Chf management at home

8 Tips for Staying Safe at Home With Heart Failure

Heart failure sounds scary, and it’s a serious condition that requires a doctor’s care, but it doesn’t mean your heart has stopped or failed. Heart failure (HF) means your heart doesn’t pump enough blood to meet your body’s needs. That may be because your heart doesn’t fill with enough blood or isn’t strong enough to pump blood throughout your body efficiently — or both.

Heart failure is a chronic condition that affects around 6 million adults in the United States, according to Cardio Smart. And each year, 400,000 to 700,000 new cases are diagnosed.

If you have heart failure, certain vital signs need daily checking, including weight and blood pressure. Certain lifestyle changes can also help you manage wellness.

Follow these eight tips for success when you’re living with heart failure.

1. Weigh Every Day

“You must weigh yourself every morning after you go to the bathroom,” says Tracy Stevens, MD, a cardiologist at the Muriel I. Kauffman Women’s Heart Center at Saint Luke’s Mid America Heart and Vascular Institute, a professor of medicine at the University of Missouri in Kansas City, and a spokeswoman for the American Heart Association (AHA). Weight gain is one of the first signs of heart failure because it means you’re retaining fluid. Keep a daily chart, and if you gain more than three pounds in one day or five pounds in one week you should call your doctor.

If you do experience sudden weight gain, check your ankles, legs, and abdomen for swelling. This could be a sign of edema, or the buildup of fluid in your tissues, which requires immediate attention from your doctor. “If you’re retaining fluid, call your doctor. We can intervene before you’re hospitalized for heart failure,” Dr. Stevens says.

2. Monitor Your Blood Pressure

Your doctor may also want you to keep track of your blood pressure, because over time, high blood pressure can put a strain on your heart, which causes the muscle to weaken and work less efficiently, according to Mayo Clinic. You can easily check your blood pressure from your kitchen with a home blood pressure monitor. Ask your doctor or nurse for advice on which monitor is best for you and how to use it. The AHA recommends using an automatic cuff-style biceps monitor. As with your weight, record your blood pressure (some devices will store measurements for you) and show your readings to your doctor at your appointments. If your pressure rises, your doctor may need to see you sooner than planned.

3. Limit Liquids

Drinking too many fluids can worsen your heart failure. “Patients often think, ‘I need more fluid to flush my body,’” Stevens says. “But that’s not the case when you have heart failure.” This is because with HF, your kidneys are less able to dispose of sodium and water. “Most people will need to limit beverages, such as coffee, tea, juice, and soft drinks, and foods with high water content like soup, watermelon, ice cream, and gelatin,” Stevens adds. The AHA suggests limiting your liquids to two quarts or less per day. But do be careful about limiting your intake of liquids too much: Dehydration isn’t a good idea either. Talk to your healthcare team about what fluids you should have each day and in what quantities. Ask about limits on alcoholic beverages, too.

4. Downsize Salt Intake

Salt is notorious for causing extra fluid to build up in your body and worsen heart failure. Dietary sodium restriction is endorsed by all HF guidelines and is the most frequent self-care behavior recommended to people with the condition, according to a review published July 2012 in the journal Circulation. “Unfortunately, America is not sodium-free,” Stevens says. But there are easy steps you can take to reduce your salt intake. If you buy canned or frozen foods, choose those marked “low-salt” or “no-salt added.” Some foods to avoid are bacon, fried foods, and salted butter. It’s also a good idea to try to avoid fast food entirely and resist adding salt to your plate.

5. Take Your Medication as Directed

Your doctor may prescribe a number of different drugs to treat symptoms of your condition, depending on the cause of your heart failure and how severe it is. It’s crucial to stay on top of taking your medication according to your doctor’s recommendations. If you live alone, set up reminders to stay on track, such as placing sticky notes on your bathroom cabinet or fridge, or using an alarm (a handy feature on some pill organizers) as a reminder.

6. Dress for (Heart-Health) Success

Skip socks or hosiery with a tight band at the top. They can restrict blood flow from the lower part of your body to the heart, which may increase the risk of a clot forming in a blood vessel in the leg. Controlling your body temperature is also important to managing heart failure, because studies have shown that decreased body temperature can predict readmission and decreased survival in heart failure patients. Dress in layers so that if it gets too hot or too cold in your house, you can add or remove clothing as needed to stay comfortable.

