COVID-19: Advice for individuals living with heart disease or stroke

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

Updated July 20th

Latest developments: 

Moving to phase 4 of the government road map has been paused. As the pandemic accelerates around the world, we must remain vigilant here in Ireland. With the reopening of society, it is important to remember that COVID-19 is a highly infectious disease. The message is to Stay Safe. Physical distancing should continue to be maintained at all times.

Continue to follow good hand washing, respiratory hygiene and physical distancing because we know these work and are even more important than ever. Face coverings are now required on public transport, should be worn in shops and shopping centres and in situations where physical distancing is not possible. If you have cold or flu like symptoms, even mild ones, it is important to isolate at home and call your GP.

Further information on latest updates can be found on the Government website.

  • People over 70 years and the extremely medically vulnerable, who have been cocooning remain at the highest risk of severe illness from COVID-19 and are advised to stay at home as much as possible, and to limit physical contact with other people.
  • It is important that you continue to attend essential medical services such as GPs and receive medical care at home (if appropriate) to protect your health and wellbeing.
  • Limit the amount of time you spend in direct contact with other people, avoiding crowded areas and limiting close contacts to a small number of people. Social visits to people’s homes should be limited to a maximum of 10 visitors – from no more than 4 other households.
  • No more than fifty people may gather socially indoors while maintaining strict social distancing. However, outdoor meetings up to 200 people are preferable to indoor meetings.
  • For further guidelines and information about how to correctly fit/ remove face mask or how to make your own mask visit the HSE website.
    • Facemasks should not be worn by those:
      • aged under 13 years of age
      • who have trouble breathing
      • who are unconscious or incapacitated
      • who are unable to remove it without help
      • with special needs and who may feel upset or very uncomfortable wearing the face covering

The Croi Health team are determined to stay connected with all our groups and supporters and aim to keep you informed and up to date on a regular basis. We will continuously explore the latest evidence on COVID-19 and cardiovascular disease and will share this important information with you.

COVID-19 is a new illness that can affect your lungs and airways. It’s caused by a virus called coronavirus. There is currently no vaccine to prevent COVID-19 and the best way to prevent illness is to avoid being exposed to this virus.

For heart and stroke patients, prevention is key. While it is normal to feel anxious about how this condition might affect you, you are at no greater risk of developing COVID-19 than anyone else. However if you do contract the virus you have a higher chance of developing complications.

Groups that are at risk of more serious illness if they catch coronavirus are:

  • Those aged 60 years of age and over; people over 70 are particularly vulnerable and should cocoon as outlined below.
  • People with a long term medical condition – for example heart disease, stroke, lung disease, diabetes, cancer, kidney disease, liver disease or high blood pressure
  • People who have a weak immune system (immunosuppressed)
  • People who have a medical condition that can affect their breathing
  • Resident of a nursing home or other residential care setting
  • People who are in specialist disability care and are over 50 years of age or have an underlying health problem

Therefore you need to be extra vigilant by following the advice of the HSE, being aware of the symptoms and by taking the recommended precautionary measures. From 30th March this now includes the advice to stay in your own home as much as possible. Staying at home is the best way to minimise the risk of COVID-19 to your friends, families and communities.

Everyone has a role to play in reducing the spread of this virus and if we all take collective responsibility we will minimise the risk for everyone.

Is there any specific advice for individuals living with heart disease or stroke?

As you are at higher-risk of a more serious illness if you contract coronavirus, you are being advised to stay at home as much as possible and to limit your social contact. We strongly urge you to take extra care in ensuring you follow all of the recommended precautions. Please see our advice below on cocooning.

While all individuals with underlying cardiovascular disease are at increased risk of complications if affected by COVID-19, those at greatest risk include individuals who have:

  • Had a heart transplant
    • At any time in the past or more recently.
  • Are pregnant with a heart condition
    • Lung viruses can cause severe illness in pregnant women, particularly those with an underlying heart condition.
    • Heart conditions include symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function), thickening of the heart muscle (left ventricular hypertrophy, pulmonary hypertension, a moderate / severely narrowed or leaking heart valve, heart failure that affects your left ventricular function), or significant congenital heart disease.
  • Had recent open heart surgery
    • Including coronary artery bypass grafts (CABG) and valve repair or replacement.
  • Heart failure
    • Especially if you have been recently diagnosed, it affects your activities of daily living or you have been recently hospitalised for treatment.
  • Heart valve disease
    • Where this is severe disease or you have ongoing symptoms or are awaiting valve surgery.
    • A heart murmur in itself where you do not have symptoms or not diagnosed with valve disease does not increase your risk.
  • Congenital heart disease
    • There are many types but in particular if you have complex disease or have other underlying conditions increasing your vulnerability.
  • Cardiomyopathy
    • Any type if you have ongoing symptoms or your daily activities are limited.
  • Angina
    • That limits your daily activities or means you have to use your GTN spray frequently.
  • Heart disease with other health conditions such as chronic kidney disease and lung disease

With the emphasis being on minimising contact outside the home, it is still important to maintain your healthy lifestyle habits and not to disregard your usual exercise routine. As this may not be possible to continue outdoors please see our website for lots of helpful health tips and advice to keep you on track.

