”Get back, Loretta!”
– Paul McCartney, “Get Back” 1969
“Get better, Loretta!”
– Wise Regional CHF 360 team, 2015
Growing up in the 1960s and ’70s, Loretta Harris no doubt heard that Beatles line a million times.
But it was the second line – a day-in, day-out, rousing chorus of “Get better!” combined with lots of skilled help – that helped get her back on her busy feet after a heart attack last September.
Loretta is a shining example of the effectiveness of Wise Regional Health System’s CHF 360 – a comprehensive follow-up program designed to help patients with congestive heart failure (CHF) stay on the road to recovery once they get out of the hospital.
For Harris, it started slowly – as most heart attacks do. The 59-year-old Chico resident noticed arm pain last September while she was working.
“I didn’t pay it any attention, and then I thought, ‘You know, they say that might be one of the signs of a heart attack.’ But I ignored it,” she said.
The next day at work, she had indigestion throughout the day – another sign.
“I never have indigestion,” she said. “But I drank orange juice, and if I’m going to get it, that’s what would give it to me. So I was kinda blaming it on that.”
At home that evening, she shared her symptoms with her husband, Dewey, who advised her to take her blood pressure and take an aspirin.
The blood pressure was a little high, but not alarming. So she took an Aleve instead.
“That night it just got a little worse, and my blood pressure was up a little,” Loretta said. “But I went on to work the next day.”
Then she called her daughter, an LVN, and went over her symptoms.
“She said, ‘You’re going to the doctor. I’m on my way down there to get you right now,'” Loretta said. “She brought me to the hospital, and sure enough …”
SLOW HEART ATTACK, QUICK TREATMENT
Tests in the ER revealed a heart attack was underway, due to 95 percent blockage in one of her coronary arteries. Soon, cardiologist Dr. Jason Finkelstein was standing at her bedside telling her she needed a stent to open that artery.
“Dr. Finkelstein said, ‘My team’s still here. Would you like to go ahead and do this?’ and that scared me because it was all happening so fast,” Loretta said. “My daughter goes, ‘Do it!’
“I’m glad I did.”
Prior to her trip to the ER, Loretta was a pretty heavy smoker – from one to two packs a day, depending on whether she was working.
“I quit the day I came into the hospital,” she said. “I don’t regret it. I smell everything now. Everything tastes different – I have food that I don’t even like anymore, now that I can taste it.”
Along with coronary artery disease, Loretta was suffering from congestive heart failure (CHF) – a condition in which the pump function of the heart falls behind, leading to fluid overload in the lungs. That leads to shortness of breath and swelling in the abdomen and legs.
“It’s a chronic disease similar to diabetes,” said Wanda Villard, MSN, NP-C and coordinator of the CHF 360 program at Wise Regional. “We can’t always cure it, but we can always manage it.
“In Loretta’s case, the pump function was affected by a lack of oxygen,” she noted. “That’s what caused the pump to not function well. So because Dr. Finkelstein could fix the plumbing, and get her heart oxygen, and then we gave her the medicines to support it, her heart pump got better.”
Loretta left the hospital a few days later. Even with the stent, her heart was still so weak she was given a “life vest” – an automated external defibrillator built into a vest that she wore 24 hours a day – to detect any abnormal heart rhthym and shock it back into proper rhythm if necessary.
She never got a shock, and by following up through CHF 360, she was able to ditch the vest by Christmas.
“I came and visited with her while she was still up in CCU,” Villard said. “Her heart function had been affected from the heart attack, so we enrolled her in the CHF 360 program, got her a blood pressure cuff and scales and all the educational materials, and then I started seeing her over in the clinic.”
Polly Jones, RN, BSN, worked in the cath lab before Villard snatched her away for the CHF 360 program.
“Loretta was very receptive to the program,” Jones said. “She called if she had questions, and she expected my phone calls. I spoke to her husband a lot on the phone – so it was very much a team effort between the two of them, and all of us. They were very involved.”