7. Develop Good Sleep Hygiene

Serious health conditions aside, getting quality sleep is a must for good overall health. When you have heart failure, getting good rest is even more critical. According to research published in September 2015 in the New England Journal of Medicine, patients with heart failure are more likely than the general population to experience sleep-disordered breathing, with reported rates of 50 to 75 percent. As heart failure worsens, so does the prevalence of sleep apnea and vice versa, so it’s important to control both conditions. To improve your sleep, adopt a bedtime routine:

  • Go to bed and wake up at the same time every day, even on weekends.
  • Keep your room dark and cool.
  • Look into special pillows designed to alleviate sleep apnea symptoms.
  • Don’t nap close to bedtime.

8. Consider a Home Monitoring Device

At-home monitoring device systems can keep you safe and check on your daily progress. There are different monitoring devices with varying purposes. Overall, these devices track your blood pressure, heart rate, weight, fluid retention, and body temperature. Some allow you to call a nurse or automated response system and report things like your morning weight, blood pressure, and if you experienced any symptoms that may warrant a checkup, such as shortness of breath. If you report a change in your condition, you’ll get a call back from your healthcare team with the next steps. “We had a patient we called back because his weight was up,” says Stevens. “He told us, ‘I knew you’d call because I ate a salami sandwich last night.’”

Research published in March 2017 in JMIR Research Protocols shows that at-home monitoring devices can be beneficial when used consistently, and most limitations come from the inability of the user to comply.

Benefits of Self-Care for Heart Failure at Home

Clinical outcomes of heart failure depend largely on how well people manage their condition between face-to-face visits with their doctor.

Taking care of yourself must be a priority when you have heart failure. It may mean some adjustments in daily habits, especially if you live alone. But these simple heart failure prevention steps will help you work with your doctor to get the heart health boost you need.

Additional reporting by Jamie Putman.

Managing Congestive Heart Failure

Congestive heart failure and its warning signs

The term “heart failure” is something of a misnomer. It makes it sound like the heart has stopped working, but that isn’t really the case. What congestive heart failure means is that the heart isn’t pumping efficiently enough to keep up with the body’s needs. “Heart inefficiency” might be a better term. With the proper treatment and lifestyle changes, many people with congestive heart failure can lead active lives for many years.

Stages of congestive heart failure . A patient’s doctor might refer to a classification system devised by the American College of Cardiology and the American Heart Association. This categorizes congestive heart failure patients into four stages, from A (the person is at high risk for developing heart failure because of high blood pressure, coronary artery disease, or another medical condition) to D (the person has end-stage heart failure, requiring frequent hospitalizations or even hospice care).

At the earliest stage, someone may not even notice his heart failure, or it may seem to disappear once he starts taking medication. His heart failure might never progress past this point, especially if he takes good care of himself. Or at later stages he may have difficulty with everyday activities, like walking up stairs or carrying groceries. He may feel more fatigued than usual because his cells aren’t getting the nutrients they need. Fluid in his lungs can cause shortness of breath — especially when he’s lying down — or it might accumulate in his legs or ankles, causing painful swelling.

To keep heart failure from worsening. A patient must make major changes in his life: He’ll need to eat differently, remember to take his medications, keep as active as possible, and reduce stress. Some of these changes might require breaking habits acquired over many years. As a caregiver, you can help him maximize his quality and length of life. Here are some ways to help.