Refill your medication prescription as normal and have over the counter medications such as paracetamol and a thermometer in your home. There is no disruption to the supply of medicines and therefore there is no need to order more medicines than you need. Ask a family member to collect any medicines you need. If you do feel unwell, it’s still really important to carry on taking any medication you’ve been prescribed and speak to your doctor if you have any concerns.

Look after your emotional health and well-being. Any unexpected changes to our daily lives can be a source of stress and COVID-19 is no different. It is important to obtain information from reputable sources and focus on the facts rather than opinions on social media.

Cocooning

What is cocooning?

Cocooning is a recommendation from the HSE and the Irish government to protect those who are most at risk of developing serious complications if they contract the COVID-19 virus. Cocooning aims to minimize interaction between those most at risk and others.

What should I do?

It is advised that you don’t leave your house for the next 2 weeks.

  • This means avoiding face to face interaction.
  • Do not go out shopping for food or medicine. Ask a friend or neighbour to do this for you, or arrange for your shopping to be delivered. Many shops are now offering this service for free. Also many communities have set up support groups to help and support those in need.
  • Ask for your shopping to be left outside at your door.
  • People who visit to help care for you should still attend as long as they have no symptoms of COVID-19. Ask them to wash their hands on arrival and when possible keep 2 meters apart.
  • Avoid anyone who is sick – If you usually have carers, have a backup plan in case one of them becomes unwell.
  • You can ask your family to keep in touch with you via Whatsapp, video or social media so you don’t miss out.
  • You may leave the house to get fresh air or exercise within 5km of your home, if social distancing is observed.
  • If you need to contact your GP use the telephone.

 

Do I need to cocoon?

The HSE have advised the following people to cocoon:

  • people aged 70 years or over;
  • solid organ transplant recipients (including heart transplant);
  • people with specific cancers, rare diseases, respiratory conditions; and
  • women who are pregnant with significant heart disease, congenital or acquired.

 

In addition to HSE recommendations, international cardiac societies advise people living with the following conditions to cocoon:

  • Heart conditions, including symptomatic coronary disease, hypertrophic cardiomyopathy (if it affects your heart function);
  • Had recent open heart surgery;
  • Heart failure;
  • Heart valve disease – that is moderate or severe;
  • Significant congenital heart disease;
  • Cardiomyopathy – any type if you have ongoing symptoms or your daily activities are limited;
  • Those with Angina that limits your daily activities or means you have to use your GTN spray frequently.

What are the symptoms of COVID-19?

The main symptoms to watch out for are:

  • a cough
  • a high temperature
  • shortness of breath
  • breathing difficulties
  • a reduced sense of smell or taste and there is no other obvious cause

Other symptoms are fatigue, headaches, sore throat, aches and pains. But these symptoms do not necessarily mean you have the illness. The symptoms are similar to other illnesses that are much more common, such as cold and flu.

If you are experiencing any of these symptoms and are concerned you should contact your GP for further advice.

How to avoid catching or spreading COVID-19

Coronavirus is spread by droplet infection – coughing and sneezing or by close contact with someone who has the virus. As it’s a new illness, we do not know how easily the virus spreads from person to person. Spread is most likely from those who have symptoms.

Limit close contact

Latest recommendations include the closure of all non-essential retail outlets. People need to stay at home and only leave to:

  • go to work
  • go to the shops for essential supplies
  • care for others
  • for brief individual exercise – within 5 kilometres of your house. (You can bring children but must keep 2 metres away from others for social distancing)

As Ireland has local transmission of the virus, the country has entered the ‘delay phase’ of managing COVID-19.  Physical distancing and avoiding close contact is strongly advised to reduce the spread of coronavirus. Key recommendations are:

  • Avoid hand shaking and close contact with people- keep a distance of 2 meters (6.5 feet) between you and others.
  • Work from home if and where possible.
  • Children should stay at home, but may leave the house to exercise within 5km radius of their house. They should not be meeting or visiting friends or family members.
  • Make a joint plan with family friends and neighbours on what to do if you become ill.

Travel

  • Avoid all non-essential travel.
  • You will need to restrict your movements for 14 days if returning from any other country.
  • You DO NOT need to restrict your  movements if you are returning from northern Ireland or you are an essential supply chain worker such as a pilot, haulier or maritime staff member.
  • Check with the department of foreign affairs for the latest advice before travelling abroad.

Self-quarantine and self-isolation

  • To help stop the spread of coronavirus you may need to either self-quarantine or self-isolate.
  • Self-quarantine means avoiding contact with other people and social situations as much as possible. You will need to do this if you are a close contact of a confirmed case of coronavirus and you are still well.
  • Self-isolation means staying indoors and completely avoiding contact with other people. You will need to do this if you have symptoms of coronavirus.

 

Other Do’s and Don’t’s include:

Do:

  • Wash your hands with soap and water often – do this for at least 20 seconds.
  • Always wash your hands when you get home or into work.
  • Use hand sanitiser gel if soap and water are not available.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.
  • Put used tissues in the bin straight away and wash your hands afterwards.
  • Try to avoid close contact with people who are unwell.

Don’t:

  • Do not touch your eyes, nose or mouth if your hands are not clean.
  • Do not share objects that touch your mouth, for example bottles and cups.
  • Do not shake hands.
  • Don’t have visitors to your home, unless they are helping with your care needs.