IT TAKES A VILLAGE
Dewey, a lifelong resident of Chico, was an integral part of his wife’s recovery.
“He’s my sweeheart,” Loretta said. “He was like my nurse when I couldn’t be with them. He told me he was proud that I didn’t give up, and I told him, ‘Well, I’m not going to give up!’
“He didn’t think I’d exercise, he didn’t think I’d give up smoking, salt, coffee – but I did,” she said.
“I love my family. It would probably kill them if I wasn’t around.”
Jones said battling CHF is very much like exercise and dieting – it’s hard to do it alone.
“It is helpful to have someone to encourage you,” she said. “It’s hard – you’re cutting out salt, cutting your fluid intake – it’s hard. You don’t think about it until you actually have to start applying it. It’s a lot to take in.”
Villard said they communicated with Harris so much that they easily recognized each other’s voices on the phone.
“We don’t even have to say who we are,” she laughed. “We’re on a voice recognition relationship.”
But she stressed that they welcome those calls.
“So often, I think people don’t want to bother the doctor,” she said. “They think, ‘Maybe I’ll just wait ’til tomorrow.’ We always encourage people, if you have a question, call us. This is all we do. You’re not bothering us. This is our job, to be your coach.”
CHF 360 starts when a patient is admitted, follows them through their treatment and for at least 90 days after dismissal.
It includes an array of resources including education, monthly support groups, transportation assistance, medication assistance including home and hospital delivery, a free blood pressure cuff and scales, a custom fitness plan created by cardiac rehab specialists, and continued testing.
The team has board-certified cardiologists, an interventional cardiologist, a board-certified cardiothoracic surgeon, a cardiac electrophysiologist, cardiac nurses, exercise physiologists and physical, occupational and respiratory therapists.
“Basically, we just try to find what are the barriers that are out there, that are keeping from getting the best care, and what can we do to help eliminate those barriers,” Villard said.
READMISSION RATE PLUMMETS
The program, which started in June 2013, grew to serve 222 people in 2014. Indications are, that growth will continue.
“Patients with congestive heart failure, their odds of readmission back into the hospital within 30 days are pretty high,” Villard said, citing the new medications, dietary and lifestyle changes.
“It’s almost too fragile of a state to go between office visits,” she said. “You go from the ICU where three or four doctors are looking at you every day, to going home, where you might see somebody every two or three weeks. So we bridge the gap.
“Polly calls, checks on vital signs, checks on weight. We can do little adjustments to medications. We do labs to follow up, to see how the body’s doing with medications – just to make sure when they leave the hospital they continue to get better.”
Nationally, about 25 percent of patients with heart failure are back in the hospital within 30 days. Wise Regional’s average was about 27 percent before they started CHF 360.
“We’re at 13 percent now,” Villard said. “It’s made a pretty significant impact on the number of patients coming back in for other complications. We try to catch those complications early, turn things around and give people resources.”
Loretta and her husband bought in completely and have achieved ideal results. She started working again about a month ago, a three-day-a-week job.
She’s grateful to be busy again, and now she faces life armed with an enormous amount of knowledge she didn’t have before.
“Now I notice any kind of little pain – anything,” she said. “If this happens again, I’ll let somebody know.”
And her exercise routine has become an inspiration for the rest of her family.
“I started exercising after about six or eight weeks,” she said. “I was a little slow getting started, but out where we live there are a lot of hills and my husband made some walking paths for me.
“I’d walk them, and he’d walk them with me,” she said. “He said if you can’t, just stop and rest. But I made me a goal and when I’d get on top of the hill, I’d celebrate.”
She has developed a deeper love for their land – and her addiction to walking has infected not only her husband, but also her kids and grandkids.
“Now, I can just walk anywhere I want to,” she said. “I think those hills, that rugged terrain, that helped a lot.
“I got them all walking.”