Watch out for warning signs. Keep alert for worsening symptoms. Call the doctor immediately if you observe any of the following:

  • Sudden weight gain (three or more pounds in one or two days)
  • Increased swelling in the legs or ankles
  • Shortness of breath while at rest
  • A dry, hacking cough or wheezing
  • Dizzy or fainting spells
  • Increased fatigue or feeling unwell all the time
  • Abdominal pain or swelling

Easing congestive heart failure with diet and exercise

Encourage heart-healthy eating

Following a diet specifically designed for people with congestive heart failure can dramatically diminish the disease’s symptoms. The key to this diet is limiting salt, because too much sodium can lead to fluid retention, which worsens congestive heart failure symptoms. Although you should ask the doctor for specific dietary guidelines, these are some of the keys to a better diet:

  • Cook with less salt. Reducing the sodium in a patient’s diet doesn’t mean condemning him to a lifetime of bland foods. Season with herbs, spices, and freshly ground pepper instead of salt. Citrus juices and vinegars can make a delicious base for marinating meat. For treats that are naturally low in sodium, stock up on plenty of fresh fruits and vegetables. Ask the doctor for a referral to a nutritionist who can offer more tips on preparing low-sodium foods.
  • Look for sodium content on labels. Packaged foods, canned soups, and condiments are often loaded with sodium. Before buying, examine the nutritional information. Be sure to look at how many servings each package contains and how much sodium is in each serving. And don’t forget to check the ingredient list: If sodium or salt is listed in the first five ingredients, find an alternative. For example, look for low-sodium versions of canned vegetables.
  • Be a salt sleuth when eating out. A patient doesn’t have to give up going out to restaurants, but he does need to watch what he orders. Many restaurants are willing to accommodate special dietary needs; ask your waitperson if the cook can prepare foods without adding salt or MSG. Substitute steamed vegetables or fresh fruit for French fries or rice pilaf. Ask for salad dressing on the side, or request vinegar or lemon wedges instead.

Even if someone follows these suggestions, it may not be easy for him to change a lifetime of eating habits. Acknowledge that it’s difficult and listen to his concerns. Discuss wh at foods he does and doesn’t like and involve him in meal planning. If he lives alone, you might help him prepare large amounts of low-sodium foods that he likes and freeze individual portions.

Keep the patient moving

It may seem counterintuitive, but if a person has congestive heart failure, he should stay as active as possible. Although strenuous exercise may overtax a heart that’s having difficulty pumping, moderate exercise can actually help the heart get stronger. Other health benefits of exercise include weight loss, lower cholesterol levels and blood pressure, and improved circulation.

If he has always been a couch potato, it may be difficult to encourage him to get going. The good news is that even short bursts of moderate exercise can be beneficial. Simply parking farther away from the store or taking the stairs instead of the elevator can add more physical activity to his day. Housework and gardening are great ways for someone with congestive heart failure to get some exercise. You might also encourage him to join you in a morning walk around the neighborhood.

Of course, he needs to avoid stressing his heart. Talk to his doctor about what activities he can safely enjoy, and what levels of exercise are appropriate. You might also ask for a referral to a cardiac rehabilitation program.

Stop smoking, minimize discomfort, and manage medications to ease congestive heart failure

Eliminating smoking

If you, the patient, or another caregiver smokes, now is the time to stop. Smoking decreases lung function, which makes the symptoms of congestive heart failure worse. But recognize that it’s not easy to stop smoking. Here are a few ways you can help:

  • Ask the patient what he thinks would make it easier for him to stop smoking. He may have suggestions you haven’t thought of.
  • Encourage him to talk about his feelings and what he’s going through. Smoking may be a comforting lifelong habit; let him mourn a little.
  • You may be tempted to nag or yell if he slips up, but it’s more effective to be supportive. Be positive and encouraging — and vent your own frustration to a friend instead.
  • Help him avoid situations that may trigger the desire to smoke. If he’s used to enjoying a cigarette after meals, try going for a short walk outside instead.
  • Be understanding as he goes through withdrawal. Try not to take it personally if he’s especially irritable, short-tempered, and tired.
  • Quit smoking yourself. If you must smoke, don’t do it around the patient. Not only will your smoking make quitting more difficult for him, but the secondhand smoke may worsen his heart failure symptoms.

If he finds it too diff icult to quit on his own, talk to his doctor. Nicotine replacement therapy, support groups, and counseling may all be helpful.