Treatment for COVID-19

There is currently no specific treatment or vaccine for COVID-19. The treatment approach involves alleviating symptoms and reducing the risk of others becoming infected. This includes:

  • Getting plenty of rest
  • Staying hydrated by drinking plenty of water
  • Taking paracetamol to help with symptoms such as a high temperature
  • Staying in isolation away from other people until you have recovered

Further information

For further information you can visit the following websites:

  • www.hse.ie
  • www.gov.ie
  • Spunout – Crisis Text Line is a 24/7 messaging support service with trained volunteers available to listen to people going through a tough time. Crisis Text Line provides in-the-moment anonymous support and problem solving when you need it most. Text YMH to 086 1800 280 to begin right now. (Standard SMS rates may apply)

Heart & Stroke Charity says #JustGo if you are having a Heart Attack or Stroke

Today (Monday June 15th, 2020) the Heart & Stroke Charity Croí, launches a national ‘patient-to-patient’ confidence building campaign aimed at saving lives and reducing disability by encouraging those with symptoms of heart or stroke emergency to seek medical help without delay. The #JustGo initiative reaffirms medical advice to always act quickly when it comes to symptoms of a heart attack or stroke. ‘Time is muscle’ – the longer you wait with a heart attack the more damage occurs to your heart muscle or in the case of a stroke, to your brain.

The campaign is in response to the fear of COVID-19, which is keeping almost half of people suffering from a heart attack away from hospitals, and now across the world, doctors are reporting that those who delay in seeking medical help are in a far worse condition when they finally arrive at hospital, and it’s often too late to benefit from the life-saving treatments that are normally available to them.

“It’s one of the unintended consequences of COVID-19 that people suffering heart attacks and strokes are delaying in seeking medical help, resulting in worse outcomes. Also, people living with known heart conditions who are experiencing new or worsening symptoms are delaying too long before calling their doctor or going to hospital,” says Neil Johnson, CEO, Croí.

National Clinical Societies and international organisations such as the World Heart Federation, World Stroke Organisation and the European Society of Cardiology are all united on the important message that ignoring cardiac symptoms or delaying treatment carries the risk of severe complications with long-term negative and potentially life threatening consequences.

Professor Jim Crowley, Consultant Cardiologist, Galway University Hospital and President of the Irish Cardiac Society, says, “In Ireland, there has been a large decrease in cardiac admissions to hospital (across all cardiac conditions), in some locations a decrease of as much as 80%, and there has been a significant decrease in hospital interventions both surgical and less invasive of up to 35% across hospitals. This is very worrying as we know cardiovascular disease has not gone away and the prospect of a surge of patients with advanced cardiac symptoms in the coming weeks and months as an indirect consequence of COVID-19 is concerning.”

Professor Bill McEvoy, Consultant Cardiologist, Galway University Hospital and Research & Medical Director of the National Institute for Prevention and Cardiovascular Health, confirms that he has been seeing patients who left it too late to come into hospital for treatment of a heart attack or stroke. “We have seen severe complications of heart attacks that we haven’t witnessed in decades, from back before the time since we have modern treatments for heart attack. We need to get the message out to patients, loud and clear, that our hospitals are safe and that patients without COVID-19 are being kept separate from patients admitted with COVID-19. We also need to reinforce the longstanding message to patients – act quickly if you have symptoms of a heart attack or stroke.”

Dr Joe Gallagher, ICGP Primary Care Lead for Integrated Care Programmes (Cardiovascular Disease) speaking as a GP says, “It is really important to look after your heart at this time and if you are worried about your heart health talk to your GP.  Don’t delay in going to hospital if you experience symptoms of a heart attack or stroke.”

The #JustGo campaign message is simple and clear – If you are experiencing the symptoms of a heart attack, – Don’t delay – Every minute counts. If you have chest pain or other heart attack symptoms – such as pain in the throat, neck, back, stomach or shoulders that lasts for more than 15 minutes – you must call an ambulance.

Equally, if you are living with an existing heart condition such as heart failure or heart valve disease and if you are experiencing new symptoms, or a worsening of symptoms, you should contact your doctor or go to a hospital as soon as possible. Similarly, for those diagnosed with Familial Hypercholesterolemia (FH) (a genetic condition where the cholesterol level is very high and needs medical treatment to lower it) or for those under the age of 55, having a family member living with FH or multiple family members with a history of heart disease or stroke – don’t ignore the symptoms of heart attack, act quickly.

The #JustGo Campaign hopes to reassure people that the risk of coronavirus infection in hospital has been minimised for patients being admitted with heart attacks or strokes. The campaign also reaffirms that the risk of dying from an untreated heart attack is 10 times higher than dying from COVID-19.

Croí says – If you are experiencing a heart or stroke emergency – this is NOT the time to ‘stay at home’ – when your heart says so, #JustGo

Learn more: www.croi.ie/justgo

The #JustGo Campaign is endorsed by:

The National Heart
Programme Ireland

Irish Cardiac Society
European Atherosclerosis Society

Part of a global initiative by the Global Heart Hub in collaboration with FH Europe.

