Chronic illness - Focus on cardiomyopathy

What is Cardiomyopathy?

Cardiomyopathy refers to a medical condition characterized by abnormalities in the heart muscle, which can significantly impact its functionality. There are three primary types of cardiomyopathy: dilated, hypertrophic, and restrictive. Each type presents its own unique challenges and implications for heart health. As the heart muscle becomes compromised, it struggles to effectively pump blood throughout the body, which can lead to serious complications, including heart failure. Understanding this condition is crucial for early detection and management, as it can significantly affect an individual's overall health and quality of life.

The signs and symptoms of cardiomyopathy

In the initial stages of cardiomyopathy, individuals may not experience any noticeable signs or symptoms. However, as the condition progresses, various symptoms typically emerge. Common indicators include:

• Breathlessness: Many individuals may find themselves becoming short of breath, not only during physical exertion but also while at rest, which can be particularly concerning.
• Swelling: Swelling of the legs, ankles, and feet is often a result of fluid retention, which can be a direct consequence of the heart's inability to pump effectively.
• Abdominal Bloating: Fluid accumulation may also lead to bloating in the abdomen, causing discomfort and an unusual feeling of fullness.
• Coughing: Some individuals may experience coughing, particularly when lying down, which can disrupt sleep and exacerbate feelings of fatigue.
• Fatigue: Persistent tiredness is a common symptom that can affect daily activities and overall well-being.
• Irregular Heartbeats: People may notice their heart beating rapidly, pounding, or fluttering, which can be alarming and may require medical attention.
• Chest Pain: Discomfort or pain in the chest can occur, which is often associated with the strain placed on the heart.
• Dizziness and Fainting: Dizziness, light-headedness, and episodes of fainting can also occur, indicating that the heart is not supplying enough blood to the brain.

Recognizing these symptoms early can be vital in seeking appropriate medical care and intervention.

Possible causes of cardiomyopathy

In many cases, the exact cause of cardiomyopathy remains unidentified. However, healthcare professionals can sometimes pinpoint specific factors that may contribute to the development of this condition. Some of the potential causes include:

• Genetic Conditions: Inherited genetic disorders can predispose individuals to cardiomyopathy.
• Long-term High Blood Pressure: Chronic hypertension can lead to changes in the heart muscle over time.
• Heart Tissue Damage: Previous heart attacks can damage heart tissue, leading to cardiomyopathy.
• Chronic Rapid Heart Rate: Conditions that cause prolonged rapid heart rates can strain the heart muscle.
• Heart Valve Problems: Malfunctioning heart valves can affect blood flow and pressure, contributing to cardiomyopathy.
• Metabolic Disorders: Conditions such as obesity, thyroid disease, and diabetes can impact heart health.
• Nutritional Deficiencies: Lack of essential vitamins or minerals, particularly thiamine (vitamin B-1), can impair heart function.
• Pregnancy Complications: Some women may develop cardiomyopathy during or after pregnancy.
• Alcohol Abuse: Long-term excessive alcohol consumption can lead to heart damage.
• Drug Abuse: The use of substances like cocaine, amphetamines, or anabolic steroids can also harm the heart.
• Chemotherapy and Radiation: Certain cancer treatments may have adverse effects on heart health.
• Infections: Certain infections can damage heart tissue, triggering cardiomyopathy.
• Iron Build-up: Conditions like hemochromatosis can lead to excess iron in the heart muscle.
• Sarcoidosis: This inflammatory condition can cause lumps of cells to grow in the heart and other organs.
• Connective Tissue Disorders: Disorders affecting connective tissues can also impact heart function.

Understanding these potential causes can help individuals and healthcare providers make informed decisions about prevention and treatment strategies.

How to register on the chronic programme

If you have received a diagnosis of cardiomyopathy, it is important to take the next steps for managing your condition effectively. You should request your doctor to reach out to our Chronic Medicine Department at 0860 11 78 59 to initiate your registration on the Chronic Medicine Management Programme. This programme is designed to provide comprehensive support and resources for individuals living with chronic conditions.

