Philippa Hobson is a Senior Cardiac Nurse at the British Heart Foundation. We’ve asked her to share what it’s been like working with people with heart disease for the past 30 years.
I walked onto my first cardiac ward at St George’s Hospital on New Year’s Eve 1987. I can’t even remember why I applied for a job there, as I hadn’t done any cardiac nursing during my training. From then on, I have always cared for patients with heart and circulatory diseases, through thick and thin, and I’ve seen so many developments — for the better, I’m pleased to say.
Although the ward was for heart patients, we nursed people who’d had angiograms (a procedure to image what’s going on inside the heart) as we didn’t have the capacity to look after people who’d had angioplasties then (a procedure to widen blocked or narrowed coronary arteries).
Angiography is a type of X-ray used to check the blood vessels. Blood vessels don’t show up clearly on a normal X-ray, so a special dye needs to be injected into your blood first to highlight them, allowing your doctor to spot any problems.
After the procedure we had to be ultra-vigilant to ensure people didn’t bleed from their wound site — they only used a femoral approach (in the groin) in those days. The conditions for patients were pretty dire back then, to be honest. They were ‘clamped’ to a hospital trolley with a device called a ‘fem stop’ (a plastic compression device), to reduce the risk of bleeding — which sadly often happened anyway. Looking back, I can’t believe it used to happen, but patients would stay on the trolley for up to 24 hours, and we often had to apply very firm pressure to the patient’s groin to stop the bleeding — very painful and undignified for them, and terrifically hard work for the nurse or doctor.
We now routinely use a device called an ‘angioseal’ — a small collagen plug that prevents bleeding at the wound site and someone can be sitting in a chair within a couple of hours of the procedure. Today, we also do angiograms via the artery in the wrist which, although this still requires a device to reduce the risk of bleeding, someone can sit in a chair straight afterwards.
Home after 4–5 days is the new ‘normal’
The patients on the ward who’d had heart surgery, usually coronary artery bypass, were often in hospital much longer than they are now. We were kept especially busy as there were so many post-operative complications in those days. The most common were terrible wound infections. People were in the operating theatre under anaesthetic and ventilated for much longer then, so chest infections were also commonplace. Unsurprisingly, nobody wanted to walk after these operations, so their circulation was poor. This meant they were at a much higher risk of blood clots in their legs and lungs. With medical advances, these operations are now so much quicker (and often performed by robots) and are becoming much less invasive. Going home after 4–5 days is the new ‘normal’, and not the exception.
I worked on the cardiac Intensive Care Unit at the Brompton Hospital in 1989. By that time and thanks to a BHF Professor Magdi Yacoub, we were doing more heart transplants nationally, so I had the opportunity to nurse quite a few people after their live-saving transplants. We know we still have a long way to go and reduce the waiting time for those needing one, but I am really happy to have had the chance to have been there in the early days.
I then moved to Coronary Care which specialises in the care of patients with various heart conditions that require very close monitoring and treatment. Thanks to the help of another BHF Professor Desmond Julian who acknowledged that heart attack patients needed close monitoring in order to improve their future outcomes.
During the course of my career sadly not everything had a happy ending. We certainly didn’t know as much then as we do now about heart failure or its causes. There was no community support or specialist doctors, so patients were often just left to get on with just a handful of tablets to try and help their symptoms. As there was (and still is) no cure for heart failure, the condition worsened, the medication no longer helped and they simply became sicker. Readmission rates for heart failure and its complications were terrifyingly high. Many patients died of pneumonia and other complications, as their bodies couldn’t fight any more.
However, heart failure management is slowly becoming more of a priority in healthcare, although much more needs to be done. Medicine is controlling symptoms and specialist nurses now visit patients in their homes. There is more clarity and dignity and we try everything we can to keep people at home with their families unless hospital admission is absolutely necessary. The BHF funds millions of pounds of research that could one day teach the heart to regenerate — this would be life changing for people who have had a heart attack.
An incredible innovation during my time as a cardiac nurse is the matchbox sized defibrillators for people living with a wide variety of heart conditions, such as those who have survived cardiac arrest and those with heart muscle disorders who are at risk of having life threatening heart rhythms. They improve the quality of life and give hope to so many people as well as saving them.
As time passed we also discovered the evidence-based benefits of cardiac rehabilitation. This covers all the help you need in getting back to as full a life as possible after a heart event, such as a heart attack or bypass surgery. It’s also about supporting you to live with your heart condition, to stay as healthy as possible, and to reduce the chance of another heart event.
As well as patients reporting significant physical and emotional benefits of cardiac rehab, Department of Health research has shown that participation reduces the risk of dying by 18% in the 6–12 months following referral and can cut readmissions to hospital by nearly a third. It’s shocking then that nearly half of eligible patients missed out on this rehab in 2015–16, according to the latest research. This must be a priority going forward, as people could be needlessly dying as a result of a lack of awareness of the rehab available, or not enough funding to cater for all patients.
I am so proud to be working for the BHF after 30 years of being a heart nurse with most of my career embedded in a charity that started just a few years before I was born.
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