Supported by:

World Heart Foundation

Croí Connects – Your questions answered

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Welcome to Croí’s weekly Q&A series, Croí Connects

Through this new series, Croí will connect with medical experts each week for a questions and answers session to help answer your questions on heart disease, stroke, COVID-19 and lots more. Our Croí Connects video series will be shared here and on our Facebook page.

Each week we will announce our upcoming guest expert on Croí Connects. You are invited to submit your questions the week in advance. Your questions can be submitted using the form below, or you can call Croí on 091-544310.

Stay tuned for our next Croí Connects!

Croí Connects: Patricia Hall and Dr. Darren Mylotte (July 30, 2020)

Croí Connects: Denise Dunne and Dr. Jenni Jones (July 17, 2020)

Croí Connects: Prof. Francis Finucane and Irene Gibson (July 3, 2020)

Croí Connects: Patricia Hall and Norma Caples (June 5, 2020)

Croí Connects: Irene Gibson and Prof. Sean Dinneen (May 22, 2020)

Croi Connects: Patricia Hall and Sarah Molloy (April 24, 2020)

Croí Connects: Suzanne Seery and Irene Gibson (April 17, 2020)

Croí Connects: Prof. Bill McEvoy & Irene Gibson (April 10, 2020)

Croí Connects: Patricia Hall and Trish Galvin (May 7, 2020)

Croí Responds to COVID-19 in the West of Ireland

New Service Launched for Heart & Stroke Patients & Carers

Local Heart & Stroke Charity Croí is responding to the increased needs of those living with heart disease and stroke, as a consequence of COVID-19. Since the beginning of the coronavirus crisis, Croí has been experiencing an ever-increasing demand for information, support and advice from heart and stroke patients and their carers.

“Our health team of community nurses, dietitians, physios and exercise specialists are receiving phone calls, emails and significantly increased web and social media correspondence from all over Ireland – with the greatest demand being from the west of Ireland” says Croí CEO Neil Johnson, who outlined the reasons for this as:

  • Increased fear, anxiety and worry among heart patients and their families due to their increased vulnerability to COVID-19.
  • Increased need for reliable information and reassurance from a healthcare professional.
  • Increased isolation and loneliness.
  • Reduced access (perceived and real) to GP’s, or community health services.
  • Reduced access to services (e.g. cardiac rehabilitation, heart failure nurse specialists etc.) due to redeployment of HSE staff or postponement of services.
  • Cancelled or postponed clinic appointments or hospital procedures.
  • Reduced quality time with doctors or nurses – quicker discharge from hospital; shorter appointments (e.g.: virtual clinics).

“Many people are afraid to visit their doctor or hospital, despite having symptoms that warrant attention and this will lead to adverse or worse outcomes,” said Johnson.

With funding support from local and national healthcare companies, Croí has launched a new community support service across the West of Ireland – Heartlink West – with endorsement from the cardiology services of the Saolta Group.

Announcing details of this new initiative, Croí CEO Neil Johnson said that: “Heartlink West will provide FREE support from our community based, multi-disciplinary health team, led by three highly-experienced cardiac nurse specialists. Concerned individuals can connect with us through a telephone helpline and daily ‘virtual health chats’. Those who call the helpline can speak with Nurses, Dietitians, Physios and Exercise Specialists. For the duration of the current crisis, we aim to provide this FREE service, Monday to Friday from 09:30 -17:30.”

Heartlink West has been made possible thanks to the support of several generous donations from regional and national companies. To learn more about this initiative or for ways to support us please visit www.croi.ie/heartlinkwest.

HeartLink West is available Monday – Friday from 9:00am – 5:30pm. Call 091-544310 or email healthteam@croi.ie.

Advice For Individuals Recovering From A Recent Cardiac Procedure

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Due to COVID-19, people admitted to hospital for cardiac care are being discharged quickly to reduce their possible exposure to infection. The consequences are that many patients and carers are not getting adequate time with doctors and nurses to understand their condition and its treatment. The following information has been developed specifically for patients who have just been discharged from hospital post a cardiac procedure.

It is important to remember that our hospitals will continue to treat heart patients where urgent emergency dictates. If you have symptoms that could be a heart attack or stroke, or if your heart symptoms get worse you should still call 999 for immediate assistance

WHAT SHOULD I DO IF I HAVE RECENTLY HAD OPEN HEART SURGERY INCLUDING HEART BYPASS AND HEART VALVE SURGERY?

Patients who have recently had surgery have an increased risk of infections due to cuts/incisions which may be exposed to germs. The normal risk of infection for open heart surgery patients is low, but in the current situation you should take every extra measure to limit your risk of infection.

It is important to keep the wound site clean and dry. Observe for any signs of infection such as, redness around the wound, discharge from the wound which may be evident on the dressing, and pain or swelling around the wound site.

Your medical team will have advised you on your expected recovery before being discharged home. This includes making sure you take lots of rest in the first 2 weeks following surgery. In this time, you should continue to do gentle exercise around your home and garden. You should avoid leaving your house and follow the COVID-19 recommendations on the website around cocooning.

You should eat a healthy, well balanced diet to boost your healing and recovery.

If you do begin to feel unwell you should contact your GP, hospital medical team or call the emergency services.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD A TAVI?

