Mount Carmel Health Partners Clinical Guidelines Heart Failure | Page 5

Step Five: Patient Engagement
Medications
• Explain the importance of compliance and benefits
• Explain possible side effects
• Avoid use of NSAIDs because they cause fluid retention
Diet and Weight
• Sodium restriction (2000mg/day) and fluid restriction (2 L/day)
• Weigh self daily and notify the physician of changes (2 lbs./day or 5lbs./wk.)
• Weight reduction if needed
Follow-up Visits
Patients who remain symptomatic despite basic medical therapy may benefit from care directed by consulting physicians who have special
expertise and training in the care of patients with HF. A collaborative model between the primary care physician and the specialist can provide
optimal care of the patient.
 Consider referral to cardiologist/heart failure specialist
 Consider referral to Mount Carmel Heart Failure Center
 Ask about symptoms of dyspnea, fatigue, and orthopnea
 Assess current activity level
 Review medications and compliance
 Blood pressure measurement ( goal BP <130/80)
 Assess lab work with each visit (CBC, BMP)
 Assess for volume overload:
- Weight
- Jugular venous pressure
- Peripheral edema
- Ascites
- Rales
- Hepatomegaly
- S3 or S4 gallop
Patient Education
• Explanation of the disease
• Signs and symptoms of recurrent HF
• Treatment plan
• When to make follow-up appointments
• When to call the physician with symptoms
• Changes in the ability to perform activities
General
• Smoking cessation
• Decreasing or limiting alcohol intake
• Sleep disorders evaluation and therapy to improve LVEF and functional status (Stage C, IIb-B).
• Early education of the patient and family regarding the expected course of illness and final treatment options, which should include end of
life considerations, advanced directives, living wills, and the role of both palliative and hospice care.
Exercise
• Exercise training (30 minutes, five days/week) should be considered for all stable outpatients.
Vaccinations
• Influenza recommended yearly
• Pneumococcal recommended for anyone with heart failure; should be received once before age 65 and again when person turns 65 (but
must be five years after the first administration)
Step Six: Implantable Cardioverter-Defibrillator
• Consider referral to cardiologist.
• Recommended for patients with:
• Ischemic heart disease who are at least 40 days post-MI, LVEF less than or equal to 35%, NYHA functional class 2 or 3 symptoms while
undergoing chronic optimal medical therapy, and have a reasonable life expectancy.
• Current or prior symptoms of HF and reduced LVEF who have a history of cardiac arrest, ventricular fibrillation or hemodynamically
destabilizing ventricular tachycardia.
• Cardiac resynchronization therapy is effective in patients with heart failure and prolonged QRS duration.
• Nonischemic cardiomyopathy with LVEF less than or equal to 30%, NYHA functional class 2 or 3 symptoms while undergoing chronic
optimal medical therapy, and have a reasonable life expectancy.
Heart Failure - 5