When patients go home with a CRT /-D it is important that patients and family are given advice about living with the device.
In order to ensure that Frank is at the centre of all the choices in his future care, he should be supported and encouraged with self-management. Click on the following link to see Frank’s discharge letter (this is an example of what may be included).
Frank’s discharge letter [PDF]
- Activity (trainers) – Frank should be advised to avoid exercises that place a heavy load on the arms and chest. If too vigorous, the lead connection within the device could be loosened. With heavy loads, there is also a tendency to breath hold, which can increase blood pressure. Upright aerobic exercise is best, and a walking programme is ideal initially.
There are certain activities that Frank should not attempt unaccompanied, in case the device is activated e.g., climbing ladders or swimming. He should also avoid contact sports because of the risk of damage to the device.
Frank can resume a normal sex life as soon as they have recovered from device implantation usually this takes 2-4 weeks. The risk of sexual activity triggering an abnormal heart rhythm which causes the device to shock is very low. Even if this does happen, his wife is in no danger at all, and is unlikely to feel anything unless he jumps slightly as a result of the shock. - Diet (eat well plate)
Fats: Reduction of fat, in particular of saturated fat is one of the pillars of dietary advice to live a healthier life. All individuals with a diagnosis of heart failure should aim to consume less than 2g of salt per day. Less salt means less fluid retention and this means less work for the heart. Patients should be encouraged to check the packaging of food to work out the salt content. Often sensible advice is to either:- Avoid adding salt to food when cooking.
- Avoid adding salt to food at the table.
- Avoid using salt substitutes such as Lo-salt as this can interfere with your medications.
- Effervescent or fizzy medicines can have a high salt content and should be considered when checking prescriptions
- All patients with heart failure should be encouraged to continue a diet high in fruit and vegetables which tend to be low in fat.
- Alcohol (beer)
All patients with heart failure should be encouraged to remain within the healthy limits for alcohol consumption. A female should not exceed 14 units of alcohol per week and a male should not exceed 21 units per week. This should be spread over the course of a week with at least 2 alcohol free days during this time. An additional consideration will be the amount of fluid contained in the alcoholic drink e.g. pint of beer. If patient has a diagnosis of heart failure due to alcoholic dilated cardiomyopathy then they should be strongly advised to abstain. - Medication (pills)
Heart failure patients are often on multiple medications. These need to be reviewed at every consultation and specific questions asked – what their prescription is, what are they actually taking, are they taking anything else? It is the fine-tuning or balance of taking these different drugs that gets the best possible function of the heart. A small adjustment can sometimes make all the difference. Frank may require many different medication considerations in order to reduce his symptoms (NYHA) and keep him stable. Another aspect of medication will be to consider if the patient is taking any effervescent medication as some can contain significant amounts of sodium. - Social (dart board)
This is an important aspect of holistic assessment and encompasses Self Care ( What each person does on an everyday basis) and Self Management( The process each person develops to manage their condition). By holistically assessing a patient and establishing good communication it is useful to discuss realistic goals with heart failure patients so they can achieve a good quality of life. Frank should be encouraged to discuss this within his careplan.If he wishes to play darts he should wait until at least 4 weeks after the operation. - CRTD (pic)
Additional Cautions: Patients should receive detailed advice about other devices and environmental considerations after CRT-D insertion. These will vary depending on many factors. Includes:- Mobile Phones
- Magnets
- Security systems
- Amusement parks
Most well maintained kitchen and office equipment pose no problems.
- Work (bus)
This depends on recovery and the type of work usually recommend that patient takes between three and seven days off work, but this can vary. The patient should discuss with specialist nurse or cardiologist.
Driving: patients living with CRT-D will have statutory restrictions on driving, they should always be advised to speak to their cardiolist or GP who can advise them appropriately. - Travel abroad (aeroplane)
Check that the doctor (GP or cardiologist) is happy for travel before patient makes any travel arrangements.
If box discharges a shock: patient shoud be advised to phone the hospital and speak with someone for reassurance/advice.
Pulse point
Further information about the above can be found at:
Page last reviewed: 28 Jul 2020
