Keeping heart failure under control


My name is Eefke Baggen and I have been a general practitioner (GP) for over five years. I knew that I wanted to become a GP ever since I started studying medicine. As the end of my education approached, I wandered away of the path towards becoming a general practitioner for a short time, and I dedicated my time to working at the emergency department and intensive care. However, after a while I decided to go back to becoming a GP. My motivation for becoming a GP is that the problems of patients are very diverse, so that I get to deal with a wide variety of health issues. Another reason is that I can be very close to people. I can be involved with them, in their daily life, with their family, and I see them regularly. That is what I especially like about being a GP.

Of course, sometimes doing my job can be hard, because people pass away. Over time one learns how to cope with this. Some people live on in my thoughts, and they stay with me. That is difficult sometimes. On the other hand, it is great that I have helped these people in being as comfortable as possible during their last days. That is what is beautiful about being a GP, and fortunately these aspects overweigh the sometimes difficult side of it.


Seeing people with heart failure
While I was working in the intensive care at the hospital, I witnessed cases where people suffered from severe heart failure. Nowadays, I regularly see people with heart failure, but mostly less acute. Most of these patients are elderly, and after many issues with their heart they have eventually ended up with heart failure. But also relatively young people can have heart failure.

It is difficult for patients to recognize the symptoms of heart failure, since these are often very vague and can also be caused by other diseases. Most of the time patients come with various complaints that together form the picture that we as GPs eventually recognize as heart failure.

There are multiple possible origins of heart failure. It may be caused by a prior heart infarction, but can also be caused by a continuously high blood pressure, congenital disease or lung problems. Heart failure is often a problem that adds to already existing health issues. It is generally hard for patients to deal with, because there is no hope for full recovery. I try to help the patient to keep the disease under control, by means of medication and diet for example.


Living with heart failure

The effect of living with heart failure depends on the patient and his/her lifestyle. When having an active lifestyle, living with heart failure can be seen as a great obstacle. In addition to this, to stay in control, patients should see their GPs regularly and visit the hospital one or two times a year. These visits are really necessary. Furthermore, the patients see general practice nurses, who monitor for instance blood pressure, glucose levels, kidney markers, cholesterol and so on. When any of these tests gives an uncertain outcome, the GP is seen and if necessary the medication is adapted.

In some cases a patient’s life can drastically change when having heart failure. For example in some cases immobile elderly people continue their lives with little adaptation, but young people, who are in the prime of their lives, suffer a considerable handicap. In some cases dreams should be adjusted since living the life you were used to is simply not possible anymore. You can become short of breath, have little air and feel anxious by that feeling. I think it is most important to avoid this feeling of discomfort. This can only be achieved by trying to live as comfortable as possible with as few risks as possible.


Detection of heart failure

In order to detect a possible heart failure, a GP has to think of several test that can be done. The way I see it, one of the best ways is to test for NT-proBNP. The NT-proBNP level gives information about the vehement of heart failure. Briefly you can say that it indicates the strain of the heart and therefore NT-proBNP tests are widely used by GPs. When a patient walks in with all sorts of complaints that refer to lung problems and heart failure, frequently I also decide to test for NT-proBNP. Just to be sure if the complaints result from the lungs or the heart.

If I suspect  heart failure and we test the patient for NT-proBNP, we will know the results of the test four days later. This delay can be too long, definitely if a patient walks in with shortness of breath problems or with already known heart problems. It is also possible to send the blood to the laboratory with high urgency, then the results are known by the end of the day. Unfortunately there is not always someone available to take some blood, then a visit to the hospital is necessary. I think this can be a obstacle when the condition of the patient is already very low due to the heart failure.


The advantages of a biosensor

Like all other diseases, early detection is best for the health of the patient. I often see patients who are short of breath and have all sorts of other vague complaints. It is very difficult to diagnose the disease of which the patient is suffering in this case, because the complaints may refer to all kind of physical failures. Therefore it would be easy if GPs could just test for NT-proBNP and directly monitor the results. With a positive outcome we can start treatment right away, and with a negative outcome we can exclude heart failure. It may also rapidly indicate if a treatment is effective.

A biosensor is also advantageous for the patient. When being able to test fast at the general practice, hospitalization might be prevented. Maybe in the future it would even be possible that a patient tests at home. But this can also lead to problems and we should think carefully about who has the possibilities and responsibilities to test for NT-proBNP and cope with the consequences of the result. Another possibility would be to test NT-proBNP at home and send the results to the GP who can directly monitor the outcome of the test. In that way it is possible to relieve the work of the home carers and give the patient a certain control of the disease.


The SensUs Competition

In my opinion the SensUs Student Competition is a very nice initiative and may lead to a working biosensor. I like the idea that there are teams from all over the world working on something that I might be using in the future. If there would be a good biosensor for indicating NT-proBNP, then I would use this biosensor for testing. I would test for NT-proBNP more frequently because it is fast and easy in use. I am very curious about the outcome of the competition!