Andrew Lansley answers BHF question on future of heart nurses

In today’s live web chat with the Royal College of Nursing, Health Secretary Andrew Lansley answered our important question about the future of specialist heart nurses.

Via Twitter, we asked: Our specialist heart nurses prevent admissions & save money. How will long term savings be prioritised over short term cuts?

In his response, Andrew Lansley seemed to emphasise the important and “effective” work our heart nurses do. He also said the health service should recognise that our nurses could provide opportunities rather than extra costs in the face of the Government’s continuing drive to make savings.

But why did we ask the Health Secretary about the future of our nurses?

Over the years, specialist heart nurses have become a lifeline for those suffering from heart disease and patients and carers have come to trust them. Their expert clinical and emotional support helps people with cardiovascular disease regain control of their lives every single day.

For the last eight years we’ve trained and supported specialist heart nurses in NHS trusts up and down the country. We now support 426 nurses who provide invaluable care to more than 80,000 patients each year.

We know that tough decisions are going to have to be made in the current economic situation. But we’re worried that a short term view to savings might see cuts to specialist nurses and we think that would be a false economy. Our nurses keep people out of hospital, reducing the enormous burden heart disease puts on healthcare services.

Let’s talk about a specific example. As you read this around 720,000 people are living with heart failure and our nurses’ caring and expert help improves the lives of so many. Having heart failure can make everyday life a challenge for so many people as they require regular check-ups, need to manage complex medication regimes while many more experience disabling symptoms which leave them housebound.

And if you weren’t persuaded by the benefits to patients, then there’s a compelling business case as well. An independent evaluation in 2008 found Heart Failure Specialist Nurses saved around £1,826 per patient after the nurse’s salary had been deducted. That’s £8m in a single year. Our efforts helped cut hospital admissions by, on average, 35%. Why would we want to make cuts to a service which actually saves us money?

If specialist posts were put at risk as part of the Government’s latest efficiency drive, the quality of life for those suffering from heart disease would be greatly diminished, at a significant cost to the NHS.

Beatrice Brooke, Policy manager

Live chat nurse Judy - the final question

Katie asks: “Hi, I am 27 years old and was born with my left coronary artery on the wrong side. I had this re-implanted at 10months old and also suffered a heart attack. I have since found out in October last year that my valves were leaking and they were going to replace them up until I had an angiogram in January and they discovered my heart was enlarged. Plus almost 1 1/3 of my heart is just scar tissue from having the heart attack as a baby. So I was told the only option for me was a heart transplant. So I now take 3 different meds a day and I am becoming more symptomatic showing breathless, limited exercise tolerance and chest pain. I have been referred to another consultant for a transplant assessment and wondered what this entails exactly? I am a mother of 3 and a wife, as you can imagine this is a very anxious time for us all. How long is recovery after transplant? How long will I be in hospital for? Look forward to hearing from you.”

Judy says:

I am so sorry to read of your very complicated medical history and of your need to have a heart transplant so young. I totally appreciate how hard it must be for you, your husband and your young family. The recovery period following a heart transplant varies considerably from one patient to another. You can read more about what to expect before and after the surgery in our BHF publication on heart transplants. I hope that you will be ok, that you will be accepted for the surgery and that you will be given a new heart soon. If you want to chat about this you might find it easier to call our HelpLine on 0300 300 3311 and talk to a cardiac nurse. I wish you good luck with everything and I hope that you have the support you need and deserve from family and friends.

You may also want to contact the heart transplant support network on 0800 027 4490 or the their website.

Live chat with nurse Judy

Denise asks: "Hi Judy I’m 42 awaiting valve surgery they have said I’ve got a tiny femoral artery it needs some electrical rewiring and there’s a hole. I’m just a bit worried about being on warfarin all my life they have said if it cant be repaired a metal valve will be fitted any info about the warfarin I’d be grateful thanks."

Judy says:

I am sorry to read that you need to have valve surgery and I understand your concern about taking warfarin for life. There are benefits and risks associated with taking warfain which you can read about here. If you have a metal valve replacement you will have to take warfarin for life as otherwise a potentially fatal clot would build up on the valve. When making the decision about surgery what you need to consider is what are the risks associated with the surgery (and with warfarin) versus the risks associated with not having the surgery in the first place.

It might be worth talking to your surgeon about this again if he or she did not explain the risks of not having surgery. You can read more about valve disease here. Whatever you decide I wish you good luck with it and good health for the future.