Keeping comfortable

Symptoms of congestive heart failure, such as swelling and shortness of breath, can be very uncomfortable. Here are some ways you can help someone feel better:

  • Comfortable, nonbinding clothing and shoes may make it easier for him to tolerate the leg and ankle swelling that often accompanies heart failure.
  • Support stockings, which you can purchase at your local drugstore, may alleviate leg swelling during the day.
  • Pillows that elevate a person’s head at night may help him breathe more easily while sleeping.
  • Limited amounts of salt and liquids can minimize retention of fluids, significantly lessening his symptoms.
Staying on top of medications

One of the most important things for managing congestive heart failure is to take medications consistently and according to instructions. Know which drugs the person you’re caring for needs to take and how often he should take them. Also find out what to do if he misses a dose.

If he lives alone, you can fill a pillbox with the medications he should take each day of the week. You can also post a simple daily medication schedule on his refrigerator or in his bathroom so he can check off each dose as he takes it.

If he has difficulty following the schedule, you might want to call him at regular intervals to make sure he’s taken his medications.

Making the most of doctors’ appointments

Start with a notebook

One of the most important aspects of managing congestive heart failure is keeping track of symptoms, medication side effects, and other concerns. Writing down this information in a notebook will help you the person in your care stay on top of any changes in his condition.

Encourage him to get in the habit of recording basic information whenever possible, including his weight, diet, activity level, breathing difficulties or coughing, and medications taken plus any side effects. Have him note any changes in his condition, including swelling, shortness of breath, and fatigue. Finally, you both should jot down any questions or concerns you’d like to bring up with the doctor.

When visiting the doctor

Most patients have a lot of visits to different doctors. T o get the most out of appointments, bring the notebook and try to do the following:

  • Prepare a list of questions before each visit. Leave spaces for the answers.
  • Take notes during the appointment. If either of you doesn’t understand something, don’t be afraid to ask for an explanation.
  • If the person you’re caring for isn’t following treatment or lifestyle recommendations, make sure the doctor knows it. Trying to protect him isn’t in his best interest.
  • Do your best to understand all the doctor’s instructions before you leave, but don’t hesitate to call the office if you have questions later.

Stay on top of depression and anxiety

Depression and anxiety are common in people with congestive heart failure. Feeling unwell, being unable to do some of the things he once enjoyed, and uncertainty about the future can all contribute to feelings of sadness. But if a patient seems consistently unhappy, he may be depressed. Look out for these signs of depression, and if you notice any, notify his doctor:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

Depression is a serious problem that requires evaluation and treatment. But you may be able to help manage his moods with these activities:

  • Help him stay active and connected by doing things he enjoys. Talk to the docto r about any physical restrictions he may have and how to get around them.
  • Help him structure the day around activities that give him pleasure and a sense of purpose. For example, he could plan to meet friends for lunch, or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don’t foster unrealistic expectations. Instead of saying, “You’ll be hiking again in no time,” you might say, “If we keep walking together every day, you’ll probably notice that it gets a lot easier.”
  • Let him talk about his fears and concerns. If it’s difficult for you to listen to his feelings, you may want to find someone for him to talk to — perhaps a therapist or some other mental health professional. A support group may also be helpful.

Help a patient help himself

Whether he lives alone, with you, or in a long-term care facility, you should encourage him to care for himself as much as possible. Although you may be tempted to take care of everyth ing for him, he’ll feel better about himself if you help him perform tasks on his own. As long as he’s able, he should be involved in managing his symptoms and making decisions about his treatment. By taking on too much responsibility for him, you risk taking away his independence (which can lead to depression) — and exhausting yourself in the process.

Plan for the future

Depending on the severity of his congestive heart failure, he may still have many years of active living ahead of him. But you both should realize that his condition could ultimately worsen. As the disease progresses, talk to him about what end-of-life treatments he does and doesn’t want. Find out at what point he wants a do-not-resuscitate (DNR) order added to his medical chart. Talk to him about a living will and an advance health care directives . Although these conversations can be painful, it’s useful to remember that these are important decisions.

You should also discuss future plans with his doctor. Ask about his prognosis whenever his condition or treatment plan changes, and don’t hesitate to ask tough questions about what you can reasonably expect. Having as much information as possible will make it easier for everyone to make difficult choices.