A TAVI (Transcatheter Aortic Valve Implantation) is a procedure that is used to replace the aortic valve. It is generally performed under local anaesthetic, but sometimes under general.

TAVI is a less invasive approach which allows the replacement aortic valve to be inserted via a catheter usually through a small incision in the groin. TAVI is now a recommended, safe and cost-effective alternative to open heart surgery for patients with severe symptomatic aortic stenosis not just at high-risk, but also at low and intermediate-risk of surgical complications.

If you have recently had a TAVI procedure, you have heart valve disease. This places you at higher risk of developing complications if you catch the COVID-19 virus.

On average it takes 2-3 months to recover fully from a TAVI procedure. Cocooning is advised to individuals who have had this procedure within this time frame.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD an Angiogram or Angioplasty?

Individuals who have recently had an angiogram or an angioplasty (plus or minus stents) are usually discharged from hospital the same or following day.

You can return to light duties within a few days and are usually safe to drive a week after the procedure. We would recommend against this at present due to the increased risk of exposure to the COVID-19 virus.

Heavy lifting should be avoided while the artery is healing. If you have had an emergency angioplasty, i.e due to a heart attack you will need to take a few weeks off work and follow the advice around cocooning. For more information on advice following a heart attack click here.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes worse or red and painful contact your GP via the telephone, for further advice.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a cardiac device implanted?

There is no evidence that the COVID-19 virus infects any type of implantable device, such as a pace maker or defibrillator. These devices can help stabilise your heart condition.

If you have recently had an ICD (Implantable Cardiac Defibrillator) or PPM (Permanent Pace -maker) fitted you should avoid heavy lifting and pulling with the affected arm for the first 4-6 weeks. This gives the device and leads a chance to settle in.

If you were advised that you had stitches in the wound site, you should still attend your GP or practice nurse to have these removed. Be sure to phone first to arrange an appointment.

You may have been told you will also need to have your device checked. This is usually around 6 months after insertion. You will be contacted by the cardiology department of your local hospital if this affects you. You may also have been set up with remote patient monitoring.

You may or may not notice when your ICD has delivered treatment, as this can vary from person to person. It can range from a fluttery feeling in the chest to an incredibly painful thump in the centre of the chest. It may be accompanied by feeling dizzy or faint.

If you experience this, you should contact your cardiac investigation team. If you continue to feel unwell after having a shock delivered you should contact the emergency services immediately.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a Cardiac ablation?

Ablation is a treatment used to treat some arrhythmias (abnormal heart rhythms). If you have recently had an ablation you may continue to have some symptoms such as palpitations following the procedure. This is very common and you shouldn’t let it concern you. It is usually takes 8-10 weeks following the procedure for doctors to determine if it has been successful.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes red and painful contact your GP via the telephone, for further advice.

Due to the COVID-19 pandemic it is unlikely you will have you’re follow up within 8-10 weeks. You will still be seen in your local hospital but it is likely it will be delayed. This is to keep both you and the medical staff safe. Until you have been reviewed by your consultant you should continue to take your medication, and contact your GP by telephone if you have any concerns.

Diet and Immune System

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Can diet help ‘boost’ our immune system to fight COVID-19?

While it is true that poor nutrition can hamper your ability to fight off illness and infection, it is misleading to think that a special food, nutrient or supplement can “boost” your immune system. There are many products being heavily promoted as “immune boosters”, however immunology is complex and there are no supplements or natural health products approved to treat or protect against the COVID-19 virus.

Alongside a healthy sleep pattern, regular physical activity and stress management strategies, now more than ever is a good time to develop a healthy eating routine.

A Balanced Diet

Following the key points below for a healthy balanced and varied diet with adequate energy and protein intake is important to best support your immune system and overall heart health.

  • Aim for 5 – 7 portions of fruit and vegetables per day (aim to include at every meal)
  • Choose brown and wholegrain versions of carbohydrates
  • Include 2 servings of lean protein per day e.g. fish, lean red meat and poultry, peas, beans, lentils and eggs)
  • Stay hydrated with water as your main fluid source
  • Limit high sugar/fat/salt foods to a few times per week

Below, we will take you through some of the key nutrients found in a balanced diet one and highlight the role they pay in supporting your immune system to work properly.

Click the image to download the Healthy Ireland Food Pyramid.
Click the image to download the Healthy Ireland Food Pyramid.

7 key nutrients for a healthy immune system

Protein is important for many bodily functions such as healing and repair and maintaining healthy muscle mass. It also has a role in the formation of antibodies that fight infection and disease.  Protein foods can be animal based such as meat, fish, poultry, eggs and dairy or plant based such as peas, beans, lentils, tofu and nuts. Vary your protein sources, choose lean meats and poultry and limit processed red meats to keep your diet low in saturated fat. Include fish twice a week one of which is oily such as salmon, mackerel, trout or sardines (tinned or fresh).

1

This vitamin is ace at supporting your immune system! It helps maintain the structure of the cells in the skin, respiratory tract and gut. It acts as an anti-oxidant which is kind of like anti-rust protection for our bodies cells, keeping them strong and ready to fight infection. Beta-carotene which is converted to vitamin A in the body is found in leafy greens, yellow and orange vegetables like pumpkin and carrots.

