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Heart failure - chronic - Management
What self-care advice should I give someone with chronic heart failure?
- Advise the person:
- How to recognize the symptoms of heart failure, and what to do if symptoms deteriorate.
- Symptoms of worsening heart failure include increasing breathlessness, tiredness, ankle or abdominal swelling, and rapid weight gain.
- When symptoms suggest worsening heart failure, the person should promptly seek medical attention or adjust the doses of their diuretics (as pre-agreed), or both.
- When and how to monitor body weight, and what to do if there is weight gain.
- Because rapid gain in weight in people with heart failure is often the result of fluid retention, worsening heart failure may be detected early if weight is measured regularly (for example daily or twice a week).
- Home monitoring of weight is not practical for all people (for example those who cannot stand safely unaided on scales).
- If body weight is to be monitored at home, normal fluctuations in body weight should be minimized; weighing should be done at the same time each day (for example after waking and voiding but before dressing or eating).
- If there is a sudden and sustained gain in weight (for example more than 2 kg in 3 days), the person should (as pre-agreed) either seek medical advice or increase the dose of their diuretic and reduce their fluid intake, or both.
- The person and their carers should understand that deterioration can occur without weight gain.
- How to keep active and do physical exercise.
- Keeping as fit as possible is safe and beneficial if exercise does not exceed the person's capacity.
- Regular aerobic exercise (such as walking) and/or resistive exercise is recommended. This may be more effective as part of a supervised exercise or rehabilitation programme, which may be available as an exercise referral scheme or as a cardiac rehabilitation programme.
- How to stop smoking.
- Advise smokers to quit, and offer referral to a smoking cessation service.
- For detailed information on the harmful effects of smoking and for advice on smoking cessation, see the CKS topic on Smoking cessation.
- How to use alcohol prudently.
- People with alcohol-related heart failure should never drink alcohol.
- People with heart failure not due to alcohol should keep their alcohol intake within recommended levels if they cannot abstain.
- For detailed information on sensible drinking limits and how to help people reduce their alcohol intake, see the CKS topic on Alcohol - problem drinking.
- How to lose excess weight and then maintain weight within recommended limits.
- For advice on the management of obesity, see the CKS topic on Obesity.
- How to restrict salt consumption.
- Excessive intake of salt is to be avoided, but there are no specific guidelines on salt intake in people with heart failure.
- People should be informed about the salt content of common foods.
- Advise people not to replace salt with salt substitutes that are high in potassium, because this may result in hyperkalaemia due to the potassium-sparing effect of angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, and aldosterone antagonists.
- Websites that have useful information about salt in the diet are listed in Online resources.
- How to avoid excessive fluid intake — people with heart failure should avoid excessive fluid intake. For example:
- Those with severe symptoms: restrict fluid intake to less than 1.5–2 L a day.
- Those with mild or moderate symptoms: restrict fluid intake to less than about 2 L a day.
- Advice on fluid intake should be non-dogmatic and should not give the impression that fluid intake is responsible for causing symptoms.
- Fluid intake should not be excessively restricted, particularly if the weather is hot (for example the person in on holiday in a hot country) when fluid intake may need to be increased.
- When people are restricting their fluid intake, they should seek professional advice if they start to feel dizzy, as this may be a sign of hypotension or hypovolaemia.
- How to recognize the symptoms of dehydration — extreme thirst, dizziness, and fatigue.
- What to do if they develop diarrhoea and vomiting — offer individual tailored advice. General recommendations are that:
- If a person with stable heart failure develops diarrhoea and vomiting while taking either an angiotensin-converting enzyme inhibitor, angiotensin-II receptor antagonist, a diuretic, or an aldosterone antagonist, they should maintain their fluid intake and stop treatment for 1–2 days until they recover. People with more severe heart failure (particularly if this is, or has recently been, poorly controlled) should not take these drugs that day and obtain same day advice from their GP (or heart failure nurse if they have access to one).
- Stopping treatment for a short time is thought to avoid dehydration, hypotension and acute renal failure, and should not cause a sudden deterioration in people with stable heart failure.
- If symptoms persist for more than 2 days, all patients should contact their GP surgery with a view to obtaining advice about drug management and to have their bloods (in particular renal function and electrolytes) checked.
- Which immunizations to have.
- Annual immunization against influenza, and a single immunization against pneumococcus, are recommended.
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