Cardiac

Our aim TESST

The Community Cardiac Specialist team offers high quality patient care, respecting individual wishes, beliefs and needs.
This involves working closely with your hospital, family doctor (GP) and other services, as well as your family, carers and friends. We help you maintain and improve your quality of life. We also listen to your views and comments and use them to develop and improve our community cardiac rehabilitation services for all our patients and their families.

How can we help?

We hope you are well on the way to recovery from your recent heart attack or cardiac surgery. We understand this may be an anxious time for you and your family and you may welcome a little support or advice to support your recovery. We are here to help.
We can:

• advise the safest way to resume physical activity
• discuss medication issues
• offer reassurance, advice and support to help you make positive lifestyle changes, such as giving up smoking, changing your diet or becoming more active
• Provide expert individualised advice regarding modifying your risk factors for heart disease.

You may be interested in joining our exercise and education programme, which is up to six weeks, based at some local sports and leisure centres. We can give you more information when we visit you.

Where do we see patients?

Our first contact with you maybe a visit to your home with your permission, or we may ask you to attend a clinic that is local and convenient to you, which is based within a health centre, for your subsequent contacts. Home visits are only provided to patients who are unable to attend a clinic due to ill health.

The Cardiac Activity Programme

What are my options?

We are currently offering three different options for you to choose from:

1. myheart app – An online app that you can access from your phone, tablet, laptop or computer. Myheart app includes an easy-to-follow cardiac rehabilitation exercise programme along with a range of easy access tools to help you manage your heart condition.
2. Home Exercise Programme – One of our team will contact you by telephone for a 1:1 consultation. Following the consultation, we will create a personalised ‘at home’ exercise programme to suit your individual goals, exercise preferences, ability and fitness levels that you can do in the comfort of your own home.
3. Active Leeds – Following current government guidelines, you can now access a variety of face-to-face activities at leisure centres and venues across Leeds. You will receive an initial 1:1 telephone consultation from the Active Leeds team to discuss your activity preferences, followed by ongoing support for up to 10 weeks. You can also take a friend/relative/carer with you to your chosen session*.

*Reduced cost will apply for your friend/relative/carer for each activity session they attend.

Read the additional information below and have a think about which option you would prefer. One of our team will contact you to discuss next steps.

Online: myheart app

myheart is a user-friendly app for use on your phone, tablet, laptop or home computer that gives you 24/7 access to a wide range of tools to help you self manage your specific cardiac condition. It has been designed by clinical experts to support, guide and empower patients. The app includes a complete cardiac rehabilitation programme for anyone recovering from a cardiac event or surgery, along with a virtual walking programme that you can access all from the comfort of your own home. The myheart app is an easy way to help you self-monitor your heart condition. As well as the cardiac rehab exercise programme it has over 100 hours of information and advice including: education; mindfulness techniques to help cope with anxiety; a medication diary; and a section where you can monitor your weight and blood pressure.

How do I get myheart app?
Leeds Community Healthcare have a number of myheart licences for patients in Leeds. Please watch the online introductory video on the mymhealth website (shown below) to see if this is the exercise option you would prefer: https://mymhealth.com/myheart
If you are interested, one of our team will sign you up – you do not have to pay anything – the cost will be paid by the NHS.

Home Exercise Programme

The Home Exercise Programme option is an easy way to keep active in the comfort of your own home. Someone from our team will contact you for a 1:1 discussion and create a personalised exercise programme – specifically for you, your condition, ability and current health and fitness level. We have a wide variety of exercises for all abilities including:

• Bodyweight exercises;
• Weighted exercises (using simply adapted equipment that you have at home eg; water bottles instead of dumbbells);
• Banded exercises (we will send you an exercise band);
• Chair based exercises;
• Stretch / flexibility / balance exercises.