2

Vitamin E is also a powerful anti-oxidant and is found in green leafy vegetables such as spinach and broccoli. It is also found in avocados and vegetable oils such as sunflower and rapeseed oil and nuts and seeds including: almonds, hazelnuts and pumpkin. Why not try adding a handful of nuts or seeds to your cereal or using rapeseed oil in cooking and salad dressings.

3

Habitual vitamin C supplementation may help with the common cold by reducing severity and duration (>200mg/day) however we don’t know if this transfers to viruses. The recommended daily allowance (RDA) of vitamin C for most adults is 80mg which is easily achieved through a balanced diet. Foods rich in vitamin C include bell peppers, citrus fruits, broccoli, Brussels sprouts and berries. Fresh and frozen are equally as nutritious. While vitamin C supplementation up to 1000mg/day won’t do you any harm, excess consumption can result in stomach pain and diarrhoea.

4

Vitamin D works with calcium and phosphorus for healthy bones, muscles and teeth. Vitamin D also helps to regulate our immune responses and a recent review of the research found that vitamin D supplements can help protect against acute respiratory infections, particularly among people who are deficient.

This is one vitamin where supplementation is recommended, although we can make vitamin D in the skin through direct sunlight, in Ireland the sunlight isn’t strong enough between March and October. We can get some vitamin D from diet as it is found in foods such as eggs, salmon and fortified milk but typically we don’t consume enough of these foods to meet our needs. Taking a 10 micrograms per day supplement is recommended for adults and children over the age of one year. With the social isolation precautions our time outdoors may be restricted a bit more and so supplementation is more important than ever.

5

Zinc helps the immune system to work properly and plays a role in wound healing. The immune system works well when we consume the recommended daily allowance of zinc which is 10mg / day. It is rare to be deficient in zinc as it is present in a wide range of foods including; lean meat, poultry, seafood, milk, whole grain products, fortified breakfast cereals, beans, seeds and nuts.

6

Selenium is involved in the normal function of the immune system. Good sources include Brazil nuts (5-6 Brazil nuts provide an adults daily needs) fish and seafood, brown rice, baked beans, sunflower seeds and oats are also good sources.

7

Most importantly, please remember that correct and frequent hand washing is your first line of defense and to continue to physically distance yourself as much as possible to break the chain of transmission. For more information check out the HSE website.

COVID-19: Advice for individuals living with Heart Failure

This advice is based on information from the Heart Failure Patient Council of the Global Heart Hub. Croí is a member of the Global Heart Hub.

Covid-19 presents the world with an unprecedented public health challenge. Its rapid spread has caused significant alarm and disruption across the globe. Understandably, those living with heart disease and heart failure are anxious and concerned.

It is well established that many virus infections can affect the heart, and experts suspect that coronavirus is no different. Viruses are known to induce inflammation of the myocardium (heart muscle). While in a healthy patient this may not lead to an adverse outcome, the situation for those living with heart disease and heart failure is different. Evidence suggests that if these individuals become infected with coronavirus they are at greater risk of adverse cardiac events and the outcomes may be poor.

COVID-19 is a new illness that can affect your lungs and airways. It’s caused by a virus called coronavirus. With the number of cases around the world increasing on a daily basis, hospitals are experiencing an unprecedented increase inpatient admissions. Consequently, hospitals are cancelling clinics and l non-urgent activity.  Only urgent and emergency cases are being treated to reduce the strain on staffing and beds, and prevent vulnerable patients being exposed to the COVID-19 virus unnecessarily.

It is important to remember that hospitals will continue to treat heart patients, but the current pressures may result in delays, cancellations of appointments and disruption of services. The decisions on who will be treated will be based on clinical need, with those in most need of treatment being prioritised.

For further information on COVID-19 virus and symptoms see Croí’s advice here.

 

Staying well

For those living with Heart Failure:

  • Take all your medicines as advised by your doctor or nurse.
  • Do your best to follow all your medical advice on how to keep your condition well controlled.
  • Continue to self-monitor your condition and record your weight on a daily basis (first thing after you get out of bed in the morning).
  • Stay in regular contact with family, friends or neighbours as you may need to ask for help if you become sick.
  • Maintain a healthy diet – unless you have been advised to adhere to a specially prescribed diet, you should continue to try and eat a wide variety of foods that are rich in vitamins, minerals, fibre and other essential nutrients.

For Family and Caregivers:

  • Know what medications are prescribed and make sure supplies are secure.
  • Watch for new symptoms.
  • Prepare a plan to make sure food and other supplies are available when needed.
  • Consider options and have a plan for what would happen if you become ill.

 

What should I do if I experience gradual or persistent worsening symptoms of Heart Failure, such as my weight increasing or my legs swelling?

Self-monitoring of your condition on a daily basis is very important. It is equally important that you take your daily medicines as prescribed by your doctor.

If you experience any of the following worsening of symptoms, you should contact your GP, if available your Heart Failure Nurse or your local Heart Failure Clinic for advice and review of your medication. Due to the outbreak of COVID-19 many hospital staff have been redeployed. If you are unable to contact you heart failure nurse or team please contact your GP or local emergency department if you are concerned.

