Carol has been an avid clogger for the past 20 years. What’s clogging, you ask? It’s a folk dance similar to tap dancing. Carol is part of a clogging group that travels all over the United States for workshops and conventions. Clogging is about more than exercise and socializing for Carol. It’s part of who she is.
In the fall of 2017 Carol started to notice an unsteadiness in her legs. Despite using her asthma inhalers, she also had a cough that wouldn’t go away. Both issues were starting to affect her life, including her clogging.
“My legs would get wobbly when I was clogging, so I’d sit down and take a break. Then when I stood up they’d be wobbly again and it would take me a minute to reorient myself. I just couldn’t keep up anymore,” she recalls.
As advised by her family doctor, Carol went to the emergency department at Hamilton Health Sciences’ Juravinski Hospital and Cancer Centre. She was in heart failure.
Heart failure is one of the most common causes of hospitalization in older adults.
Heart failure occurs when damage to the heart makes it too weak or stiff to work properly. Common causes include heart attacks, high blood pressure and other conditions that affect the heart. When someone is in heart failure, their heart must work much harder to pump blood through the body.
Carol is not alone. There are about 600,000 Canadians living with heart failure. It’s one of the most common causes of hospitalization in older adults. For about a month after they leave the hospital, these patients have a higher risk of their symptoms becoming worse. One in four patients return to the hospital during this period.
A Hamilton doctor is on a mission to change this.
Finding a way for heart failure patients to live long healthy lives
Dr. Harriette Van Spall, a cardiologist at Hamilton Health Sciences and researcher at Population Health Research Institute, is exploring how improving services for heart failure patients can benefit their health. She has led the Patient-centered Care Transitions in Heart Failure (PACT-HF) clinical trial, which is investigating how education and access to resources following hospital discharge can help patients like Carol avoid another hospital admission.
Her prior research shows certain services, like regular nurse visits and multidisciplinary clinics, can reduce readmissions in heart failure patients. These services require collaboration among multiple health care settings and professionals, which makes them difficult to implement. The PACT-HF study is bringing everyone together to set patients up for success.
“Heart failure requires lifelong management,” says Dr. Van Spall. “Supporting these patients when they’re most vulnerable is a key way to ensuring they’re well equipped to manage their condition. And, if managed with appropriate services, they can live long healthy lives and stay out of hospitals.”
“If managed with appropriate services, they can live long healthy lives and stay out of hospitals.”
Dr. Van Spall and her team have worked with hospitals, home care agencies, and clinics in participating regions in Ontario to coordinate education and care. Before leaving the hospital, a nurse navigator teaches patients and their caregivers how to recognize and manage symptoms, and what to do if things get worse at home. Patients who need additional support are referred to specialized clinics in the community. They also receive regular nurse visits in the month after they’re home to ensure their recovery is on track.
“Dr. Van Spall understood how important it was to me to return to clogging so she told me about her study. Now, I’m thrilled to be back to clogging three times a week,” says Carol.
The primary goal of the study is to reduce hospital visits after discharge, but Dr. Van Spall hopes to accomplish that and more.
“We’re hoping we also find that patients felt more prepared for their recovery process and ongoing management once they’re home,” she says.
Dr. Van Spall developed the program so it can be easily integrated on a more permanent basis. If it proves effective, she hopes to make it a routine part of care for heart failure patients at Hamilton Health Sciences.
Dr. Van Spall will present results of the PACT-HF study at a Late Breaking Clinical Trials session at the European Society of Cardiology Congress in August 2018.
Click here for more stories of our explorations.
Research at Hamilton Health Sciences is conducted in partnership with McMaster University.