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CHRONIC HEART FAILURE
TAKING POSITIVE ACTION
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CONTENTSAbout this guide 3
What is chronic heart failure? 4
What can cause CHF? 6
What are some of the symptoms of CHF? 7
What to expect when you visit the doctor 8
Why do I need an Action Plan? 10
How is CHF managed? 12
Medications for CHF 13
Self-management of CHF 18
Other health conditions 29
The Chronic Heart Failure Action Plan 32
Where can I get further information? 43
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ABOUT THIS GUIDEThis guide offers general advice, current research and information to help people affected by chronic heart failure (CHF). It may also be a useful resource for family and friends who want to know more about CHF.
Inside this guide, you’ll find the following:
° Information about CHF and how to help reduce the impact it can have on your health and everyday life.
° A Chronic Heart Failure Action Plan that you can prepare together with your doctor (found at the back of this guide).
Living with CHF is not always easy. However, a combination of lifestyle measures such as heart healthy eating and physical activity, along with medication and other treatment that works for you can help make a difference. Following a personalised, written CHF Action Plan may help significantly reduce the long-term effects of your heart condition. So take this guide with you when you next visit your doctor and get started on making your CHF Action Plan together.
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WHAT IS CHRONIC HEART FAILURE? Chronic heart failure is also known as CHF or congestive cardiac failure. Sometimes it is simply called heart failure.
The term ‘failure’ is a technical term that means your heart isn’t pumping blood around your body as well as it should and ‘chronic’ means that it’s a long-term condition.
Your heart is a muscular pump with four chambers (two on the right and two on the left) that work together to pump the blood around the body. The pair of chambers on the right (the right atrium and right ventricle) pump blood into the lungs, where it takes up the oxygen that our body requires to function. The blood flows from the lungs back to the heart via the pair of heart chambers on the left (the left atrium and left ventricle). From here, the oxygen-rich blood is pumped to deliver oxygen to the rest of the body.
Heart failure is usually noticed when the left side of the heart is not pumping efficiently. But it can happen because of problems in the right side of the heart too. When the blood isn’t pumped around the body properly, a number of things can happen.
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Firstly, the body doesn’t get the oxygen it needs as efficiently and effectively as it should. Lack of oxygen can leave you feeling tired and breathless. Reduced oxygen supply to the heart muscle can also cause temporary chest pain or discomfort (known as angina).
Secondly, when blood does not effectively circulate around the body, it can’t help remove excess fluid from the body. This fluid has nowhere to go so it builds up in your body. This is known as fluid retention. The fluid may stay around your heart and lungs, causing further breathing difficulty and discomfort. Gravity can cause fluid to pool in your feet, ankles and calves. This causes puffiness, swelling and sometimes tight, irritated skin. This type of swelling is called oedema. Sometimes swelling occurs in other places such your hands and wrists.
Doctors classify heart failure into four grades of severity (I – IV), a system devised by the New York Heart Association. It’s based on how much physical activity you’re able to do and other symptoms. People with grade ‘I’ heart failure have no limitations on the amount of physical activity they can do, while those who have grade ‘IV’ heart failure have symptoms at rest, severely limiting their ability to do any activity.
The number of people with some degree of heart failure is growing due to our ageing population and it’s the only cardiovascular condition not to have declined in recent years. There are around 300,000 Australians living with some degree of heart failure, while around another 30,000 people are newly diagnosed with it each year.
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WHAT CAN CAUSE CHF?CHF is the result of damage, overwork and/or scarring of the heart and can be caused by things like:
° Coronary heart disease events such as past heart attacks.
° High blood pressure which is not well controlled so that the heart has to work harder to pump blood against the high pressure in your arteries.
° Heart valve disease.
° Congenital heart problems that you’re born with.
° Cardiomyopathy — a disease where the heart muscle becomes weaker and the heart becomes enlarged. This can be caused by viral infections or excessive alcohol intake over a long period of time.
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WHAT ARE SOME OF THE SYMPTOMS OF CHF?There is a range of heart failure symptoms that can include the following:
° Shortness of breath on exertion
° Fatigue
° Fluid retention
° Chest pain or tightness
° Cough
° Sleep disturbance due to shortness of breath lying flat
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WHAT TO EXPECT WHEN YOU VISIT THE DOCTORBecause many of the symptoms of heart failure can have other causes, your doctor will need to ask you about the history of your problems and examine you carefully. A careful physical examination is important for the initial diagnosis of CHF and to identify the potential causes and trigger factors. Your doctor will probably also want to see you from time to time to assess how well you’re going and how well your heart failure is being managed.
Investigations you may need include:
° An electrocardiogram (ECG) to look at the electrical impulses within your heart.
