Roger
Roger was diagnosed with heart failure 18 months ago after complaining of breathlessness on lying down, and having a heart attack. He had previously been diagnosed with COPD. As part of research into telemonitoring he has measured his weight and blood pressure daily.
Roger went to see his GP about eighteen months ago when he found he couldn’t breathe lying down at night and was having to sleep sitting upright. The doctor suspected a chest infection and prescribed steroids then antibiotics, neither of which had any effect on Roger’s breathing. When Roger nearly passed out in the GP’s surgery he was sent to hospital in an ambulance, where they discovered that about a fifth of his heart muscle was not pumping properly due to a blocked artery (heart attack) and his heart beat was irregular. Putting a stent in was considered too risky, so Roger has been treated with medicines and told to take things easy and control his diet. He has reduced the amount of fat, salt and sugar he consumes and also restricts his fluid intake to two litres a day. After attending cardiac rehabilitation sessions he joined a gym but later decided to go for walks instead to save paying for the gym membership.
Fifteen years ago, before his heart problem was discovered Roger had been told he was asthmatic and later that he had chronic obstructive pulmonary disease (COPD). He gave up smoking at that time because the doctor warned that he could end up in a wheelchair by the time he was sixty if he continued to smoke. As a result of his poor heart and lung health Roger tires easily and gets breathless when walking up hill. He occasionally experiences angina pain, which he treats with glyceryl trinitrate (GTN) spray. He also experiences pains in his legs, particularly at night, which could be due to his poor circulation or a side effect of the statin he takes to control his cholesterol levels. He has two knee replacements, which have cured the arthritic pain he used to suffer from but they restrict his range of movement—kneeling down and climbing ladders can be a problem, particularly as he works as a painter and decorator.
He currently has a check-up with a cardiologist every six months at the hospital and a blood test every month to check his blood clotting time because he takes warfarin. He only sees a GP if he has a problem. In the past he took part in a research study of telemonitoring, which involved him measuring his weight and blood pressure every morning for about four months and using a tablet computer to automatically send the measurements to the hospital over the telephone line. Roger appreciated having such frequent measurements of his blood pressure and would have liked to continue but the study came to an end and the equipment, which had been supplied by the researchers, was taken back. He has since bought a blood pressure home monitoring machine, which he uses two or three times a week. He also weighs himself occasionally but no longer keeps records of his weight or blood pressure measurements. Roger is happy being monitored by the hospital because he feels well supported by the health professionals there and has more faith in them than the GPs. At first he felt depressed by having heart failure but has since learned to accept his condition.