Worsening symptoms to look out for:

  • Weight increase greater than 3lb overnight or 5 lb (2kg) in a week .
  • Increased swelling in the legs or abdomen.
  • Increased shortness of breath on exertion, lying down or in bed at night.

If you have very sudden or very severe symptoms call for an ambulance so that you can be taken to hospital for treatment as soon as possible.

 

STAY CALM!

It is perfectly understandable that people may be feeling anxious or concerned about what might happen to them or their loved ones over the coming months. However, we must remind ourselves that this crisis will end. Only seek information from reliable sources – there is a huge amount of ‘fake news’ and false rumours which do nothing more than cause unnecessary anxiety and distress.

Already many heart patients are slow to respond to changes in their health or they are dismissing new symptoms because they do not wish to burden their doctor or local hospital. Despite the Covid-19 crisis, doctors and emergency rooms are still there to help heart patients so do not ignore worrying symptoms or delay in contacting them if you are unwell. Keep up to date with your local health information notices on how best to contact your GP or Heart Failure Nurse.  The Heart Failure Patient Council of the Global Heart Hub are being advised by medical and public health experts and we will keep you updated on any changes in information that could affect those living with Heart Failure.

 

See Croí’s health page for more information on heart failure.

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

COVID-19: Advice for individuals with Heart Valve Disease

People living with moderate or severe heart valve disease are at increased risk of complications if affected by COVID-19. Those at greatest risk are individuals with severe disease, significant ongoing symptoms or awaiting valve surgery.

It is important to remember that hospitals will continue to treat heart patients, but the current pressures may result in delays, cancellations of appointments and disruption of services.

This advice is based on information from the Heart Valve Disease Patient Council of the Global Heart Hub. Croí is a member of the Global Heart Hub.

What should I do if I am due to have heart valve surgery or have a heart valve procedure?

If you are due to have surgery you should continue to prepare for it unless told otherwise by your clinician. If your surgery is rescheduled for a later date you should monitor your symptoms closely. If your symptoms get worse and you begin to feel unwell you should report this to your GP, call your hospital medical team or in severe cases, call the emergency services.

 

What should I do if I have recently had heart valve surgery or a heart valve procedure?

Patients who have recently had a procedure have an increased risk of infections due to cuts/incisions which may be exposed to germs. The normal risk of infection for heart valve disease patients is low, but in the current situation you should take every extra measure to limit your risk of infection. If you do begin to feel unwell you should contact your hospital medical team or call the emergency services.

 

How do I reduce my risk of contracting the COVID-19 virus:

There is currently no vaccine to prevent COVID-19 and the best way to prevent illness is to avoid being exposed to this virus. As you are at higher risk of a more serious illness if you contract coronavirus you are being advised to stay at home as much as possible and to limit your social contact.

We strongly urge you to take extra care in ensuring you follow all of the recommended precautions.

You need to be extra vigilant, be aware of your symptoms and take the recommended precautionary measures by physically distancing.

 

What are the symptoms of COVID-19?

For further information on COVID-19 virus and symptoms see Croí’s advice here.

If you are experiencing any of these symptoms and feel you need medical help, you should follow the guidelines issued by your health authority on how best to seek medical help.

Any heart valve patient with progressive or new onset symptoms, particularly syncope (fainting, ‘passing out’ or collapse) should contact their doctor immediately.

See Croí’s health page for more information on heart valve disease.

The Croí Health Team is here as always if you need support. Contact us by email at healthteam@croi.ie or call 091-544310.

Looking after your emotional health & well-being

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It is normal to feel concerned about COVID-19. Being asked to avoid and reduce human contact, to socially distance ourselves and to self-isolate goes against human nature. It is the opposite of what humans want to do in a crisis. This can affect your mental and physical health. However, there are many things you can do to mind your mental health and it is important to stay positive and focus on what can you do rather than what you cannot.

Firstly, being aware of your own emotions addressing how you think and feel, will help you in coping. Over the coming days, weeks and months people’s lives will change, but it is important to keep things in perspective as this will pass.

You may notice feeling

  • increased anxiety
  • feeling stressed
  • finding yourself excessively checking for symptoms, in yourself, or others
  • becoming irritable more easily
  • feeling insecure or unsettled
  • fearing that normal aches and pains might be the virus
  • having trouble sleeping
  • feeling helpless or a lack of control
  • having irrational thoughts

People with cardiovascular disease

People who have cardiovascular disease or who have experienced a stroke may be more likely to experience anxiety or stress in relation to the outbreak of COVID-19 virus. There are many reasons for this, such as the fact that you are in the at risk group for COVID-19 virus. You are at no greater risk of developing COVID-19 than anyone else. However, if you do contract the virus you have a higher chance of developing complications. 

Although the link between stress and the risk of heart disease and stroke is not well understood, we do know that stress can increase your blood pressure, impact on the blood clotting mechanism and result in people leading an unhealthy lifestyle. For example as a coping mechanism people are more likely to increase their caffeine intake, smoke, drink more alcohol and be less active when they are stressed.

If you have heart disease, being anxious or stressed may bring on symptoms like angina (chest pains).  If you do experience chest pains, please do not delay in calling 999 or 112. The emergency departments are still open for business as are all hospitals.

