Medications. Information regarding the patient’s medications must be discussed in detail to insure they understand when and how to take their medications. Depending on which issues the patient had that led to heart will failure will determine the class of medications the patient is on for their regimen. For example, “In all patients with a recent or remote history of MI or ACS, statins should be used to prevent symptomatic HF and cardiovascular events” (JACC, 2013). The clinic must also assess the ability for the patient to obtain their medications they need, and other meds to discontinue as well. Provide the patient with a list of medications, how to take them, when to take them, and a pill organizer should be provided if the patient doesn’t have one already.
Daily weights. Instruct the patient on how to correctly obtain their weight every day to keep track of. Patient’s must weight themselves every morning after emptying their bladder, and prior to eating breakfast. They need to wear lightweight clothes that are similar in weight as well. The patient needs to record their weight every day to report it to the care team. Inform the patient they must call their doctor if they gain more than the 3 pounds in a day or 5 pounds in a week, per the AHA guidelines. Confirm that the patient has a scale at home, if not, provide one.
Diet. Patients with heart failure must understand the importance of a low-sodium and low-fat diet, as this can lead to fluid retention which can exacerbate symptoms. The clinic should provide a list of recommended and restricted foods, along with a food diary for tracking. The patient must also be informed to not consume alcohol as well. The clinic staff needs to assess the patient’s ability to obtain healthier food options, while being conscience of any cultural or socioeconomic factors. The clinic must provide resources to the patient and family if they need help with access to healthy food options.
Physical activity. Clinic staff must discuss in detail the approved exercise and daily activity level prescribed by the physician specifically for that patient. The patient must understand to take rest periods and breaks whenever necessary. The patient should avoid any heavy lifting, pushing, or pulling of heavy objects, especially if any implantable device therapy is in place. If any cardiac rehab was ordered, this must be discussed in detail and set up prior to leaving the clinic. Patients and physicians should discuss resuming sexual activity also.
Follow-up appointments and referrals. “The institution of a structured system of patient and family education that involves a multidisciplinary team and emphasizes medication adherence, sodium and fluid restrictions, and recognition of signs and symptoms that indicate progression of disease may be as important as ensuring that patients are prescribed appropriate medical therapy” (Paul, 2008). The clinic must make sure that the patient has a follow-up appointment schedule with their physician within seven days of discharge, or within three days if they are high risk. If the patient has not already made this appointment themselves, the clinic must do it to insure continuation of care and management. The clinic should provide the patient with all contact info for the appointment, including date and time. The clinic should assess for the patient’s ability to make the appointment, including transportation, funds, or disease process. If there are any barriers found to be present, the clinic should set up resources to help the patient attend their appointment in order to not delay care. The clinic may follow up within three days to make sure everything is still in place and ready to go.
Part of the clinic’s most important factors will be to make sure the patient has all necessary resources they need once they get home before they leave. In addition to the clinic’s handouts/booklet they will receive, they should also provide a list of resources the patient can utilize online or locally if they need. Some examples of online resources are the American Heart Association and Heartfailurematters.org, and Mended Hearts. Locally they can use their care team and physicians, the heart failure clinic, local hospitals and United Way. Should the patient end up needing palliative care services, the clinic should assist with the startup process with it.
Comorbidities in heart failure. It is important to address any comorbidities that the patient has that can develop or contribute to the patient’s diagnosis in heart failure. Some examples of important considerations in relation to heart failure are: atrial fibrillation, anemia, hypertension, hyperlipidemia, diabetes, chronic kidney disease, COPD, and Alzheimer’s/dementia. Each must be discussed in detail with how they may affect the patient and how to manage the disease in conjunction with heart failure. The care team must also address any secondary prevention interventions such as smoking cessation and influenza and pneumococcal vaccines.
Symptoms and when to call for help. After discussing all the previous educational needs, the staff should describe any symptoms the patient may experience and when to call the MD or 911. Some signs and symptoms needing to be addressed in detail are: weight gain of 3 pounds in 1 day or 5 pounds in a week, shortness of breath or increased effort to breathe at rest, dizziness, increased swelling or edema (feet, ankles, legs, or stomach), increased fatigue or feeling tired, new or worsening chest pain, and confusion. Some of these signs may be due to an emergent situation or perhaps a change in medication dosage.
Tools for monitoring. Everyone who enrolls in the heart failure clinic should be given all the tools and educational resources available to take home with them upon discharge. Any extra resources available for hands on learning and visuals will only help the patient and family members succeed at managing the disease. Some of these tools were previously mentioned, but some were not, these will be in the handout packet each person receives:
- Daily weight record
- Restricted and approved food lists with food diary
- Medication list and pill organizer
- Color coded HF zones chart of symptoms and when to call MD
- Calendar to keep up with appts
- DVD and internet links for recipes, education, self-care
- AHA HF Path app to download to smart: “a self-management tool that empowers heart failure patients to better manage and live with their condition” (AHA, n.d.).
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