Conjestive Heart Failure CHF Program

The treatment of Congestive Heart Failure is more than providing physical relief. It's about managing a chronic disease. That includes monitoring the patient's condition and providing education about the disease, as well as giving them emotional support. WakeMed's CHF program, started in 1999, is designed to work in conjunction with the patient's primary care physician and cardiologist.

When patients enroll in the CHF Program, a cardiovascular educator provides them with educational materials, including a booklet about heart failure, a weight diary, a sodium checkbook and medication cards for recording information about their medicines. These tools provide valuable information to health care providers on the daily condition of the CHF patient. Even after a patient has been diagnosed with CHF, hospital readmissions frequently occur because of not knowing how to manage one's lifestyle while suffering from the condition. It is the program's goal to eliminate that problem.

Follow-Up Care By Phone

A key component of the WakeMed CHF program is follow-up care after a patient goes home from the hospital called 'telemanagement.' Patients receive a telephone call from a CHF educator on a weekly basis for six weeks, which tapers down to once a month later on during the program. The educators ask patients a number of probing questions about weight management, blood pressure, medications, and general well-being. The CHF educators are rapid responders and listen closely for signs that a patient's condition may be declining. If they hear a 'red flag,' they try to resolve it quickly before the patient has to be readmitted to the hospital. After six weeks of phone calls, CHF educators taper down the calls to every other week. Eventually, the calls will come only monthly as the patient learns to manage his or her condition.

Not only do patients get calls regarding their physical well being, but they receive calls from a volunteer chaplain about their emotional well being. The chaplains participate in the support group meeting for people with CHF, helping patients deal with the psychosocial aspects of heart failure. The chaplain affirms their fears, concerns and anger at having to deal with disease, and lets them know they're not alone.