It isn’t possible to avoid stress completely but we can change the way we cope with it, particularly with of the outbreak of COVID-19 and the imposed control measures. 

Our top 5 recommendations for reducing stress and anxiety:

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1. Stay connected

Social support is proven to be an important factor in protecting our mental health against negative feelings. Stay in touch with friends and family using mobile technology such as WhatsApp, Skype and video calls. Telephone, text and email. Check in on elderly and vulnerable neighbours. Remember you don’t have to appear strong and try to cope with things on your own. Speaking to others and talking things through can reduce anxiety and worry.

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2. Limit your exposure to media

The constant stream of updates and news about COVID-19 can be overwhelming and cause increased anxiety. It can be difficult to separate facts from fiction. Use only trustworthy and reliable sources such the HSE and the Department of Health. Try to limit social media usage, set yourself times during the day to check for updates. If you are finding the COVID-19 coverage upsetting or too intense talk it through with a friend or family member. Remember much of the information online is driven by people’s personal opinion’s, beliefs and agendas and it may not be helpful for you to take these on as your own right now.

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3. Get a good night’s sleep

Sleep is closely linked to our mood and mental health, sleep disruption and poor quality sleep can negatively impact on your mood. Try to maintain regular sleep patterns it can be unhealthy to fall into bad habits such as going to bed later and getting up later. Changes to your sleep pattern now could impact on your mood in the weeks, months ahead. Try to maintain a routine scheduling daily activities throughout the day such as exercise and relaxing activities. If worrying feelings or thoughts are preventing you from achieving good quality sleep, try talking them through with someone.

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4. Maintain a healthy routine

Your normal daily routine may be affected by COVID-19, but trying to keep some structure will help. Pay attention to your needs and feelings during this time especially during times of stress. You may still be able to do some of the things you enjoy and find relaxing. For example this may include regular exercise, practicing relaxation techniques or reading a book. Try Chair Yoga with our incredible instructor, Vicky Harkin!

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5. Practice self-care

In times like this with the outbreak of COVID-19 we have a responsibility to ourselves to practice self-care. If we don’t practice self-care we will be of less use to ourselves and to others. Examples of self-care include:

  • cooking healthy nourishing meals
  • allowing yourself time to engage in the things you enjoy
  • taking time to relax
  • setting boundaries – such as saying no to visitors and reducing demands on yourself to prevent burn out
  • Practice mindfulness, meditation, walking or baking- small changes that you will be able to continue with post COVID-19

Try to keep things in perspective, things will get better.

Prioritise COVID-19 testing for patients with underlying conditions

The Irish Platform for Patients, Science and Industry (IPPOSI) calls on the HSE and GPs to prioritise COVID-19 testing for patients with underlying conditions and urges the public not to flood new testing centres unnecessarily.

Last week the HSE announced that it will be rolling out large scale Covid-19 testing throughout Ireland from Monday 16th March. The Irish Platform for Patients, Science and Industry (IPPOSI) says patients with underlying conditions want the HSE and GPs to prioritise testing for them, their families and carers. IPPOSI also calls on the public to act responsibly and not to flood new testing centres and GP surgeries unnecessarily with requests for testing.

Patients with chronic conditions are at particular risk of serious illness and death from COVID-19. It is essential that these people are diagnosed quickly and treated immediately and early testing for this community is essential.

Derick Mitchell, CEO of IPPOSI, urges the public to heed government advice on identifying the symptoms of COVID-19, namely having a cough and high temperature, and not to unnecessarily flood GPs and testing centres with requests for testing. “Our patient organisations tell us that their members our increasingly worried about accessing testing with many people self-isolating from family members already while they wait for access to testing.”

IPPOSI says that patients need advice that is targeted at the high risk and vulnerable groups rather than generic help line information currently available. Not only are high risk groups worried about contracting COVID-19 but they are also concerned about the impact on their regular treatments and medicines.  IPPOSI is calling for the following:

  • More streamlined and standardised communication process between the HSE, CHOs and Service Provider organisations as the situation escalates and regular services are impacted.
  • Dedicated contact points be identified within the Department of Health and HSE to ensure effective flow of information with patient organisations and to answer their concerns

IPPOSI also highlights the fact that information overload and false information is causing unnecessary worry and confusion amongst the High Risk Covid community. It urges members of the High Risk Covid community to follow the following guidelines:

  • The patient organisation for your specific disease should be your main information point. Patient organisations are open and are providing timely information updates for their communities regarding COVID-19.
  • Patient organisations are working with their respective clinical programmes and medical advisors in relation to condition-specific information of relevance to their members.
  • If you are worried about prescription medicines supply, please contact your local pharmacist for information. They are the experts in relation to supply of medicines.
  • IPPOSI as a partnership of patient organisations, science and industry is in an unique position to provide updated and reliable information through our Twitter account (@ipposi) & website ipposi.ie and we encourage people to follow these channels.

IPPOSI Chairperson, Ava Battles of MS Ireland added:

“We welcome the work of the National Public Health Emergency Team on COVID-19, in particular the engagement with patient groups and the subgroup for vulnerable people.  It is critical that these engagements provide leadership bringing clarity to the specific issues faced by both patient organisations and vulnerable groups and supports the roll-out of critical responses.

Croí is a proud member of IPPOSI.