1. Congestive Heart Failure Patient Advocate Joe R. Anderson, PharmD, PhC, BCPS Associate Professor Pharmacy Practice and Internal Medicine University of New Mexico College of Pharmacy and School of Medicine

2. Living with Heart Failure Symptoms Symptoms –Shortness of breath, fatigue, lack of energy, swelling, bloating, decreased appetite, difficulty sleeping –Symptom burden effects quality of life and ability to function (Eur J Cardiovasc Nurs 2005;4:198-206) –Depression, anxiety, confusion (Eur J Cardiovasc Nurs 2005;4:198-206; Arch Intern Med 2001;161:1849-56; Am Heart J 2006;152:940e1-940e8)

3. Living with Heart Failure Medications Medications –Minimum of 2 drugs (ACE inhibitor and beta- blocker) –Typically, 3 to 5 drugs to control heart failure (diuretic, digoxin, spironolactone, angiotensin II receptor blockers) –Additional medications typically needed for other cardiovascular conditions or co-morbid disease states (exp: aspirin, cholesterol-lowering medications, nitroglycerin)

4. Living with Heart Failure Lifestyle Modification Lifestyle Modification –Taught to recognize signs and symptoms of heart failure ( –Taught to recognize signs and symptoms of heart failure (Circulation 2007;116:1549-54.) –Low-sodium diet –Supervised exercise program (Circulation 2003;108:554-9.; Circulation 1999;99:1173-82.) –Discontinue harmful behaviors (tobacco, alcohol, illicit drugs) Circulation 2007;116:1549-54.

5. Living with Heart Failure Healthcare Visits Healthcare Visits –Heart failure clinic visits may be every 2 weeks initially for medication titration and patient education. –Cardiac rehabilitation three days a week –If have a cardiac device, need follow-up every 3 – 6 months –Primary care provider visits

6. Living with Heart Failure Costs Costs –Medications –Food –Clinic visits –Transportation

7. Disability Process Application process Application process –Confusing to patient and provider –Limited time for providers to assist patient with process –Lengthy –Rule of “3”

8. Disability Process Application process Application process –Patient quotes: “They try to discourage you in hope that you will give up.” “I would give anything to be able to work again.” “They don’t realize that in addition to the medications and doctor visits, we have to pay for food, property taxes, utilities, car and home insurance, phone bill.” “The hardest thing was having to ask our daughter to lend us money to buy food.” “I’m not any good to nobody.”

9. Disability Process Conclusion Conclusion –Heart failure is a condition that affects both physical and mental well being resulting in functional limitations. –If patients and providers manage appropriately, the functional limitations can be improved and stabilized. –Appropriate management requires the patient to have adequate financial resources.

10. Disability Process Conclusion Conclusion –My wish Provide temporary SSI or SSDI to patients with heart failure provided they have valid documentation of their condition. Provide temporary SSI or SSDI to patients with heart failure provided they have valid documentation of their condition. Reevaluate their status at 6 or 12 months Reevaluate their status at 6 or 12 months Simultaneously, appoint patients to vocational rehabilitation Simultaneously, appoint patients to vocational rehabilitation