° A chest X-ray to look at the size of the heart and if there is any fluid in the lungs.
° An echocardiogram (a type of ultrasound) to show the structure of the heart and how well it’s pumping.
° A coronary angiogram to look at the condition of your coronary arteries
° Blood tests.
Your doctor may also want to do other investigations to look for any additional factors that might be contributing to or affecting your heart failure.
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WHEN TO SEE YOUR DOCTOR If you have one of more of the following signs you need to see your doctor right away:
° Weight increase or loss of more than 2kg over two consecutive days
° Worsening shortness of breath with your normal activities
° Very rapid heart beat
° Dizziness or passing out
° Angina (chest pain) that is getting worse
° Increased swelling in your ankles, legs or abdomen
° A high temperature, shivering or confusion
° Coughing fits, especially at night
° More tiredness than usual
° Asthma and more need for medication than usual.
Also talk to your doctor if you think you may be getting side effects from your medications.
This guide does not take into account individual circumstances and should not be used as a substitute for medical advice from your doctor or other health professional. If you’re concerned about any symptoms you may be experiencing, we recommend you go and see your doctor. Call an ambulance immediately by dialling triple zero (000) if you have:
° Chest pain, tightness or discomfort that lasts longer than 10 to 15 minutes and has not been totally relieved in that time by taking your angina medication, for example glyceryl trinitrate (GTN) tablets or spray under the tongue
° Severe shortness of breath
° Any new symptoms or any other symptoms that are causing you more distress than usual.
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WHY DO I NEED AN ACTION PLAN?CHF can be fatal. The number of people dying from heart failure over the past five years has increased by 20 percent.
CHF is also a common reason for a worsening of quality of life as we get older. It can limit your ability to live an active life and is a common reason why older people visit the doctor or get admitted to hospital.
That’s why it’s better if heart failure is diagnosed early so that it can be treated in the early stages before it gets worse.
Managing heart failure can help reduce the risk of:
° further heart problems and possibly hospitalisation
° other serious health problems such as kidney failure
° your heart stopping suddenly if you have severe disease
° uncomfortable and debilitating symptoms of heart failure, so you feel better more of the time.
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Managing your heart failure effectively can also help you to enjoy more physical and social activities.
Having a better understanding of your own health can help you be more informed and confident about what you can and can’t do. You can also become more aware of signs that you might need urgent medical help.
Developing a written Action Plan together with your doctor to record medication and other recommended strategies can help you take an active role in managing your heart failure. This can help reduce the likelihood of needing to go to hospital and other problems.
Taking positive action can help you and your doctor to slow down the progress of heart failure and perhaps prevent any further deterioration to your health.
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HOW IS CHF MANAGED?Although there is generally no cure for CHF, effective management may slow down progression of the disease, reduce debilitating symptoms and increase your quality and length of life.
Being involved in the management of your heart condition gives you the opportunity to become aware of the causes of heart failure and what you can do to help improve your heart function. You can learn how to manage your symptoms and help reduce the progress of your condition.
There is no single way to manage CHF. Management is tailored to each person and usually involves a combination of:
° medication
° self-management
° a healthy lifestyle
° a healthy state of mind
° cardiac rehabilitation
° surgery.
It can be helpful for your close family members to talk to the doctor about your condition and your program for management. They can get involved and help you follow your program and they may even notice changes in your condition before you do.
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MEDICATIONS FOR CHFA number of different medications are often used in the treatment of CHF. Some medications are used to treat the underlying heart condition that causes your heart failure such as coronary artery disease and/or high blood pressure (hypertension). Other medications are used to treat the symptoms of heart failure, for example, fluid retention.
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Remember:
° You may need to take several different medications together. Check with your doctor or pharmacist that you are taking them correctly, so they have the best chance of working.
° You may need to try different medications or doses to work out the best regimen for you. This can take several months but it’s important to stick to the medication regimen that your doctor has prescribed you.
° If you can’t take a particular medication ask your doctor to explain why and note this in your Chronic Heart Failure Action Plan. This helps other doctors know what medications you can’t take and why.
° An organised approach can help ensure you take the right medications at the right times and in the correct dose. One way could be to use a dose administration aid such as a Webster pack or a dosette box. Ask your pharmacist what might be suitable for you.
° For many of the medications you take you’ll need regular blood tests to see if the levels are in the right range or if they’re causing problems such as increasing your potassium levels.
° Tell your doctor if you think you’re developing side effects to a medication.
° Tell your doctor and pharmacist about any other medications you’re taking, such as vitamins, ‘natural remedies’ or over-the-counter cold, flu or pain medications. These other medications may alter the way your CHF medications work.
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Commonly recommended medicationsThe following section outlines commonly recommended medications for CHF and what they do. You may not need all these types of medications — treatment will be tailored to you. This medication information is for general explanatory purposes only and is not medical advice.
