The use of compression therapy for peripheral oedema: considerations in people with heart failure

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Compression, Editor's Pick, Heart failure, Oedema

The use of compression therapy for peripheral oedema: considerations in people with heart failure

Supported by Essity

Jacqui Fletcher, Leanne Atkin, Donna Brown, Roo Byrom, Garry Cooper-Stanton, Rebecca Elwell, Sam Haigh, Craig Irvine, Christine Merrick, Tim Houghton

Christine Merrick, Craig Irvine, Donna Bown, Garry Cooper-Stanton, Jacqui Fletcher, Leanne Atkin, Rebecca Elwell, Roo Byrom, Sam Haigh, Tim Houghton

1 June 2023

Heart failure affects an estimated 26 million people worldwide (Ambrosy et al, 2014), and an estimated 920,000 in the UK (Conrad et al, 2018). We are likely to see an increase in these numbers for several reasons: first, heart failure is more common in the elderly as risk increases with age, and – thanks to advances in healthcare and access to good nutrition – people are generally living longer. Due to improvements in emergency medicine and treatment, people are more likely to survive a cardiac event and go on to develop heart failure (Hobbs et al, 2002; Bleumink et al, 2004). Finally, we are seeing in practice an increased number of patients with risk factors for heart failure, such as diabetes, high blood pressure, obesity and social deprivation (Danielsen et al, 2017).

Hospitalisations due to heart failure increased by one-third between 2013 and 2019, three times faster than all other conditions, with patients staying twice as long on average (Blake, 2019). With an already overburdened NHS, it is important to diagnose, treat and manage heart failure and associated symptoms in a timely manner. Diagnosing heart failure typically involves the collaboration of healthcare professionals at all levels to conduct blood tests and refer patients for echocardiograms (Yancy et al, 2013; McDonagh et al, 2021).

Heart failure is a clinical syndrome characterised by a number of clinical signs and symptoms that can vary in severity, including shortness of breath, fatigue and weakness, rapid or irregular heartbeat and oedema. The accumulation of excess fluid in the arms or lower legs is known as peripheral oedema. The prevalence of peripheral oedema in the lower legs is rising globally in the UK and, from a patient perspective, living with oedema can negatively affect the patient’s quality of life and wellbeing. Lymphorrhea and ulceration are common complications of uncontrolled/severe lower limb oedema, leading to high risk of chronic ulceration, patient suffering and financial burden on healthcare systems.

This document will address the use of compression therapy in conjunction with medical treatments to manage lower limb oedema to reduce inflammation and swelling and ultimately accelerate healing. Compression therapy typically involves the use of elastic stockings, bandages or compression wrap devices to reduce excess blood and fluid retention, aid venous hypertension and improve lymphatic insufficiency, helping to reduce oedema and inflammation (Montero et al, 2020).

Compression therapy is the gold standard of care for treating lower limb oedema and ulceration; however, uncorrected knowledge gaps and misconceptions surrounding its use for patients with heart failure can deter healthcare professionals from applying it. This document will also address common misconceptions about compression therapy and provide the information necessary to understand compression therapy’s fundamental principles, as well as the value of a multidisciplinary approach that
ensures that the patient receives the best care possible.

This document was developed with the following overall objectives:

To provide an overview of heart failure and compression therapy as a treatment approach for symptoms of the condition
To assist practitioners in appropriately assessing for, choosing and applying compression therapy when managing a patient with lower limb oedema or ulceration in combination with heart failure
To encourage all clinical and support staff to collaborate in order to provide consistent care to patients with varying degrees of heart failure and oedema/ulceration.

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Disclaimer: This document has been developed by Wounds UK and is supported by an unrestricted educational grant from essity

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Resources

The use of compression therapy for peripheral oedema: considerations in people with heart failure

The use of compression therapy for peripheral oedema: considerations in people with heart failure

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