心不全は、管理を続けることが最も重要な病気です

心不全は、心臓のポンプ機能が低下し、全身に十分な血液を送れなくなる状態です。息切れ・むくみ・体重の急増・疲れやすさといった症状が現れ、悪化すると入院が必要になります。日本では現在約120万人が心不全と診断されており、高齢化に伴いその数は増え続けています。

心不全の最大の特徴は、適切に管理すれば症状を抑えて安定した生活を続けられる一方、管理が乱れると短期間で急激に悪化するという点です。体重が2〜3日で2kg以上増えた、足のむくみが強くなった、少し動いただけで息が切れる——こうした変化のサインを早期に捉えることが、入院回避の鍵です。

そのため、「外来受診が難しくなった」という状況でも、定期的な医療管理を絶やさないことが何より大切です。そのための選択肢が、在宅診療です。

在宅診療で心不全を管理する

心不全の在宅管理では、毎回の訪問で以下を確認します。体重の変化（2〜3日で2kg以上増えていないか）。足首・すねのむくみの程度と性状。安静時・労作時の息切れの変化。血圧・脈拍・酸素飽和度。服薬状況と副作用の有無（特に利尿薬の効果）。

こうした評価をもとに、アンジオテンシン受容体ネプリライシン阻害薬・β遮断薬・SGLT2阻害薬・ミネラルコルチコイド受容体拮抗薬・利尿剤などの薬剤を細かく調整します。「ちょっとむくんできたな」という段階で利尿効果のある薬剤を調整できれば、入院を回避できることが多いです。外来通院では月1〜2回の受診が限界ですが、在宅診療では電話相談も含め、状態変化に迅速に対応することができます。

在宅酸素療法・NIPPV・CPAPも自宅で継続できます

心不全が進んだ方の中には、在宅酸素療法（HOT）や非侵襲的陽圧換気療法（NIPPV）が必要な方がいます。これらの機器を使いながら自宅で療養されている方も、在宅診療の中で継続的に管理します。機器の設定確認・症状の変化への対応・機器メーカーとの連絡調整も、担当医師が行います。

また、睡眠時無呼吸症候群（SAS）は心不全を悪化させることが知られています。SASがあると、夜間の低酸素状態が繰り返され、心臓への負担が増大します。CPAP療法を継続されている方についても、在宅診療の中で機器管理を続けることができます。SASの適切な治療が心不全の管理改善につながることが、複数の研究で示されています。

心不全増悪のサインを知ってください

心不全の在宅療養では、患者さんご自身とご家族が「悪化のサイン」を知っておくことが重要です。以下のような変化があった場合は、すぐに担当医師に連絡してください。2〜3日で体重が2kg以上増加した。安静にしていても息苦しい。夜間に息苦しくて目が覚める。足のむくみが急に強くなった。食欲が著しく低下した。意識がぼんやりする。

こうした変化を在宅診療医に早めに伝えることで、外来受診や入院を避けながら自宅での治療継続が可能になります。

「入院を繰り返したくない」という気持ちに応えたい

心不全で何度も入院を繰り返している方やそのご家族から、「もう入院したくない」「できるだけ家で過ごしたい」という言葉をよく聞きます。その気持ちに応えるために、在宅診療では状態の変化を早期に捉えて先手を打つことを心がけています。

心不全の管理に必要なことは、診察室でもご自宅でも変わりません。循環器専門医が定期的に訪問し、状態を継続的に把握する——それが在宅での心不全管理の基本です。ご本人・ご家族どちらからのご相談も歓迎します。

ご相談やお問い合わせは、お電話・受付窓口にて承っております。
詳しくは、在宅診療のページをご覧ください。

大林賢史
Kenji Obayashi, MD, PhD
　医師の研究者プロフィールはこちら

　
　
　
　
　
　
　

Heart Failure and Home Medical Care — Continuing Treatment Safely at Home

Heart Failure Is a Condition Where Ongoing Management Matters Most

Heart failure is a condition in which the heart’s pumping function declines, leaving it unable to deliver enough blood throughout the body. Symptoms such as shortness of breath, swelling (edema), rapid weight gain, and fatigue appear, and when the condition worsens, hospitalization becomes necessary. In Japan today, approximately 1.2 million people have been diagnosed with heart failure, and this number continues to rise as the population ages.