You should only take medication that has been prescribed to you by your doctor and you should always check with your doctor prior to taking any medications as they may cause side effects. If you’re experiencing side effects or symptoms from your medication, contact your doctor as soon as possible. You may also have to be careful about mixing the medication/s you are on with other medications and/or alcohol.
ACE InhibitorsACE (angiotensin converting enzyme) inhibitors are medications for your heart and blood vessels. They lower blood pressure by helping blood vessels relax and widen, which also helps to reduce the strain to your heart.
Most people with heart failure are recommended to take ACE inhibitors. It’s common to take other medications along with ACE inhibitors to help protect against heart attacks, strokes or kidney failure.
Some people who take ACE inhibitors can develop a high potassium level. Since there are usually no obvious symptoms for high potassium, your doctor may ask you to have regular blood tests to keep track of your potassium levels. Most people will have few or no other side effects with ACE inhibitors. However some people may develop skin reactions such as a rash, flushed skin or develop a dry cough which can be as small as a tickle in the back of the throat to something more bothersome. If the cough is very bothersome, the ACE inhibitor can often be replaced by a similar medication called an angiotensin II receptor blocker.
It’s important to understand why you need to take your medicines, the dose you need, and any common side effects. When in doubt, ask your doctor or pharmacist to explain. Write down the explanations so you can refer to it later.
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Aldosterone antagonistsThis medication is a special type of diuretic (fluid tablet) that is helpful for people whose symptoms have not been controlled with other medications. These medications help to remove excess fluid from the body and also help lower blood pressure.
Aldosterone antagonists keep potassium in your blood, so your potassium levels may need to be measured from time to time to make sure it does not rise too high. Other side effects can include diarrhoea, cramping, nausea and itching.
Angiotensin II receptor antagonists These medications are sometimes known as ‘sartans’ and work similarly to ACE inhibitors. They are sometimes prescribed when ACE inhibitors cannot be used. Common side effects include headache and dizziness. You will likely need to have your potassium levels tested while taking these medications.
Anticoagulants Anticoagulants (blood thinners) help prevent or slow clotting. They’re often prescribed for people who have a problem such as an irregular heartbeat (atrial fibrillation). Common side effects include bleeding that can be difficult to stop, and bruising easily. Tell your doctor if you develop any unexplained bleeding. If you take warfarin (one type of anticoagulant) you will need regular blood tests to check the levels of the medication in your blood.
Beta-blockersBeta-blockers help reduce strain on your heart by relaxing the heart muscle, slowing your heart rate, and lowering blood pressure. Most people with mild to moderate heart failure can benefit from treatment with a beta-blocker and have little to no side effects, although some can experience wheezing, tiredness and increased shortness of breath. If you have asthma, discuss the benefits and risks of taking certain beta-blocker medications with your doctor as they may not be suitable for you.
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DigoxinDigoxin helps the heart pump more efficiently and regularly. It can be helpful for some people who have an irregular heartbeat, and those who aren’t responding well to other medications. Common side effects include poor appetite, nausea and vomiting, altered vision and heart rhythm problems. You’ll need to have blood tests to measure the level of digoxin in your blood as well as other blood tests to make sure you are not experiencing any unwanted side effects.
DiureticsDiuretics (fluid tablets) help your body to get rid of excess fluid and control fluid retention. Diuretics cause your kidneys to produce more urine, so it’s best not to take them before bed unless you’re advised to because you’re experiencing symptoms of fluid retention, such as breathlessness, during the night.
Some people who take diuretics can lose too much potassium in their urine so your doctor may ask you to have regular blood tests to keep track of your potassium levels. Most people will have few or no other side effects with diuretics. However some people may develop reactions such as dizziness, nausea and skin rash.
NitratesNitrates can be used to lessen the workload of the heart by reducing the pressure of the blood entering it. This may help with symptoms in some patients. Common side effects can include headache, flushing, dizziness and low blood pressure.
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SELF-MANAGEMENT OF CHFThe following information is to help you learn more about the day-to-day management of CHF, what complications it may cause and most importantly, how you can lower the risk of them occurring.
Fluid managementFor patients with CHF, controlling fluid intake and keeping an eye on weight everyday is very important.
Controlling fluid intakeThere are a number of things you may need to do to help manage fluid retention and improve your symptoms. This could include taking diuretics (fluid tablets) and controlling the amount of fluid you drink (or eat). Depending on how severe your symptoms are, you may need to restrict your fluid to 1–1.5L a day. Your doctor will advise what amount of fluid intake each day is right for you. You may need to adjust this amount in hot weather, when you are sick or have a fever.
