Practice Guidelines: Managing Chronic Heart Failure

With the U.S. population aging, chronic heart failure is on the rise. Now healthcare professionals must diagnose and manage this complex, life-threatening syndrome more effectively than ever. To help, the American College of Cardiology and American Heart Association provide complete practice guidelines for the four stages of heart failure.

The American Heart Association has identified these four stages of heart failure (HF), which complement the NYHA classifications:

  • Stage A: At high risk for HF but no structural heart disease or HF symptoms
  • Stage B: Structural heart disease but no HF signs or symptoms
  • Stage C: Structural heart disease and prior or current HF symptoms
  • Stage D: Refractory HF that requires specialized interventions

According to the guidelines, possibly the most effective and least followed general measures are close attention and follow-up. These require regular assessment, patient teaching, monitoring of adherence to the plan of care, and evaluation of the patient’s response. To help you and your colleagues align your practice with current guidelines, the following list summarizes teaching for patients with Stage C heart failure. 

General Teaching

Review and reinforce the following with the patient and family:

  • The prescribed treatment plan for hypertension, lipid disorders, and diabetes mellitus, if appropriate. As needed, encourage the patient to discuss weight-loss options with the healthcare provider. 
  • Smoking cessation. Provide options for quitting and emphasize its health benefits.
  • Regular exercise program recommended by the healthcare provider. Discourage heavy physical labor or exhaustive sports.
  • Avoidance of alcohol and illicit drugs. Describe options for support, such as Alcoholic Anonymous, if needed.
  • Restriction of dietary sodium intake to a moderate level. Describe ways to do this, such as reading food labels and substituting herbs for salt. As needed, involve the dietitian in the treatment plan. 
  • Daily weight measurement, using the same scale at the same time of day and wearing the same amount of clothing. Instruct the patient to report a gain of 2 lb in 1 day or 3 lb in 1 week.
  • Staying alert for minor changes in symptoms. Instruct the patient and family to report any changes and seek treatment promptly.
  • Influenza and pneumococcal immunizations to reduce the risk of respiratory infection.
  • Blood tests to monitor the serum potassium level. Explain that too much or too little potassium can affect the heart rhythm and may lead to sudden death.

Teaching about Drugs and Other Treatments

  • Instruct the patient to take medications exactly as prescribed. A diuretic, angiotensin-converting enzyme inhibitor, and beta blocker may be ordered. An aldosterone antagonist, angiotensin receptor blocker, digoxin, hydralazine, or nitrate may also be prescribed. If side effects or other problems interfere with the regimen, instruct the patient to notify you or the physician. 
  • Advise the patient that some medications can exacerbate heart failure symptoms and require more vigilance in monitoring. Such medications include: 
    • antiarrhythmics other than amiodarone and dofetilide 
    • calcium channel blockers other than vasoselective ones 
    • nonsteroidal anti-inflammatory drugs, with the possible exception of aspirin.
  • If the patient has an implantable defibrillator or biventricular pacemaker, explain how it works. Also discuss routine device testing and related safety precautions.

Did you know that February is American Heart Month? Learn more by visiting the American Heart Association’s website

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