Remember: The key to successful management of long term conditions ultimately rests in the hands of the person who lives with the condition and their ability and aspiration to care about themselves, however they may require support to self manage. (COSMIC 2013).
Anticipatory care tries to consider these factors in supporting self management.
- Self Care: What each person does on an everyday basis is often compromised for a person living with a long term condition such as heart failure.
- Self Management: The process each person develops to manage their condition.
- Diet:
Fats: Reduction of fat, in particular of saturated fat is one of the pillars of dietary advice to live a healthier life.
All individuals with a diagnosis of heart failure should aim to consume less than 2 g of salt per day. Less salt means less fluid retention and this means less work for the heart. Try to keep salt intake less then 2 grams per day. Patients should be encouraged to check the packaging of food to work out the salt content.
Often sensible advice is to either:- Avoid adding salt to food when cooking.
- Avoid adding salt to food at the table.
- Avoid using salt substitutes such as Lo-salt as this can interfere with your medications.
- Effervescent or fizzy medicines can have a high salt content and should be considered when checking prescriptions.
All patients with heart failure should be encouraged to continue a diet high in fruit and vegetables.
- Alcohol:
All patients with heart failure should be encouraged to remain within the healthy limits for alcohol consumption. A female should not exceed 14 units of alcohol per week and a male should not exceed 21 units per week. This should be spread over the course of a week with at least 2 alcohol free days during this time. An additional consideration will be the amount of fluid contained in the alcoholic drink e.g. pint of beer. If patient has a diagnosis of heart failure due to alcoholic dilated cardiomyopathy then they should be strongly advised to abstain. - Medication:
Heart failure patients are often on multiple medications. These need to be reviewed at every consultation and specific questions asked – what their prescription is, what are they actually taking, are they taking anything else? It is the fine-tuning or balance of taking these different drugs that gets the best possible function of the heart. A small adjustment can sometimes make all the difference. Raza may require many different medication considerations in order to reduce his symptoms (NYHA) and keep him stable. Another aspect of medication will be to consider if the patient is taking any effervescent medication as some can contain significant salt as an accelerant. - Vaccinations:
It is advisable for Raza to have an annual influenza immunisation and pneumonia immunisation (once only) injection to protect against infection which can place strain on the heart and worsen HF symptoms. - Fluid management : Some people are advised to limit the amount of fluid they consume in a day. This something to consider when discussing fluid intake and diuretic therapy in particular. You could also say to Raza that sucking ice cubes or freezing juice can be useful in reducing fluid intake. This should always be discussed on an individual basis and a good way to do this is with the use of a day discussion to determine patients own daily routine. Fluid restriction to within 2 litres in 24 hours (which includes all foods plus liquids) is part of a self management plan in heart failure. Patients would rather monitor fluid intake to within 2 litres than add in more water pills which make them run to the toilet. As there is no point adding in more diuretics if they then override this by drinking too much liquid which will make fluid overload worse.
- Weight :
Carrying extra fluid causes an increase in body weight. This is why many people are asked to weigh themselves daily and keep a record of it. Weight charts can be found at the back of the CHSS: Living with Heart Failure publication.
Not everyone is able to weight themselves due to frailty or eyesight issues but for Raza this is an important self management aspect. Early reporting of sudden weight gain is vital and should be emphasised to Raza!
Patients should be told to weight themselves every morning around the same time without clothes on. Then a gain of over 2lbs two days running or 3- 4lbs in a week should be reported to the doctor or nurse. Often this only requires a prescription of a small dose of diuretic for 3 days before reviewing weight gain and symptoms. (often by telephone)
Page last reviewed: 28 Jul 2020