The defining feature of heart failure is this: with proper management, symptoms can be kept under control and a stable life maintained—but when management breaks down, the condition can deteriorate rapidly over a short period. A weight gain of more than 2 kg over two to three days, worsening swelling in the legs, becoming short of breath after only slight exertion—catching these warning signs early is the key to avoiding hospitalization.

For this reason, even in situations where “getting to outpatient appointments has become difficult,” maintaining regular medical management without interruption is more important than anything else. Home medical care is one option for achieving exactly that.

Managing Heart Failure Through Home Medical Care

In home-based management of heart failure, the following are checked at each visit: changes in body weight (whether it has increased by more than 2 kg over two to three days); the degree and nature of swelling in the ankles and shins; changes in shortness of breath at rest and on exertion; blood pressure, pulse, and oxygen saturation; and medication adherence and the presence of any side effects (especially the effectiveness of diuretics).

Based on these assessments, medications such as diuretics, ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists are fine-tuned. If diuretics can be adjusted at the stage when swelling is just beginning to appear, hospitalization can often be avoided. While outpatient visits are limited to once or twice a month, home medical care—including telephone consultations—allows for a rapid response to changes in the patient’s condition.

Home Oxygen Therapy and NIPPV Can Also Be Continued at Home

Among those whose heart failure has advanced, some require home oxygen therapy (HOT) or non-invasive positive pressure ventilation (NIPPV). Patients who are recovering at home while using this equipment can also be continuously managed through home medical care. The attending physician handles checking the equipment settings, responding to changes in symptoms, and coordinating communication with the equipment manufacturer. For those who feel they “can’t get to outpatient appointments because of the equipment,” home medical care can be especially helpful.

In addition, sleep apnea syndrome (SAS) is known to worsen heart failure. When SAS is present, repeated episodes of nighttime low oxygen levels increase the strain on the heart. For patients who are continuing CPAP therapy, equipment management can also be maintained through home medical care. Multiple studies have shown that appropriate treatment of SAS leads to improved management of heart failure.

Please Learn the Warning Signs of Worsening Heart Failure

In home-based care for heart failure, it is important for patients themselves and their families to know the “warning signs” of deterioration. If any of the following changes occur, please contact the attending physician immediately: a weight gain of more than 2 kg over two to three days; difficulty breathing even while at rest; waking up at night short of breath; a sudden worsening of swelling in the legs; a marked decline in appetite; or a clouding of consciousness.

By reporting these changes to your home care physician early, it becomes possible to continue treatment at home while avoiding outpatient visits or hospitalization.

Responding to the Wish to “Avoid Repeated Hospitalizations”

From those who have been hospitalized again and again for heart failure, and from their families, we often hear words like “I don’t want to be hospitalized anymore” and “I want to spend as much time as possible at home.” To honor these wishes, home medical care focuses on detecting changes in condition early and acting proactively.

What is needed to manage heart failure is the same whether in the consultation room or at home. A cardiologist visits regularly and continuously monitors the patient’s condition—this is the foundation of home-based heart failure management. We welcome inquiries from both patients and their families.

Features of Home Medical Care at Okada Clinic

At Okada Clinic, home medical care is provided by a board-certified cardiologist. We offer the same standard of care as our outpatient clinic to those recuperating at home while managing conditions that require specialized care of heart failure

In addition, those using CPAP (continuous positive airway pressure therapy), home oxygen therapy (HOT), or NIPPV (non-invasive positive pressure ventilation) can continue to receive ongoing management as part of their home medical care. Our visiting area centers on the city of Nagano. We welcome inquiries from patients and family members alike. Please feel free to give us a call.

　

　

　

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