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Measuring your daily weight Weighing yourself around the same time each day lets you know if fluid is building up in your body.
You can make your weigh-in part of your daily morning routine using these steps as a guide:
Step 1. Wake up
Step 2. Go to the toilet
Step 3. Weigh yourself with the same type of clothing on, before getting dressed or eating breakfast
Step 4. Record your weight remembering 1 kg weight = 1 L body fluid.
If you notice you have gained weight suddenly, follow the instructions in your action plan that you’ve discussed with your doctor (eg increasing the dose of your diuretic medication or going to hospital).
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Also see your doctor if you have symptoms of fluid build up such as worsening shortness of breath with your normal activities or problems sleeping because of breathlessness while lying flat in bed.
A healthy lifestyle: nutrition and physical activity Eating a healthy diet and getting enough physical activity and exercise is vitally important for people with heart failure because there is a close relationship between nutrition, weight, the amount of physical activity and the risk of further cardiovascular disease.
You can help reduce the load on your heart by managing your weight and keeping your blood pressure under control. If you are overweight, losing weight in the longer term helps lower the workload on your heart and may also help you become more active. Ask your doctor or a dietitian for help.
If you have heart failure and you are still smoking, the risk of further and continuing heart damage and death is greatly increased. Giving up smoking is an urgent priority. Ask your doctor or pharmacist for advice and information to help you quit.
If your weight increases by more than 2 kg over two consecutive days, call your doctor without delay.
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Heart healthy nutritionEating a healthy, well-balanced diet can help improve your cholesterol levels, your blood pressure, and your weight, all of which help maintain good heart health.
Use the nutrition information on the following pages to help you make better choices when you’re shopping, cooking or eating out.
Variety and balance is important. The Australian dietary guidelines and the Heart Foundation recommends a balanced diet including a range of fresh fruits and vegetables, wholegrain cereals (such as in bread, pasta and rice), fish (especially oily fish such as tuna and salmon), lean meat and low-fat dairy products (including milk, yoghurt and cheese).
To help reduce cholesterol levels, the main nutrition factors include reducing saturated fat intake and increasing soluble fibre intake. It’s also important to limit your intake of salt to assist with blood pressure management.
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Watch your fat intake The type and amount of fat you eat is important. Not all fats are the same; generally:
° Unhealthy fats = saturated fats and trans fats
° Healthy fats = mono-unsaturated fats and poly-unsaturated fats.
It’s important to reduce saturated fat and trans fat because these raise your ‘bad’ LDL-cholesterol levels. This contributes to clogging your blood vessels with fatty material called plaque and affects your heart health.
Foods high in saturated fats or trans fats can include:
° Butter or ghee
° Fatty cuts of meat, sausages and delicatessen meats such as salami
° Snack foods such as potato crisps
° Baked goods such as sweet biscuits, donuts and cake
° Deep fried foods
° Fast food takeaways
° Full fat dairy products
° Palm oil and coconut oil.
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Some ways to help reduce unhealthy fats in your diet include:
° Use polyunsaturated and monounsaturated oils or spreads (olive oil, sunflower oil and canola oil) instead of butter and ghee
° Remove fat from meat before cooking — NOT after cooking. Also, try to limit fatty meats including sausages and delicatessen meats such as salami
° Try to limit snack foods such as potato crisps, sweet biscuits, donuts and cake to once a week or less
° Choose low-fat or reduced-fat dairy products (eg milk and yoghurt)
° Use cooking methods requiring little or no fat at all like stir-frying, steaming, microwaving, roasting and grilling.
And where possible, replace saturated fat with poly- or mono-unsaturated fats which can help lower cholesterol. Common sources of these fats include:
° margarine spreads
° olive, canola, sunflower, safflower and soya bean oils
° fish (see below)
° some nuts (walnuts, Brazil nuts, hazel nuts, peanuts, cashews, almonds)
° seeds (eg pumpkin seeds)
° avocado.
Fish (preferably oily, fresh or canned) is a great source of omega-3 fatty acids, a type of polyunsaturated fat that can help reduce the risk of cardiovascular disease. The Heart Foundation recommends adults eat about 2 to 3 serves (around 150g each) of oily fish a week. Oily fish includes Atlantic and Australian salmon, blue-eye trevalla, blue mackerel, gemfish, sardines and tuna.
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Remember, as fat is a concentrated source of energy, you still need to eat ‘healthy fats’ in moderation as too much of any type can lead to weight gain.
Limit your salt intakeThe amount of salt you eat can affect your heart failure. Eating too much salt can cause your body to retain fluid and make your condition worse. The good news is a low-salt diet can help improve your symptoms.
Salt is made up of sodium and chloride (about 40% sodium). Because Australian nutritional information panels list sodium content, the information below focuses on sodium intake.
