Adequate patient self-care is essential in the effective management of HF and allows patients to understand what is beneficial, and to agree to self-monitoring and management plans.
319HF patients who report more effective self-care have a better QOL, lower readmission rates, and reduced mortality.
309Misunderstandings, misconceptions, and lack of knowledge all con- tribute to insufficient self-care and therefore patient education is vital.
Improving patients’ knowledge of their condition is fundamental for the development of self-care skills.
304Education to improve self-care should be tailored to the individual patient and based on, where available, scientific evidence or expert opinion. There is little evidence that specific lifestyle advice improves
Multidisciplinary interventions recommended for the management of chronic heart failure
Recommendations Classa Levelb
It is recommended that HF patients are enrolled in a multidisciplinary HF management pro- gramme to reduce the risk of HF hospitalization and mortality.309,314,315,316
I A
Self-management strategies are recommended to reduce the risk of HF hospitalization and mortality.309
I A
Either home-based and/or clinic-based pro- grammes improve outcomes and are recom- mended to reduce the risk of HF hospitalization and mortality.310,317
I A
Influenza and pneumococcal vaccinations should be considered in order to prevent HF hospitalizations.315,316
IIa B
HF = heart failure.
aClass of recommendation.
bLevel of evidence.
ESC 2021
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Table 11 Important characteristics and components in a heart failure management programme
Characteristics1. Patient/person-centred318 2. Multidisciplinary
3. The focus of the programme should be flexible and include:
•
prevention of disease progression•
symptom control•
maintaining patients in their preferred place of care for end-stage heart failure 4. Competent and professionally educated staff5. Encourage patient/carer engagement in the understanding and management of their condition Components
1. Optimized management; lifestyle choices, pharmacological, and devices 2. Patient education, with special emphasis on self-care and symptom management 3. Provision of psychosocial support to patients and family caregivers
4. Follow-up after discharge (clinic; home visits; telephone support or telemonitoring) 5. Easy access to healthcare, especially to prevent and manage decompensation
6. Assessment of (and appropriate intervention in response to) an unexplained change in weight, nutritional and functional status, quality of life, sleep problems, psychosocial problems or other findings (e.g., laboratory values)
7. Access to advanced treatment options; supportive and palliative care
Table 12 Patient education and self-care
Education topic Goal for the patient and caregiver Professional behaviour and educational tools Explanation about HF To understand the cause of their HF, symptoms and treat-
ment choice.
Provide tailored information.
The HF trajectory To understand prognosis and the different possible phases in the HF trajectory.
To make joint treatment decisions that recognise the patient’s position on the HF trajectory.
Sensitively communicate information on prognosis at time of diag- nosis, during decision making about treatment options, when there is a change in the clinical condition and whenever the patient requests.
Medical treatment
Medication To be able to make joint decisions about medication.
To understand the indications, benefits, the need for long- term adherence to certain drugs, and the dosing and side effects of medication.
To be able to recognize the common side effects of medi- cation and know what actions to take.
Provide written and oral information on indication, benefits, dos- ing, effects and side effects.
Discuss practical issues such as optimal time-schedule, what to do in case of a missed dose etc.
Discuss possible barriers for medication taking.
Advise on support aids such as dosette box, electronic reminders etc. when appropriate.320
Implanted devices To be able to make joint decisions on device implantation.
To understand the indications, importance, expectations and check-up routine for implanted devices, and any exception management.
To be able to recognize the common complications (including the risk of inappropriate defibrillator shocks), and know what actions to take.
Provide written and oral information about the importance and expectations of implanted devices, and possible ways of follow- up (remote monitoring).
Discuss expectations and any possible impact on driving.
Clearly identify situations where the device might be deactivated or explanted.
Involve patient and caregiver in decision making.
Self-care aspects
Activity and exercise To undertake regular exercise and be physically active.
To be able to adapt physical activity to symptom status and personal circumstances.
Advise on exercise that recognizes physical and functional limita- tions, such as frailty, comorbidities.