Upon your registration, a chronic medicine consultant will collaborate with your healthcare provider to develop an appropriate treatment plan tailored to your needs. Once the necessary diagnostic criteria have been satisfied and relevant blood tests have been submitted, your treatment will be reviewed and approved. We will inform you whether the prescribed treatment is included in the Momentum Medical Scheme formulary or if a co-payment will be required.

Once you obtain authorization, you can present your prescription to your designated service provider to acquire your medication. It is essential to understand that a designated service provider (DSP) refers to a healthcare provider, such as a doctor, pharmacist, or hospital, that is preferred by the medical scheme for the diagnosis, treatment, or care of a Prescribed Minimum Benefit condition. If you choose not to use a DSP and opt for a different hospital, doctor, or pharmacy, you may incur additional co-payment charges.

It is important to note that the authorization for your treatment typically expires after 12 months. If there are no changes in the medication you need, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. The same renewal process applies if there are any changes or additions to your treatment plan.

For more detailed information regarding your chronic benefits and how to access chronic medication and treatment, please click here.

Hospitalisation

In the event that you require hospitalization due to complications arising from cardiomyopathy, it is crucial to take prompt action. You can log in to the Momentum App, or alternatively, reach out to us via the web chat feature on momentummedicalscheme.co.za. You may also email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59 to request pre-authorization for your hospitalization. Upon your request, we will assign a case manager who will follow up with you regarding your hospital stay and ensure that your needs are met.

Treatment plan

Once you are successfully registered on the Chronic Medicine Management Programme, you will gain access to a personalized treatment plan. This plan may encompass coverage for necessary medical tests, consultations with doctors, and other benefits deemed medically essential by your healthcare provider. Our clinical team will review these benefits to ensure they are appropriate and aligned with your treatment needs.

Compliance

Compliance with your treatment regimen is critical for managing cardiomyopathy effectively. To ensure your health and well-being, you must adhere to the following guidelines:

• Obtain your chronic medication on a monthly basis to maintain consistent treatment.
• Follow the prescribed dosage and quantity as directed by your healthcare provider to achieve optimal results.
• Avoid missing doses, as this can have serious implications for your health and overall treatment efficacy.

Please ensure that your claims include the appropriate ICD-10 code. It is essential for all claims to incorporate the correct ICD-10 codes (diagnostic codes) so that we can accurately identify and process your claims through the Chronic Benefit.

We may pay claims from your Day-to-day Benefits if:

• The claims are submitted without the relevant ICD-10 codes.
• You have exceeded the frequency limit for consultations or tests.
• The treatment is deemed not clinically appropriate.

Contact us

If you need assistance or have questions, you can reach out to us through the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59. We are here to help you navigate your treatment and benefits.

Glossary of terms

Designated service providers: Momentum Medical Scheme employs a network of designated service providers, including associated general practitioners, specialists, and state facilities, to ensure that our members receive the necessary diagnosis and treatment for Prescribed Minimum Benefits.

A formulary refers to a comprehensive list of medications covered under your health plan, from which your doctor can prescribe the appropriate treatment for your chronic condition.

ICD-10 is the code used for diagnosing medical conditions.

Prescribed Minimum Benefits represent a set of benefits that all medical schemes in South Africa are required to provide coverage for, as stipulated in the Medical Schemes Act 131 of 1998 and its accompanying regulations. To qualify for these benefits:

• Your medical condition must meet the criteria for coverage and be included in the defined list of Prescribed Minimum Benefit conditions.
• The necessary treatment must align with the treatments outlined in the defined benefits.
• You must utilize the Scheme’s Designated Service Providers. For more information, see the definition of Designated Service Providers.

If you choose to use non-designated service providers voluntarily, the Scheme will cover benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you require emergency medical care from non-designated service providers, this is considered involuntary, and co-payments will be waived.

In cases where your medical condition and treatment do not meet the specified criteria for accessing these benefits, we will process your claims according to the benefits associated with your selected plan option.