Norma Caples is an Advanced Nurse Practitioner in Heart Failure at University Hospital Waterford (UHW).
A heart failure nurse specialist is a nurse with additional specialist clinical training in heart failure. They are key members of the patient care team and central to helping people live well with heart failure.
Q. As a professional specialising in heart failure what does a typical day look like in your practice?
A. These are a number of different parts of my role. I work with three other heart failure nurses Alison, Kelly, and Deepa. I run a nurse-led diagnostic clinic for people with symptoms of heart failure. This includes confirming or ruling out a diagnosis of heart failure.
My role also includes reviewing heart failure patients in clinic and ensuring they are on the correct medication. Most importantly I teach people living with heart failure how to keep themselves well.
I regularly receive phone calls from patients or I call them to ensure they are well and their symptoms are stable. I also work continuously with my heart failure nursing colleagues and senior management in UHW to ensure we are providing the best possible service to our patients. This involves regular audits, submitting reports, writing business cases, and developing new clinics.
I am also involved in research to help develop ways of improving care for patients living with heart failure.
Q. There are currently more than 90,000 people in Ireland living with heart failure, do you think this is an underestimate- is there a large number of people who are undiagnosed?
A. In 2017 the number of people worldwide living with heart failure was 26 million, in 2020 that number had risen to more than 64 million. So that number for Ireland is most likely very underestimated at present.
Q. What is heart failure?
A. Heart failure does not mean that the whole heart is failing. It means that your heart pump might fail to work properly at times. This can cause fluid to build up in the body.
Q. What causes heart failure?
A. The most common causes are coronary artery disease which is anyone who had a heart attack or angina. High blood pressure, diabetes, obesity, also when the valves of the heart fail to work properly. Drugs like alcohol, recreational drugs, or even some types of chemotherapy. Other causes of heart failure can include, pregnancy, infection, autoimmune disease, genetic conditions, smoking, inactivity, thyroid problems, nutritional deficiencies, anaemia, and some lung diseases. You might be born with it and sometimes we may not know how it was caused.
" The most common signs are fatigue and breathlessness."
Q. How is heart failure diagnosed?
A. Heart failure is diagnosed with the help of a blood test called BNP or NT Pro BNP which measures if your heart muscle is under stress. If the value is elevated this will indicate the need for more tests such as an ECHO or ultrasound of the heart. The ECHO will confirm if you have heart failure or not.
Q. What are the most common symptoms of heart failure?
A. The most common signs are fatigue and breathlessness. Other symptoms include sudden weight gain, swelling of the legs or abdomen, cough, waking up from your sleep breathless, or finding it difficult to lie down as this can worsen the breathlessness. You may feel that you are slowing down or less able to do normal activities. Additional symptoms include loss of appetite, and dizziness.
Q. How is heart failure treated?
A. It is treated with lifestyle changes, and medication. Sometimes heart devices are implanted and a small number of people may need a heart transplant.
Q. Have the treatments for heart failure improved over the past decade if so in what way?
A. The treatments for heart failure have improved greatly especially in the last decade. And the good news is it continues to get better. Most people can live very well if they adhere to correct medication and follow the lifestyle advice given.
Q. What age groups are most affected, and does it impact more women than men?
A. Heart failure can happen at any age from birth upwards. As you get older the risk of developing heart failure increases therefore the number of people living with heart failure aged over 65 is higher than in other age groups. As there is a higher number of men with heart disease the amount of men with heart failure due to this condition is higher than women. But women can develop heart failure due to high blood pressure more commonly than men.
" When symptoms worsen call your nurse or doctor. This may not just help you to keep well but could also save your life. "
Q. Do young people get heart failure?
A. Yes young people can also get heart failure. It might be more common in older people but you do not have to be old to develop heart failure.
Q. Is it possible to live well with heart failure and how do you do this?
A. Yes, it is very possible to live well with heart failure. It is also important to know that sometimes it can also be avoided. It is so important to have your blood pressure or diabetes properly treated, don’t smoke, eat healthily, engage into exercise, reduce stress and don’t drink alcohol in excess or use recreational drugs.
Q. What is the best and worst part of your job?
A. The best part of my job is helping people to live well. The worst part is when they have delayed that phone call to their nurse or doctor when their symptoms have worsened. Because sometimes we could have made them feel much better if they had made that call earlier.
Q. If you could give one piece of advice to the general public regarding heart failure prevention, what would it be?
A. Eat healthily, reduce stress, engage in daily exercise, stop smoking and drink alcohol in moderation.
Q. If you could give one piece of advice to people living with heart failure, what would it be?
A. When symptoms worsen call your nurse or doctor. This may not just help you to keep well but could also save your life. Heart failure is very well managed for the majority of people. There are great supports out there, so become familiar with what is available to you, look them up, and join in. It all contributes to helping you to live well.