After your 1:1 telephone consultation, you will be sent your personalised home exercise programme. This programme is suitable for everyone as it is prescribed just for you – no matter what your current ability, mobility, activity level is. You will then receive ongoing support throughout the length of your programme – with as much or as little contact as you require.

Active Leeds

The Active Leeds option gives you the opportunity to access a variety of different activities at a leisure centre or community venue.
Someone from the Active Leeds team will contact you for a 1:1 discussion and help you to decide on your preferred activity preference. There are a wide variety of activities including:

• Walking groups
• Walking sports
• Gym
• Strength and balance
• Zoom online classes (that you can do at home)
• Dance
• Adapted bikes
• Tai Chi
• Swimming
• Group exercise classes
• Aqua mobility
• Gentle exercise.

You will receive ongoing support from Active Leeds for up to 10 weeks and continued support moving forward into other activity choices to help you to continue with your healthy lifestyle.
There is also the option of taking along a friend, relative or carer for support who will be able to join you in your chosen activity session*.
*Reduced cost will apply for your friend/relative/carer for each activity session they attend.

What is the aim of the clinic?

• Explain your heart condition
• Explain and review your medication
• Review your general health
• Check your blood pressure, pulse and weight
• Give healthy living advice that could improve your heart condition
• Review your medication regime and alter or introduce medication to improve your heart condition (this may take several appointments).

How many appointments will I need?

• This will vary according to the type of heart condition you have.
• If you are being followed up because of a heart attack or heart surgery you will usually require one or two appointments.
• If you are being followed up after an angioplasty or stent and wish to join a heart rehabilitation class you will usually require one appointment.
• If you are being followed up because of a diagnosis of heart failure you will require more frequent appointments as we will be altering your heart medication. Your follow up may last several months.

What if I am housebound?

Providing care for housebound patients is an important part of our service.
However, you will not be eligible for a home visit if you are able to go out either by taxi, private car, motorised scooter, bus or use the access bus to visit any of the following:

• GP
• Shops
• Relatives
• Hairdresser / barber
• Dentist / optician
• Pension
• Phlebotomist / nurse
• Luncheon clubs

In these circumstances you will be requested to attend the heart clinic at your local health centre.

Getting to the clinic

The following may help you:

• Use public transport.
  Metro 0113 245 7676
  www.wymetro.com
• Access Bus if appropriate.
  Access Bus 0113 348 1903
• Leeds Alternative Travel will take you door to door for a small charge.
  0113 386 8880
• Contact Leeds Directory 0113 391 8333 for information about local travel schemes.
  www.leeds.gov.uk
• If you receive the high rate mobility component of the Disability Living Allowance or War Pensioner Mobility Supplement you must use this to pay for your transport costs to clinic.

Travel costs

If you are on a low income you may be able to claim for a refund of your travel costs under the Healthcare Travel Costs (HTC) scheme.
To find out if you are eligible and how to claim, visit the NHS Choices website www.nhs.uk or phone 0845 610 1112 to order a paper copy of the travel claim form and eligibility document (HC5, HC11). You can ring the Patient Experience Team in Leeds (number below). Please keep receipts and records of your journeys.

Change in circumstances:
If your situation changes and you are unable to attend your local heart clinic please contact the Cardiac Service. You will need to complete the enclosed mobility questionnaire that should be returned to the cardiac nurse.

What is the Heart Failure Nursing service?

We are a team of specialist nurses with broad nursing experience and specialised cardiac skills. We care for people who have already been diagnosed with heart failure with a reduced ejection fraction (HFrEF)

The team will:

• Work closely with you, your GP and your hospital consultant to try and improve your symptoms and quality of life.
• Plan your care with you to meet your individual needs.
• Offer support and individualised advice for you and your family.
• Discuss and review your medication and adjust your doses if necessary.
• Monitor your condition and blood tests as needed.
• Refer you to other services where appropriate.

What is heart failure?

Heart failure is a condition where the heart is unable to pump strongly enough to meet the body’s demands for blood and
oxygen.

