Managing Heart Failure

Originally published during Heart Failure Awareness Week 2023, this article provides guidance on managing heart failure and the importance of patient education to understand your condition.

Managing Heart Failure

While heart failure is a life-altering disease, with appropriate management and lifestyle changes, individuals are able to maintain a consistent quality of life for a longer period of time. Understanding your condition and remaining educated will be crucial to success. By incorporating the steps below and making sure you have a clear understanding of each, you can stay one step ahead of the disease. [1]

Education

Knowledge is power! It is essential that both you and your family understand what heart failure is, what the symptoms are, what you should do if your symptoms change and how your doctor treats the disease. Remember to always ask questions and take notes if you don’t understand or if you need more information. See what heart failure organizations had to say on this topic.

Medication Adherence

Taking your prescribed medications as directed is crucial to the health of your heart. While the doses of your medications will be fine-tuned over time, never stop taking a medication before consulting with your medical team. If you have concerns about side effects or the way a medication is making you feel, reach out to the team right away.

Four Pillars of Guideline Directed Medical Therapy

The 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure establishes that the four pillars of Guideline Directed Medical Therapy (GDMT) now form the foundational standard of medical therapy for patients with HF with reduced ejection fraction. These medications include:

ARNI (angiotensin-receptor neprilysin inhibitor) or ACE-I (Angiotensin converting enzyme inhibitor) or ARB (angiotensin receptor blockers) as alternatives to ARNIs
Evidence-based Beta-Blockers (Metoprolol succinate, carvedilol, or bisoprolol)
MRA (Mineralocorticoid Receptor Antagonists)
SGLT2i (Sodium-Glucose Cotransporter 2 Inhibitors) [2]

It’s critical that patients with HF with reduced ejection fraction receive treatment that is based on these four pillars – and that the patient remains diligent in adhering to the treatment plan created by their providers. It is important to note that while these medications form the four pillars, the regimen developed for you by your healthcare providers may not include all of these medications and it may vary significantly from another patient’s regimen. Some medications are not right for some patients due to cost barriers, tolerance, etc. It’s important to listen to your healthcare team first and foremost and adhere to your individual regimen.

Most people with heart failure require several medications for the best results. It is common for your health care provider to start at low doses and then increase the doses of these medications over time, even if you feel better after starting them. That is because most heart failure medications have a “dose response”, meaning that they work better at higher doses. Their purpose is not only to make you feel better in the short run, but also to treat the underlying disease and improve your health in the long run—helping you to live longer, stay out of the hospital, and feel better! Therefore, it is important to take all of your medications at the prescribed doses even if you are feeling better. [3]

Dietary Choices: Watching your salt consumption and fluid intake (water, soda, juice, etc.) is necessary to prevent your heart from having to work harder than it needs to. Talk with your dietitian to ensure you understand what foods will work best for you and your heart.

Exercise: In addition to medicine and diet, exercise will help your heart and keep you physically strong. For some, a cardiac rehabilitation program may be the right course of action to support your activity. [4] Make sure to talk with your doctor before beginning an exercise program, as they may want you to gradually build towards certain goals.

Daily Weight: You should weigh yourself daily in the morning, after using the bathroom, and report a weight gain of 2-3 lbs in 24 hours or 5 lbs in one week. Large changes in weight may be a signal that your medications or diet needs an adjustment.

Be Prepared: Finally, make sure that you are prepared for appointments with your healthcare providers. Arrive with a comprehensive list of all your daily medications and a log of your daily weights and blood pressure. Be prepared to discuss your use of medications and any concerns about side effects, tolerability, cost or access such as prescription coverage. Bring a notepad or other tool for recording any notes. If needed, bring a trusted caregiver to the appointment to ensure that all guidance and instructions are recorded.

Explore the resources and references below to support you in managing your heart failure.