Live chat with nurse Judy

Eric asks: I had a minor heart attack in 2002 and have been put on ramipril, simvastatin, metoprolol tartrate and asprin for life. What evidence is there to prove that I will live any longer taking the pills. Being a scientist by training I like to evaluate evidence for myself and not do something because some government dept. thinks its a good idea! I run, go to a gym twice a week and have not had a problems since 2002. Have I improved my chances of avoiding HA or are the chances still the same as if I had put my feet up?

Judy says:

I am sorry to read that you have experienced a heart attack but it’s great that you have made a good recovery. It’s difficult to point you in the direction of the evidence which supports the use of the cocktail of medication used to prevent a second heart attack as this evidence is not in one place. As a scientist yourself I am sure you will appreciate that the vast body of evidence has been accumulated over many years from scientists and medical researchers across the world. If you have a look at the stats on our website you will see that the death rate from heart disease has been steadily declining and the medication prescribed post a heart attack will have contributed to this decline. Other contributing factors include more prompt diagnosis and better access to emergency treatment (clot busting drug) at the time of the heart attack.

But you are right when you point out that medication alone is not enough and a healthy lifestyle is a vital part of the post heart attack rehabilitation. Its great that you have taken control over your health by going to gym twice a week.

I hope that this has answered your questions and I wish you good health in the future.

Live chat with nurse Judy

Carey asks: “Hi Judy, I'm 31 and had a heart attack end of March this year. I was put on 1.25mg Ramipril once a day (amongst other things!), which last week was increased to 2.5mg. On the lower dose I felt fine, but since the dose being increased my heart misses a beat quite frequently; approx. 5 times an hour. Is this something to... be concerned about and should i go to see my GP to go back on the original dose? Thanks Carey”

Judy says:

I am very sorry to read that you have had a heart attack at such a young age. Ramipril belongs to a group of drugs called Ace Inhibitors. Those drugs can drop your blood pressure quite quickly when you first start taking them. So it is standard practice to start on a low dose and gradually increase. 1.25 mgs is usually considered to be too low for long term use so it is not surprising that your GP increased it to 2.5 mgs.

Your symptom of being aware of your heart beat or feeling that your heart misses a beat every now and then is not uncommon. It may be that you have a disturbance to the heart rhythm or it may be that you are just experiencing an extra beat every now and then which is harmless. It would be worth reporting it to your GP who could arrange for some tests to help you get to the bottom of it. Hope this helps. I wish you good health for the future.

Live chat with nurse Judy

Luke asks: “I recently had my cholesterol checked and it was high. 7.9 to be exact, but the HDL was high at 1.3. I am 33 years old, my mother and grand mother both have high cholesterol and take tablets. No family history of heart attacks before 50. I am fit and well, and very active. Gym 2-3 times per week, football twice a week. I changed my diet as I ate a lot of eggs, and now only have eggs once a week. I take benecol and use flora pro active butter. I have cut down on my saturated fat intake, and I eat more porridge, lentils, pulses, fish etc. I always have 5 a day in fruit and veg. I drink alcohol at weekends and probably consume between 20-30 units. I smoke 1-2 cigars at the weekend. I was surprised by my reading, as I am not over weight, and I have a good diet or so I thought. I have lowered it to 5.9 now, but I still need to lower it further. Is there anything more I can do?”
Judy says:

It’s great that you are doing lots of exercise each week and eating healthily, so it’s a shame that your smoking and drinking habits are so unhealthy. 20 to 30 units of alcohol over 2 to 3 days is excessive and way beyond the recommended guidelines of 2-3 units a day for men. Alcohol is very high in calories and binge drinking is potentially damaging to the liver and the heart. Smoking is also a significant risk factor for developing heart disease in the future. It sounds as though it’s the weekends that you struggle with – it might be worth trying to identify small steps you could take to change your weekend habits. Only you will know which steps are realistic and achievable but I recommend that you identify some tangible goals to reach as a starting point such as having one cigar instead or two, and take it from there until you have given up completely.

A family history of high cholesterol should not be ignored and it may be that you have a genetic condition called familial hypercholesterolemia. You can find more information on the condition here. Take this to your GP for further advice as you may benefit from taking a statin. But a healthy lifestyle is a vital part of reducing your risk of developing heart disease in the future. I wish you the best of luck in reducing our alcohol intake and with quitting smoking.

Live chat with nurse Judy

Karen asks: “My husband had a heart attack at the end of January, he had a stent fitted, he was off work 3 weeks. He is now back to playing football twice weekly and golf, I say he is doing too much and should be taking it easy, wasn’t this a sign telling him to slow down. How likely is he to have another heart attack, he is 55.”

Judy says:

Your concern is understandable and is very commonly experienced by partners/spouses of someone who has had a heart attack. When I first started nursing it was common practice to keep patients in bed for ages following a heart attack. Now thanks to research we know that regular exercise is good for the heart, and that it’s an important part of the rehabilitation programme for those who have had a heart attack.