The main causes of heart failure are:

• Damage to the muscle caused by a heart attack
• High blood pressure
• Heart valve disease

The main symptoms of heart failure are:

• Shortness of breath
• Swelling of the ankles and feet
• Tiredness

Aim of the service

The Community Cardiac Specialist team offers high quality patient care, respecting individual wishes, beliefs and needs.

The team will help you maintain and improve your quality of life.

They will also listen to your views and comments and use them to develop and improve services for all patients and their families.

Where are patients seen?

Housebound patients are seen at home by arrangement.
The service also runs from local clinics across Leeds.
These are:

• Armley Moor Health Centre
• Bramley Clinic
• Chapeltown Health Centre
• Kippax Health Centre
• Kirkstall Health Centre
• Meanwood Health Centre
• Morley Health Centre
• Otley Health Centre
• Pudsey Health Centre
• Seacroft Clinic
• St George’s Centre
• Wetherby Health Centre
• Yeadon Health Centre

Frequently Asked Questions

How can diuretics be given?

The most common way to give diuretics is in tablet form (water tablet).
Sometimes the tablets do not work as well as they should and fluid can build up in your body.
Giving the diuretic by injection can be more effective. There are two ways of doing this:

1. Intravenously (IV) This is where a fine tube called a cannula is inserted into a vein and the diuretic is given by injection over a period of time (the period of time will depend on the dose given)
2. Subcutaneously (SC) This is where a small fine tube called a cannula is inserted under the skin and the diuretic is infused over 24 hours. Before a cannula is inserted the procedure will be explained and a sample shown to you first if you choose. This will be done by the nurse visiting you at home.

Do I need to be in hospital or can I be at home for my IV treatment?

This treatment was previously only offered in hospital but is now available as a community treatment for many patients with heart failure.

Do I have to purchase anything?

No. The nurse will arrange and deliver everything needed to give you this treatment (unless you currently have to pay for your medical prescriptions in which case the usual prescription charge will apply). If you are being discharged from hospital on this treatment then a supply of the drug will be sent home with you.

Are there any risks to me if I receive treatment at home?

An allergic reaction to a drug may sometimes occur when a new drug is given, but this is rare (and you may have already safely received this treatment in hospital). You will be given advice about reactions and what to do if one occurs.
You may experience some side effects including dizziness. This is usually due to a drop in your blood pressure and must be reported to your nurse.
Diuretics can sometimes alter your kidney function. You will have regular blood tests at home to monitor this closely.

Can I bathe/shower?

You can still shower and bath so long as the line is kept clean and dry. The cannula should not be immersed in the bath. If the dressing does become wet underneath please tell your nurse when she arrives.

How is the cannula removed when it is no longer needed?

A nurse will remove the cannula. It will come out easily. A dry sterile dressing will be placed over the site if required. This can be removed after 24 hours.

Who will give me my IV medication?

A nurse will come to your home to insert the cannula, prescribe and administer your medication. You may decide that you prefer to have this treatment in hospital which can be arranged if necessary.

What if it does not work?

This will depend on your individual wishes. Your heart failure nurse may recommend that you are admitted to hospital or she may seek advice from the cardiologist. It may be that you are not well enough for any further hospital treatment and that you would prefer to stay at home or possibly the hospice – this would all be discussed with you by your heart failure nurse.

How can I help care for my cannula?

To prevent infection your cannula must be kept clean and dry. A dressing will cover the cannula site. Your cannula will be checked every day by your nurse. The cannula will normally need to be removed after three days and replaced if the treatment is still needed.
You should avoid heavy lifting and excessive movement of your arm to prevent the cannula from becoming dislodged.
Complications with cannulas are rare but please seek advice if you have any of the following problems with your cannula:

• Pain at the cannula site
• Redness, swelling or oozing at the cannula site
• If it becomes dislodged or falls out (in which case cover the site with the clean dressing provided and press firmly to stop any bleeding)