lifestyle and risk factor management in heart failure

Last edited 10/2018

Life style and risk factor management is aimed at maintaining physical stability; avoiding actions which may worsen the condition and detection of the early symptoms of deterioration (1).  

Literature has shown that only 20 – 60% of patients adhere to their prescribed treatment regiments hence patients should be educated about the importance of adhering to treatment. This will aid in decreasing the morbidity and mortality and also improves well being of the patient (1)

The following general measures should be considered in a patient with heart failure:

• the primary cause of heart failure should be treated where this is appropriate:
• hypertension
• anaemia
• hypoxia
• valve disease

• bed rest (acute heart failure):
• erect posture and exercise exacerbate renal vasoconstriction

• dietary modification:
• salt and fluid restriction (3)
  • do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows:
  • restricting fluids for people with dilutional hyponatraemia
    • restriction of fluid to1.5–2 L/day may be beneficial in acute severe heart failure especially with hyponatraemia (1)
  • reducing intake for people with high levels of salt and/or fluid consumption
  • continue to review the need to restrict salt or fluid
  • advise people with heart failure to avoid salt substitutes that contain potassium
• alcohol in moderation only
  
  
• air travel
  • air travel will be possible for the majority of people with heart failure, depending on their clinical condition at the time of travel
    
    
• driving
  • consult DVLA guidance

• stop smoking

• maintain optimal weight - increase in weight is associated with fluid retention and deterioration of HF (although deterioration without weight gain may also occur)
• patients should weigh themselves on a regular basis at the same time each day (for example after waking and voiding, before dressing or eating) (1,2)
• in a sudden weight gain of >2kg inside 3 days, patient can either increase the dose of their diuretic or seek medical advice (1)

• educate the patients and/or caregivers on how to recognise symptoms of deteriorating HF and what steps should be taken e.g. - seek medical attention or adjust the doses of their diuretics (as pre-agreed), or both (1)

• regular low intensity physical activity in all stable chronic HF patients is recommended (1,2)
  • exercises in water or swimming should be avoided in patients with NYHA III or IV HF

Reference:

• (1) European Society of Cardiology (ESC) 2008. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
• (2) Scottish Intercollegiate Guidelines Network (SIGN) 2007. Management of chronic heart failure: a national clinical guideline
• (3) NICE (September 2018).Chronic heart failure in adults: diagnosis and management