Lots of people ask us to quantify the risk of having a second heart attack. It’s impossible to do this but what I can tell you is that a healthy lifestyle, including regular exercise, can help to reduce the risk of another heart attack. It’s also important that your husband takes the medication he has been prescribed.

Another benefit of regular exercise is that it’s great for mental health and well being and can help boost the confidence of the person who has had the heart attack. So whilst I can fully understand your concerns it would be best to encourage your husband to keep active. Obviously if he were to experience symptoms such as chest pain or shortness of breath on exertion he should stop and rest and report it to his GP. But if he has no symptoms on exercise he should continue to enjoy it and all the benefits it brings.

Live chat with nurse Judy - we're back!

Lindsay asks: "Hi about three months a go I had an ablation on my heart which my consultant told me was successful, since the operation I have not felt very well and have found it hard to get around without feeling dizzy and off balance, also I keep getting a severe headache pulsating at the back of my head, so I went back to my consultant and had a 24hr tape put on and he has now diagnosed me with Inappropriate Sinus Tachycardia and put me on a tablet called Ivabradine 5mg twice a day. I’m still feeling really unwell and wondered if anybody could help, thank you"


Judy says "I am very sorry to hear of your considerable symptoms – it must be difficult to tolerate the headache you described. Ablation treatment for heart rhythms problems is usually reserved for those people for whom medication did work. In other words it is used for people whose rhythm and associated symptoms are difficult to control. Unfortunately it does not always work and sometimes a second attempt is needed or other medication. I suggest you keep in communication with your cardiologist who can continue to monitor your symptoms and make adjustments to your treatment accordingly. Sometimes it takes a while to identify the effective treatment for some people with heart rhythm problems – I hope yours will soon be under control and that you’ll feel better soon."

Thanks for your question, we hope that has helped.

Live chat with nurse Judy - out to lunch

Hi everyone, thank you for all the questions so far today, we have been inundated! We hope that the answers have helped you all.

Our nurse Judy is now on lunch and we will be back at 1:45 to answer more questions. Please keep the questions coming and we will try to answer as many as we can.

Thanks, see you all at 1:45.

Russell asks: I have a 47 year old sister with Downs Syndrome who has always had a slight heart murmur that has never caused any concerns. In the last 6 months she has been suffering from 'funny turns' when she describes her head as 'being funny.' She has undergone several tests including a heart scan and being wired to a heart monitor for 24 hours. The results showed that she has a thickening of the aortic valve that the doctors have told us is no cause for concern. Our family history includes a grandmother who had angina and died of a heart attack, our mother (she also had angina) who during a routine stent operation suffered heart failure and died ten days after the op from a heart attack, a sister (who at the time was 52) who had a massive heart attack and ended up in the bed next to our mum in coronary care. In total there are 9 offspring of whom 3 have heart problems and 4 who have high cholesterol. Gosh, we do sound a right lot don't we?! Our concern is that the valve problem our sister has, given our family history seems to have been dismissed. Should we be doing anything specific regarding this matter? If you could offer any advice we would be very grateful.

On a final note my whole family think you do a fantastic job! Although sadly mum couldn't be saved the care and attention mum, my sister and our whole family received from the staff on the coronary care unit at the Alexander Hospital in Redditch was second to none, they were truly wonderful. Our family did a sponsored walk in memory of mum and to say a massive 'Thank You' and we managed to raise £2,349 which we hoped show our appreciation in a small way.
I am so sorry to read that several members of your family have been affected by heart disease. Thank you for raising funds for us in memory of your mum which will help us to continue our work.

Judy says:

Down’s Syndrome is often associated with congenital heart disease so I am not surprised to hear that your sister has always had a murmur (an unusual sound which can be heard with a stethoscope). Its good news that your sister was told that the thickening to her aortic valve does not need to be treated right now. I am not sure why she is experiencing dizzy spells though so it would be worth revisiting the GP if it persists. Another option is to call an ambulance at the time of her dizzy spell. Your GP may be able to advise you further on this. I hope that your family will have better luck in the future.

Thank you for all the money you have raised for us, what an amazing achievement! Thanks for your question and we hope our answer helped.

Live chat with nurse Judy

Stan asks: "I had a triple heart bypass in April 2007, and over the last two years I have had a tight chest which at times causes me to become a bit short winded, I have told my Doctor of this about ten times over the last two years, Four months ago he thought that I had asthma, after having an asthma test everything was normal, he then sent me for an E C G which everything was normal, He then suggested that it is muscle caused by the operation, I decided to see another Doctor who as told me that it is cartilage which takes a long time to heal after such an operation, I have asked other people that have had the same operation and no one as had anything similar to what I am experiencing. In your experience have you ever come across anything like this, I am asking this because I am concerned about it."