Refer to exercise programme or other activity modes.
Discuss possible barriers, side-effects and opportunities.
Sleep and breathing To recognize the importance of sleep and rest for (CV) health.
To be able to recognize problems with sleeping and how to optimize sleep.
Review sleep history.
Advise and discuss the importance of good sleep and provide advice on ‘sleep health’ (including timing of diuretics).
Continued ESC 2021
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Table 12 Continued
Education topic Goal for the patient and caregiver Professional behaviour and educational tools
Consider and carefully discuss the benefits and deleterious effects of sleep medication.
Fluids To avoid large volumes of fluid intake. A fluid restriction of 1.52 L/day may be considered in patients with severe HF/hyponatraemia to relieve symptoms and congestion.
To avoid dehydration: where fluids are restricted, increase intake during periods of high heat/humidity and/or nau- sea/vomiting.
Provide information and discuss the advantages and disadvantages of fluid restriction.
Advise to adapt fluid intake to weight, and in times of high heat and humidity, nausea/vomiting.
Adjust advice during periods of acute decompensation and con- sider altering this advice towards end-of-life.
Healthy diet To be able to prevent malnutrition and know how to eat healthily, avoiding excessive salt intake (>5 g/day) and maintaining a healthy body weight.
Discuss current food intake, role of salt, role of micronutrients.
Discuss the need for supplementing in case of nutrient deficien- cies but there is no clear role for routine micronutrient supplementation.321
Discuss maintaining a healthy body weight.
Alcohol To be able to abstain from or avoid excessive alcohol intake, especially for alcohol-induced CMP.
To restrict alcohol according to CV prevention guidelines.
Tailor alcohol advice to aetiology of HF; e.g. abstinence in alco- holic CMP.
Inform and discuss alcohol intake according to CV prevention guidelines (2 units per day in men or 1 unit per day in women)a. Immunization To be aware of the need for immunization for influenza
and pneumococcal disease.
Discuss benefits and possible barriers.
Advise on local immunization practice.
Smoking and recrea- tional drugs
To be aware of the consequences for health of smoking and use of recreational drugs.
Stop smoking (including e-cigarettes) and taking recrea- tional drugs.
Inform, discuss and help in decision making.
Refer for specialist advice for smoking cessation and drug with- drawal and replacement therapy.
Consider referral for cognitive behavioural theory and psychological support if patient wishes to stop smoking or taking drugs.
Travel, leisure, driving To be able to prepare travel and leisure activities accord- ing to physical capacity.
To be able to take an informed decision about driving.
Inform and discuss practical issues related to long haul travel, stay- ing abroad, exposure to sun (amiodarone effects), high humidity or heat (dehydration), and high altitude (oxygenation).
Provide practical advice related to travel with medication/devices (keep medicines in hand luggage, have a list with medication, device name/card and treating centres).
Inform about local/national/international regulation related to driving.
Sexual activity To be able to resume or adapt sexual activity according to physical capacity.
To recognize possible problems with sexual activity and their relationship with HF or its treatment.
Inform and discuss that sexual activity is safe for stable HF patients.
Provide advice on eliminating factors predisposing to sexual problems.
Discuss and provide available pharmacological treatment for sex- ual problems.
Refer to specialist for sexual counselling when necessary.
Symptom monitoring and symptom self- management
Monitor and recognize change in signs and symptoms.
Being able to react adequately to change in signs and symptoms.
Know how and when to contact a healthcare professional.
Provide individualized information to support self-management such as:
In the case of increasing dyspnoea or oedema or a sudden unex- pected weight gain of >2 kg in 3 days, patients may increase their diuretic dose and/or alert their healthcare team.
Living with HF
Psychological issues To be able to live a good life with HF.
To be able to seek help in case of psychological problems such as depressive symptoms, anxiety or low mood which may occur in the course of the HF trajectory.
Regularly communicate information on disease, treatment options and self-care.
Regularly discuss the need for support.
Treat or referral to specialist for psychological support when necessary.
Continued