak P. A Randomized Controlled Trial to Assess Effectiveness of a Nurse-led Home-based Heart Failure Management Program. J Pract Cardiovasc Sci 2017;3:28-33. [Full text]
Seth S. “Dhadkan,” an indigenous smartphone app for heart failure patients. J Pract Cardiovasc Sci 2016;2:141. [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]