Wingham et al33 suggest that self-management “is dependent on a range of factors including social and personal influences in conjunction with healthcare systems and health professionals” (p.150). Indeed, research suggests that the link between patient confidence and self- care1,34 may depend on the quality of the patient–health professional relationship.35 However, problematic patient-physician interactions continue to be among the most commonly reported barriers to patient self-management,36 e-health strategies will likely form a pivotal role in addressing these shortfalls. Trials in progress, such as PROMETHUS37, BEAT-HF38 and CHF-CePPORT39 will examine whether e-health platforms can overcome patient barriers, such as cognitive impairment, to improve self-management in CHF. Related work points to the potential for e-health to be integrated into patient social networks to optimise self-management.

Health-promoting, social support may improve patient self- management behaviours.7,40,41 Vassilev et al42 recommend a shift in the way we conceptualise patient self-management “from individualised, behaviour-based interventions to community and network-centred approaches” (p. 73); i.e. from patient self-efficacy towards collective efficacy.43 Peer-support programmes have shown improvements in patient self-management in some chronic diseases settings, such as diabetes. For example, the ROMEO trial27 showed a significant benefit of group education sessions for diabetes patients, scheduled quarterly over a period of two years, on knowledge, health behaviours and quality of life outcomes compared with usual care. Reeves et al44 found that self-management was associated with social connectedness and that the support offered by social networks was responsive to the changing needs of heart disease and diabetes patients. Although Heisler et al45 found no benefit of a CHF peer-support programme compared to usual care on hospital readmissions or mortality, most of the participants did not engage with the programme. Poor engagement in self-management interventions, whether at the level of the patient or practitioner, is common; e-health strategies may offer a means by which to more seamlessly integrate programmes into existing systems of care, patient lifestyles, and their social networks.46

E-health self-management interventions may improve symptom control and monitoring in chronic disease;28,47,48 however, the long-term benefits (such as reduction in hospital admissions and mortality risk) are not yet clear. Nonetheless, there is potential to harness social networks via social media platforms to enhance self-management49 and some evidence to support this approach in diabetes patients.50 The Internet Chronic Disease Self-Management Program (ICDSMP) is a web-based programme with links to self-management tools and resources and social discussion forums to explore “problem solving, action planning, difficult emotions, and celebrations”.51 From baseline to 6 months post-enrolment in the ICDSMP, the authors reported a significant reduction in hospital emergency attendances, with a non-significant trend at 12 months (P=0.049); a randomised trial is needed to confirm these benefits. Other approaches, such as the PLANS initiative, use e-health platforms to tailor access to community resources as a means by which to support self-management as it is contextualised in everyday life.52 Future investment in randomised controlled trials will enable us to evaluate the clinical, quality of life, and economic benefits of these interventions.

Conclusions and Future Directions

Self-management is considered a cornerstone of CHF outcomes; however, poor patient adherence is common. Patients and their partners may be empowered to self-care through a supportive relationship with their healthcare professional, but can be limited by the complex demands of maintaining their regimen. Strategies designed to optimise patient self-management have shown some success in improving symptom monitoring, but these have not translated to reduced hospital admissions or mortality risk. There is high-level evidence to support patient medication adherence, exercise training and smoking cessation to reduce hospital admissions and mortality risk.3 Conversely, evidence to support a morbidity and survival benefit of other patient self-care behaviours (such as symptom monitoring, restricted fluid, sodium and diet, and optimised mental health) is less conclusive. The Patient Care Committee of the Heart Failure Association of the European Society of Cardiology2 provides a good summary of the evidence – and evidence gaps – supporting patient self-management. Future research that systematically evaluates programme components to identify drivers of positive outcomes is needed to develop this evidence base.

New work in this field that adopts e-health technologies, such as the PROMETHEUS,37 BEAT-HF38 and CHF-CePPORT39 trials, will undoubtedly inform future practice. Recent developments point to a role for social networks in self-management support,42 although efficacy is not yet well-established. Vassilev et al43 suggest that social networks may effect change in self-management by improving awareness and access to network resources, adjusting social roles, relationships and communication in response to needs and through collective efficacy to achieve behavioural goals. Future research that harnesses a social network perspective to enlist and mobilise collective resources through e-health interventions may improve self-management in chronic disease settings.

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