The Heart Foundation recommends people with heart failure restrict sodium intake to less than 2 g/day (equivalent to 5 grams a day of salt).
For most of us, around 75 percent of the sodium we eat comes from packaged and processed foods, so try to eat more fresh produce and choose low-sodium products (less than 120mg sodium per 100g).
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To make it easier to find lower-salt options at the supermarket, try the SaltSwitch feature of the FoodSwitch app (bupa.com.au/foodswitch). It’s a great free tool to help you find out how much salt is in the food that you buy, and can even help you switch to lower-salt options. Simply scan barcodes of packaged foods with your smartphone camera to get easy-to-interpret nutritional information, with traffic light-style colour-coded ratings for salt as well as a list of lower salt healthier alternatives where available.
To further help reduce your sodium intake, don’t add salt to your food at the table or during cooking, and try replacing salt with other flavour boosters such as garlic, herbs and spices.
You may initially find it difficult to cut down on the salt but your taste buds will adapt. After a few weeks you’ll find that you can do without all the extra salt.
Limit your alcohol intakeLimiting your alcohol intake can have a direct effect on your fluid retention and prevent further damage to your heart. It’s best for people with heart failure to have no alcohol, but if you drink alcohol then limit it to one or two standard alcoholic drinks at most per day because too much alcohol can damage the heart and contributes to fluid intake.
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Physical activityPhysical activity of any kind is also vital for your heart health and for maintaining a healthy weight. Remember, any excess body mass makes the heart work harder. As a general rule:
° Try to get active every day
° Do what you can without getting breathless or over-tired — you should be able to talk easily as you do it
° If you can’t manage one longer session of activity, divide your activity into two or three shorter sessions
° Avoid strenuous activities that make you breathless unless your doctor has approved them.
Appropriate physical activity may include walking, cycling, light weightlifting and gentle stretching exercises. Try to walk for 10–30 minutes a day on at least 5 days of the week. Make sure you’re not overdoing it and that you can carry on a normal conversation while you’re exercising.
Talk to your doctor, physio or exercise specialist about the amount, type and intensity of activity that’s best for you to develop safe and achievable daily activity goals. If your condition changes, your health care professionals can help you change your exercise plan.
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A healthy state of mindKeeping a positive mindset and good attitude is often associated with better health outcomes. A short program of cognitive behaviour therapy (CBT) offered by a clinical psychologist can provide you with tools to assist with developing a positive mindset. CBT is sometimes done within groups of people who have the same condition. Ask your doctor if this is right for you.
Many people with heart failure feel ‘down’ or experience depression related to frustrations and fears of living with heart failure. Depression can interfere with your commitment to managing your condition including following your Chronic Heart Failure Action Plan. It can also contribute to a reduced quality of life, which can lead to a further deterioration of your condition.
Feeling low every now and then is normal. However, if this continues for more than two weeks, and your low mood is affecting your ability to carry out your normal routine, it’s best to see your doctor because there are effective treatments available. Dealing with these feelings is part of gaining greater control of your condition.
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CARDIAC REHABILITATIONCardiac rehabilitation is an individually tailored program designed to optimise your health and help you carry out your day-to-day activities. Initially your healthcare team (which could include doctors, nurses, physiotherapists, exercise specialists and dietitians) can do an assessment and create a program especially for you. The program may include exercise training, nutritional advice and education about your condition.
A cardiac rehabilitation program can help you manage your health and wellbeing by learning more about your condition and how various treatments work. Learning about your condition and how to manage it can help you make informed decisions and manage your own program for positive health. Talk to your doctor about modifying the Chronic Heart Failure Action Plan to suit your needs and use it to evaluate your progress.
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SURGERYDepending on the cause of the heart failure, your general health and other factors, your doctor may recommend surgery. This may include surgery to replace or repair heart valves, to insert a special kind of pacemaker that helps the heart beat properly (cardiac resynchronisation therapy) or to insert an implantable defibrillator to monitor or correct your heart rate. Whether or not surgery is suggested in your case depends on your unique situation and your doctor’s clinical judgement. Check your level of hospital cover to see if cardiac surgery is included and if necessary, call us to discuss the level of cover to suit your needs.
OTHER HEALTH CONDITIONSMost people who have moderate or severe heart failure have other health problems, which may affect how they manage their heart failure.
Coronary heart diseaseCoronary heart disease is also known as ischaemic heart disease or coronary artery disease. Coronary heart disease can cause heart failure so looking after your overall heart health is important for managing both conditions. Your Chronic Heart Failure Action Plan includes steps to minimise the potential for further problems with the coronary arteries that might make your heart failure worse, including paying attention to your diet, weight, blood sugar, cholesterol and exercise and taking all your prescribed medications.