Judy says:

"You are not the first person I’ve heard talking about reoccurring pain following surgery though it is not the norm for everyone. It is reassuring that your doctor does not think that it is related to your heart but that it is more likely to be related to the healing process. If the pain is causing you considering distress it may be worth asking your GP if he or she thinks it is appropriate to refer you to a chronic pain specialist. Hopefully you will not experience a heart attack in the future but should you get chest pain that feels different to the pain you described above you should call 999 immediately. I wish you good health for the future."

Live chat with nurse Judy

George asks: "I am 38 had my heart attack in october 2009 i continually keep getting back pain and colds as well as discomfort on my left hand sude while i am sitting down no fear over another heart attack but i am worried if this is normal or not and any suggestions about the cold."

Judy says:

"I am sorry to hear that you had a heart attack so young. Your symptoms are not common so I am not sure if they are related to your heart condition or not. Its not typical of heart disease to only experience pain on sitting down nor to suffer from head colds regularly. But I am not in a position to make a diagnosis for you or suggest what could be the cause of your symptoms.

It would wise to report your symptoms to your GP who could arrange tests for you. If you do expereince chest pain again you should call 999 immediately as it could be another heart attack. I hope that you will feel better soon. We have a range of booklets for people who have had a heart attack including: ‘heart attack’, ‘Returning to work with a heart condition’ and ‘cardiac rehabilitation’ which I hope you will find useful."

Live chat with nurse Judy

Anita asks: “Good Morning Julie, just a small question, my 7 yr old daughter had open heart surgery to close a hole and cut muscle bundles, 4yrs ago next month, but since the start of the year, 4 times, most recent few wks before the summer holidays started, she has said her heart hurts (her words). should i be concerned or is it normal? Thank you”

Judy says:

Congenital heart disease varies from one child to another so it hard for me to comment. However, I would say that given your daughter’s history it would be wise to take her to GP who could listen to her heart and examine her. If the GP picks up any issues he or she could refer your daughter for tests and back to the specialist team at the hospital for a check up. I hope your little girl will get a good report from the doctor and that she will enjoy the rest of her summer holidays from school.

Live blog with nurse Judy

Linda Hill asked on Facebook:

"hiya judy, can I ask a question about me heart condition please, i have a bp of 200 over 170 and i have cardiomyopathy,my heart also is thickening due to the bp,i feel pooly and out of breath quite a lot and have bad palpitations is that caused by the thickening and he,s the biggy can they reverse the damage,im on a lot of medication to try to control my bp,ive also had 24hrs monitors and even when im a sleep my bp is surging in to the highs thanks :0) im 46."

Nurse Judy says: "Sorry to hear that you are not feeling very well. Cardiomyopthy is not a reversable condition, but the symptoms can be improved and controlled. Some people respond very well to treatment, but it depends on the type of cardiomyopthy you have have and whether or not you have any other chronic conditions.

Your blood pressure is still uncontrolled, so I would advice that you need to see your GP as soon as possible. It might be worth asking him to refer you to the cardiologist for more specialist support.

I hope you get better soon, thank you for asking your question. We have booklets on different types of cardiomyopthy - you can find out more on our website."

Live chat with BHF nurse Judy

Morning everyone, hope you are all well today.

Our live chat with our BHF nurse Judy O'sullivan is going to start at 10am. We can't wait to hear all your questions.

The live chat will be running from 10am to 4pm with a small break at lunch. We hope to answer as many questions as possible throughout the day.

You can submit a question in the following ways:

• You can email internet@bhf.org.uk
  
• You could post a question on our Facebook fan page


• Or you could tweet your question using the hashtag #BHFQs.

We will answer all the questions on this blog, so keep an eye out for your question and answer.

Heart of the matter - our annual report

Meet Pat McKenna - a heart attack survivor from Scotland who attributes her survival to cardiac rehabilitation.

Pat was a non-smoker and a hillwalker with normal blood pressure and cholesterol but in 1999 she had a heart attack.

After having a double bypass operation she began walking on the hills again with the support of a cardiac rehab team.

She now mentors others and supports our campaign for high quality cardiac rehab treatment.

Pat's inspirational story is one of dozens in our 2008 Annual Report.

The report tells you what we've been up to during the year, including the latest on our life saving research, details on how we raise our money, our successful health education campaigns and infomation on the work of our BHF nurses.

Dive into our interactive Annual Report website at bhf.org.uk/report08 to find out more.

Let us know what you think by posting a comment on the blog.