A new Best Practice Statement has just been launched, tackling a subject that many of us at Legs Matter grapple with. Titled: The Use of Compression Therapy for Peripheral Oedema: considerations in people with heart failure. This Best Practice Statement has been produced for healthcare professionals. But whether you’re an academic, clinician or patient just short on time, this article explores the current issues and provides some much needed direction on care delivery.
The use of compression therapy in heart failure patients is a topic many healthcare professionals have reservations about, with many myths existing, centred around a fear of overloading a patient’s heart.
Legs Matter was happy to partner with Essity for a webinar to discuss this subject, which you can view on their website. You will need to sign up for their free clinical education system PATH to access the recording if you are not already a member, but it is free of charge.
Follow the link to the recording of the webinar on PATH – you will be prompted to log in or register
Problem with the language surrounding heart failure and compression therapy
The language we use of heart failure can be misleading and often is unhelpful when considering compression therapy. It is important that all clinicians treating patients with heart failure have an understanding of what chronic heart failure really means.
In heart failure the heart doesn’t totally fail; instead, it loses some of its functionality and is therefore unable to effectively pump blood around the chambers of the heart or the body. Heart failure is classified in terms of its clinical symptoms. The management of heart failure is complex and should involve a specialist practitioner. Oedema, especially lower limb oedema, is one of the fundamental features of heart failure. So, when thinking about using compression therapy in a person with heart failure there needs to be a simple understanding of what heart failure isand what the extra pressure of the limb emptying impacts on the heart and the person.
Can you apply compression therapy to someone with heart failure?
Commonly compression therapy is not routinely offered to patients with oedema due to heart failure. This is due to the fear that applying compression to the lower leg will overload the heart. However, this is no published medical evidence to support this fearThis is why we need this Best Practice Statement and consensus on how best to manage patients with heart failure and lower limb oedema safety. The majority of patients with heart failure and lower limb oedema will benefit from compression therapy, as will help to reduce discomfort caused by the swelling, will increase mobility as the legs will not feel as heavy and it will also decrease the risk of the patients developing blistering, weeping or ulceration.
Compression therapy is an highly effective solution to help improve the efficiency of the blood being return from the lower legs of patients with conditions associated with venous hypertension / insufficiency and other related health conditions. It is also great for reducing inflammation and swelling by preventing blood and fluid congestion within the capillary bed. The effects of compression therapy can be significant, reducing oedema, risk of cellulitis and pain while also promoting the healing of ulcers. Compression therapy also doubles up as a potent anti-inflammatory device that works by decreasing venous pressure in the legs while improving venous return to the heart.
Other benefits of compression therapy include significant improvements to a patient’s quality of life, with relieved lower limb symptoms and reduced pain.
Who should not use compression therapy?
There are only a small number of patients who are not suitable for any form of compression therapy. These are patients who are suffering from acute decompensated heart failure and those where there is a sudden deterioration of condition directly due to an exacerbation of heart failure.
For these patients we shouldn’t be thinking about compression therapy at this point in time and instead concentrate on ensuring they receive the right care to help stabilise their condition, these patients should be urgently escalated to an appropriate clinician who is able to manage this acute heart failure.
Acute decompensated heart failure is defined as deterioration of any of the following red flags in the last seven days :
- Increasing breathlessness (either at rest or on exertion)
- Presence of truncal oedema
- Increased reports of waking up due to breathlessness
- Inability to lie flat due to breathlessness
- Rapid increase in weight
Living with heart failure and using long term compression
Patients with heart failure are at risk of developing lower limb oedema, and it is important that health care professionals act as soon as the oedema occurs. Unmanaged lower limb oedema increases the risk of permanent changes to the shape and/or appearance of the skin and increases the risk of cellulitis, skin blistering or weeping, and ultimately ulceration.
When oedema occurs, this needs to be appropriately managed with compression therapy. For many patients with heart failure, compression therapy will be a vital aspect of their holistic care. It is important to remember that apathy is not harm free, and watching patients limbs increase in size, the limbs starting to leak and the impact on their lifestyle is harmful to that patient. We need to ensure patients are able to access optimal compression therapy to effectively manage their symptoms and decrease the risk of secondary complications.
Related resources
Talk to someone
You can call the British Heart Foundation’s heart helpline on 0300 330 3311 to find out about support groups in your area.
Best practice statement published by Wounds UK & Essity
Anyone can read and download this Best Practice Statement, but it is written for healthcare professionals so some of the language may feel more complex. You can always use our handy glossary to help if needed.
Supporting resources
Legs Matter has a range of films, patient leaflets and clinical evidence ready for you to use.