For more information you can refer to the Bupa Coronary Artery Disease and Angina Guide.
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High blood pressure or hypertension High blood pressure can put a strain on the heart and can also cause heart failure so some of the medications you may need to take are the same for both. It’s important to keep monitoring your blood pressure to check it’s under control. That way you’re not asking your heart to do more than it should.
Diabetes People with diabetes are at a much greater risk of heart disease if it’s not under control, so managing your blood glucose levels has a direct effect on your heart health.
Getting better control of your diabetes involves regular monitoring, appropriate diet and regular check-ups of your HbA1c (a measure of your blood glucose control over the previous 3 months). These can make an important contribution to your long- term health.
Exercise is also helpful in the management of diabetes, but you may need a different program, so check with your diabetes specialist and physiotherapist about what exercise is right for you.
For more information you can refer to the Bupa Diabetes Guide.
Kidney disease Kidney disease can also result in fluid retention, and heart failure can make certain types of kidney disease worse, so make sure you’re taking good care of your kidneys as well.
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Pneumonia, flu and serious chest infections These conditions can affect how well your lungs transfer oxygen to the blood and they can place other strains on the heart. The following tips may be helpful:
° Seek medical attention early if you have moderate to severe heart failure and get a chest infection.
° Get the annual flu vaccine as this can help prevent a serious infection.
° Get a pneumococcal vaccination. Ask your doctor if you need to have one or two vaccinations for this.
° When prescribed antibiotics, make sure you complete the course prescribed.
° Stop smoking, if you’re a current smoker.
Anaemia, infections and thyroid disease are other conditions that can put a strain on your heart. You must take extra care with your heart failure if you have any of these conditions and talk to your doctor about what you need to do to stay healthy.
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This Action Plan is designed to help you work with your doctor and take positive steps to maximise your health. Take this Action Plan with you when you visit the doctor.
Essentials 1. Understand the cause of your CHF, how it is
treated and what makes it worse. This can help keep the underlying condition in control and allow you to manage your heart failure better too.
2. Work with your doctor to make sure your medications are right for your stage of CHF. Taking them regularly will help you control your symptoms better.
3. Weigh yourself daily and record this in a diary so you can see changes over time. Visit your doctor if your weight rises by more than 2kg over two consecutive days.
4. Follow any fluid restriction guidelines you’ve been given as this will help you control your symptoms.
5. Adopt healthy habits that will help reduce the strain on your heart. Talk to health professionals such as your doctor, physiotherapist or dietitian about ways you can:
a. Keep to a healthy diet
b. Lose weight, if needed
c. Adopt a daily exercise program
d. Quit smoking if you need to
e. Keep your diabetes or high blood pressure under control (if appropriate)
THE CHRONIC HEART FAILURE ACTION PLAN
Name Date
/ /
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3534
Goal to be reviewed
Actions/ medications
Minimum recommended frequency
Comments Date due
Have a thorough assessment of your condition. Keep a record of the tests and measures of your condition from the time you go to the doctor and regularly after that. Discuss your improvement or deterioration whenever you are reassessed, and note any reasons for the change if you can.
Blood pressure Every routine visit or more frequently if not under control
/ /
Electrocardiogram As directed by your doctor / /
Chest X-ray As directed by your doctor / /
Echocardiogram As directed by your doctor / /
Weight assessment
Measuring weight has two purposes:1. To see if you are overweight as this could be contributing to your chronic heart failure2. To act as a baseline for measuring daily weight to assess your fluid balance
/ /
Blood tests
Haemoglobin to check for anaemia
Initially as a base measurement and then as required
/ /
Lipid studies (cholesterol) that can inform you of the need to take preventive action such as modifying your diet or taking medication
Annually or more often if recommended by doctor
The Heart Foundation recommends the following goals for people who have heart disease:
° Low-density lipoprotein cholesterol (LDL-C) less than 1.8 mmol/L
° High-density lipoprotein cholesterol (HDL-C) greater than 1.0 mmol/L
° Triglyceride (TG) less than 2.0 mmol/L
° Non-high density lipoprotein cholesterol (NHDL-C) less than 2.5 mmol/L
/ /
Blood test for diabetes
Initially blood sugar level as baseline, and possibly a Glucose Tolerance Test if suggested.
If you have diabetes:
° regular measurement of blood sugar as required by doctor
° HbA1c every 3 months
If you are told you have diabetes aim for HbA1c less than 7% (53 mmol/mol).
/ /
Diagnosis and assessment
3736
Goal to be reviewed
Actions/ medications
Minimum recommended frequency
Comments Date due
Have a thorough assessment of your condition. Keep a record of the tests and measures of your condition from the time you go to the doctor and regularly after that. Discuss with your doctor your improvement or deterioration whenever you are reassessed, and note any reasons for the change if you can
Blood test for kidney function
Annually or as required / /
Doctor to record severity of heart failure. This is often done using the NYHA classification.
After full assessment Based on the severity of your condition, recommended medications may be different.
/ /
BNP (Brain Natriuretic Peptide)
As required This test can help with diagnosis, determining severity and guiding treatment of heart failure. / /
Echocardiogram At initial assessment This is an ultrasound of the heart to help work out how well it’s functioning. / /
Ongoing management
Adjust your fluid and food intake and adopt healthy habits
Fluid restriction As directed by your doctor / /
Modify your salt intake
As directed by your doctor / /
Very clear guidelines have been established for the best treatment of CHF based on sound clinical research
This may be the most important thing you can do to maintain your function and quality of life. Your doctor will be able to prescribe treatment that meets
Try to understand which drugs you are taking and for what reason
/ /
Ensure you are on the correct medications
Diagnosis and assessment
3938
Diagnosis and assessment
Goal to be reviewed
Actions/ medications
Minimum recommended frequency
Comments Date due
Ensure you are on the correct medications. Your doctor will review how well they are working and any side effects you may have. Your doctor may recommend you change the dose or sometimes change the medication.
Your individual needs from among the medications listed below and any others
Talk to your doctor and pharmacist about how to establish a schedule of when to take each medication to help you keep on track
/ /
ACE inhibitor medication
Every routine visit If you are not receiving this type of therapy, ask your doctor to record the reason for not treating with ACE inhibitor.
/ /
Beta blocker Every routine visit If you are not receiving this type of therapy, ask your doctor to record reason for not treating with a beta blocker.
/ /
Diuretic Every routine visit / /
Aldosterone antagonist
Every routine visit If your symptoms are not controlled on other drugs, and you are not receiving this type of therapy, ask your doctor to record reason for not treating with spironolactone.
/ /
Flu vaccination Annually Ask your doctor about yearly flu vaccinations. / /
Vaccination for pneumococcal disease
Discuss with your doctor
Digoxin (Lanoxin or Lanoxin PG)
If your symptoms worsen or were not under control on other medications
If you have severe heart failure symptoms, or suffer “atrial fibrillation” and you are not receiving this type of therapy, you can ask your doctor whether you should be treated with digoxin.
Manage your weight
° Improve diet
° Manage weight
° Develop and maintain a fitness routine
° Record weight same time daily to assess your fluid balance. Use a separate chart to do this.
° Waist measurement
° Calculate Body Mass Index (BMI)
Ideally your waist measurements should be:
° male < 94cm
° female < 80cm
Body Mass Index (BMI) is calculated by dividing your weight in kilos by your height in metres squared.
/ /
Moderate your eating habits so that you can work towards a fit weight that puts less strain on your heart
There are many ways to seek help with this: establish your goals and work with your doctor, dietitian, family and/or friends to achieve a good weight for you in achievable steps
/ /
4140
Diagnosis and assessment
Goal to be reviewed
Actions/ medications
Minimum recommended frequency
Comments Date due
Keep active
Develop and maintain a fitness program of moderate intensity physical activity for at least 30 minutes on 5 or more days per week
Discuss with your doctor at each visit
Moderate activity will cause a slight increase in breathing and heart rate and may cause light sweating. Try walking, cycling or swimming. You should be able to carry on a conversation whilst exercising. If you can’t manage 30mins in one block, then break them up into 2 or 3 smaller blocks.
/ /
Commence muscle strengthening program
Discuss with your doctor at each visit / /
Especially if you have recently had an acute cardiac eventsuch as a heart attack. Ask your doctor if you could benefit from a cardiac rehabilitation program
Discuss with your doctor
This is particularly useful after an acute event like a heart attack.
/ /
Quit smoking
Give up smoking
Avoidance of passive smoking
As soon as possible This is good advice at any time with your condition. Talk to your doctor about strategies that can help you quit. / /
Ensure you maintain adequate nutrition
Establish and maintain healthy eating
Review your diet
Annually or as required It is recommended you:
° eat plenty of fruit and vegetables;
° keep to any fluid restriction your doctor gives you;
° restrict your salt intake;
° restrict saturated and trans fatty acid intake; and
° seek more education about healthy foods.
A dietitian can help you develop a healthy, balanced eating plan.
/ /
Limit your alcohol intake
Low risk alcohol consumption
It is recommended that you limit intake to no more than 2 standard drinks per day
Your doctor should assess medications for potential interactions with alcohol
It is recommended that you restrict your alcohol intake to less than or equal to 2 standard drinks daily. However, if alcohol was the cause of your heart failure, then you should avoid alcohol / /
Keep a positive mindset
Keep focused on a positive outcome
Discuss with your doctor If you are having problems with feeling down or feel you may be depressed, or even if you are having trouble keeping to a regime that is controlling your symptoms, you may benefit from seeing a clinical psychologist and/or cognitive behaviour therapy
/ /
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References
Athertin J Dowden J Emblem G et al. Systolic heart failure — improving treatment. [Online] 2011 [Accessed Jul 2012] Available from: www.nps.org.au
Cardiovascular Expert Group. Therapeutic Guidelines: cardiovascular. Version 6. Melbourne: Therapeutic Guidelines Limited. 2012.
Diabetes Australia. Diabetes management in general practice: guidelines for type 2 diabetes. [Online]. 2012 [Accessed May 2014]. Available from: www.diabetesaustralia.com.au
Driscoll A Davidson P Clark R et al. Tailoring consumer resources to enhance self-care in chronic heart failure. Australian Critical Care. 2009; 22: 133—140.
Immunise Australia Program. Pneumococcal disease. [Online] [Last updated Feb 2014, accessed May 2014]. Available from www.immunise.health.gov.au
National Health and Medical Research Council and Department of Health. Eat for Health. Australian Dietary Guidelines: 2013 [Online] [Accessed 12 May 2014]. Available from: www.eatforhealth.gov.au
National Heart Foundation of Australia. Cardiomyopathy. [Online]. 2014 [Accessed May 2014]. Available from www.heartfoundation.org.au
National Heart Foundation of Australia. Dietary fats, dietary cholesterol and heart health. [Online] 2009 [Accessed May 2014]. Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. Heart failure. [Online]. 2014 [Accessed May 2014]. Available from www.heartfoundation.org.au
National Heart Foundation of Australia. Living well with chronic heart failure. [Online] 2012 [Accessed May 2014]. Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. Multidisciplinary care for people with chronic heart failure: principles and recommendations for best practice. [Online] 2010 [Accessed Jun 2014] Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. Position statement: antioxidants in food, drinks and supplements for cardiovascular health. Updated Aug 2010 [Online] 2010 [Accessed May 2014]. Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. Position statement: the relationships between dietary electrolytes and cardiovascular disease. [Online] 2006 [Accessed May 2012]. Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. Position statement: the relationships between carbohydrates, dietary fibre, glycaemic index/glycaemic load and cardiovascular disease. [Online] 2006 [Accessed May 2014]. Available from: www.heartfoundation.org.au
National Heart Foundation of Australia. A systematic approach to chronic heart failure care: a consensus statement. [Online] 2013 [Accessed Jun 2014] Available from: www.heartfoundation.org.au
National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Guidelines for the prevention, detection and management of chronic heart failure in Australia. Updated Oct 2011.[Online] 2011 [Accessed Jun 2014] Available from: www.heartfoundation.org.au
National Institute of Health and Clinical Excellence (NICE). Chronic heart failure: management of chronic heart failure in adults in primary and secondary care. [Online] 2010 [Accessed May 2012]. Available from: www.nice.org.uk
NICE. Respiratory tract infections — antibiotic prescribing. [Online] 2008 [Accessed May 2012]. Available from: www.nice.org.uk
National Vascular Disease Prevention Alliance (NVDPA). Quick reference guide for health professionals. Absolute cardiovascular disease risk assessment. Available from: www.heartfoundation.org.au
Novartis. Full product information: Slow- K (potassium chloride) slow release tablets. MIMS Online. 2010.
Pfizer. Full product information: Aldactone (spironolactone) tablets. MIMS Online. 2010.
Rossi S (ed). Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. 2013.
Unwin RJ Luft FC Shirley DG. Pathophysiology and management of hypokalemia: a clinical perspective. Nat Rev Nephrol. 2011; 7(2):75-84.
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The information in this brochure has been developed and reviewed for Bupa Australia Pty Ltd and its related entities (‘Bupa’) by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It is intended to be a guide only and should not be relied upon as a substitute for professional medical advice. The mention of specific products, services, tests, doctors, specialists or other health care professionals, procedures or opinions does not constitute or imply a recommendation or endorsement by Bupa, unless specifically stated as such. Bupa makes no warranties or representations regarding the completeness or accuracy of the information and is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health or wish to discuss your individual symptoms or circumstances.
The information in this brochure does not represent which products and services may or may not be covered under your level of cover.
WHERE CAN I GET FURTHER INFORMATION?For more information and support, contact:
° Your local doctor
° The National Heart Foundation of Australia on 1300 36 27 87 (local call cost) or at heartfoundation.com.au
° Dietitians Association of Australia at daa.asn.au
° Quitline on 13 QUIT (7848) to give up smoking (local call cost)
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