Heart Talk: Living with Heart Failure Education for patients, families and caregivers

An accompanying patient booklet can be downloaded for free at www An accompanying patient booklet can be downloaded for free at www.Qualidigm.org. Search for it and more under “Heart Talk”

What is Heart Failure? Weakness of the heart muscle Sometimes also called: Congestive heart failure Pulmonary edema Fluid on lungs Retention of fluid

Common Symptoms of Heart Failure Hard time breathing Swollen ankles, legs, or abdomen (edema) Feeling weak and tired

Heart Failure Can Be Treated Medications Procedures Surgery

Heart Failure is Chronic It requires lifelong treatment.

Heart Failure is Common More than 5 million Americans have Heart Failure. 1 American Heart Association. 2008 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association; 2008. 7 7

6 Tips for Staying Healthy Following these tips and doing what your doctor tells you will help keep you healthy

6 Tips to Stay Healthy Take Medications as Ordered by Your Doctor Go to Doctor Appointments Monitor (watch) Your Symptoms and Weight Adapt Diet (eating) and Fluids (drinking) Get Exercise as Directed Limit Alcohol, Caffeine and Tobacco 9

1. Take Medications as Ordered by Your Doctor

What You Need to Know Take Medications as Ordered Medications for heart failure are necessary even when you are feeling well.

How to Keep Healthy Take Medications as Ordered Go over your list of medications with your doctor or nurse Make sure you understand how and when to take them Ask about side effects (reactions) or possible problems with taking medications with other medications and/or vitamins

How to Keep Healthy Take Medications as Ordered Know how to refill your prescriptions Call your doctor’s office a few days before you run out of your pills Make sure you have a way to get your medications How will you get to the pharmacy? possibly add - Will your pharmacy deliver?

How to Keep Healthy Take Medications as Ordered Bring your medications or a list of your medications to all of your doctor appointments Tell your doctor about any side effects or reactions Do we want to instruct patients on how to read a prescription label… how to know if you have refills left? 14

What You Need to Know Take Medications as Ordered Patients who take their medicines live longer, feel better, and spend less time in the hospital.

2. Go to Doctor Appointments

What You Need to Know Doctor Appointments Heart failure is not simple The doctor needs to see you often to keep you well

How to Keep Healthy Doctor Appointments Set up an appointment with your doctor before you leave the hospital or other facility Set it up on the best day and time for you Make sure you have a ride to your appointments

How to Keep Healthy Doctor Appointments Bring a friend or family member Bring all medications or a medication list to all appointments Ask questions! Your doctor wants to make sure you take care of yourself

What You Need to Know Doctor Appointments Patients who go to doctor appointments live longer, feel better, and spend less time in the hospital.

3. Monitor (watch) Your Symptoms and Weight

Monitor Symptoms Common heart failure symptoms: Hard time breathing Swollen ankles, legs, or abdomen (edema) Feeling weak and tired

Monitor Weight When your body holds extra fluid (water), your weight goes up Weight gain from fluid can start up to two weeks BEFORE symptoms By weighing yourself every day, you can avoid getting sick

How to Keep Healthy Watch Your Symptoms and Weight Get a scale if you don’t have one Make sure you can read the numbers Write your weight down every day Bring the weight chart to your doctor appointments

How to Keep Healthy Watch Your Symptoms and Weight Weigh yourself every morning at about the same time: After urinating Before having anything to drink In the same amount of clothing Use the same scale

How to Keep Healthy Watch Your Symptoms and Weight Tell your doctor if you gain: 3 pounds in one day 5 pounds in one week

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Talk about what to do…hospital vs. SNF vs. home 28

Talk about what to do…hospital vs. SNF vs. home 29

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What You Need to Know Watch Your Symptoms and Weight By monitoring for symptoms and weight gain, patients with heart failure can live longer, feel better, and spend less time in the hospital

4. Adapt Diet (eating) and Fluids (drinking)

Salt and Water Salt = Sodium High salt intake will make the body hold extra fluid (water) Extra fluid leads to swelling and heart failure symptoms Eating a low salt diet helps patients stay well

How to Keep Healthy Eating and Drinking Do not add salt to any meals Try to eat less than 2000 mg of sodium a day One teaspoon of salt = 2300 mg of sodium If you don’t buy and cook your own food, speak to the person who does

Reading a Label Check to see how many servings are listed on the label Eating more than one serving size increases salt intake more than what is listed on the label

Common Food Salt Sources Canned foods Frozen dinners Deli meats Hot dogs

Other Food Salt Sources Sea salt Adobo seasoning Salad dressings Cheeses Soy sauce Jar tomato/pasta sauce Pickles Sausages and Kielbasa Ham and Bacon French fries

How to Keep Healthy Eating and Drinking If you do eat salt, tell your doctor Medications may need to be adjusted More doctor visits may be needed You may need to talk with a diet specialist Ask about a diet specialist

How to Keep Healthy Eating and Drinking Eating out: choose heart healthy foods Baked or broiled foods Salad dressing, sauce or gravy on the side Safe dishes: baked chicken or fish, steamed vegetables

What You Need to Know Eating and Drinking By avoiding salt in your diet, you can live longer, feel better, and spend less time in the hospital

Fluid Restriction Sometimes doctors will limit the amount of liquids patients can have every day Foods that count as liquids are: yogurt, pudding, ice cream, and gelatin Some fruits have liquid: 1 orange or ½ Grapefruit = 4 ounces of fluid Fluid Restriction means……

Fluid Restriction Space your liquids out over the day Save liquids to take your medicines Some patients can take their medicine with applesauce instead of a drink

Tips to Battle Thirst Use ice chips or freeze juice in an ice cube tray Rinse the mouth Use a lemon wedge, gum, frozen grapes, strawberries or hard candy

5. Exercise as Directed by Your Doctor

Exercise and Activity Always check with your doctor. Your doctor can tell you what is good for you: Exercise: Most of the time is safe and good for you Sex and driving: Most of the time is safe for you Ask your doctor about what activities are safe for you

6. Limit Alcohol, Caffeine and Tobacco Use

Alcohol and Caffeine You should check with your doctor about alcohol and caffeine use Alcohol is usually okay in moderation Less than 2 drinks per day for men Less than 1 drink per day for women Caffeine is usually okay in moderation Less than 1 or 2 cups per day

Tobacco If you smoke, please STOP! Bad for anyone, but especially for those with heart failure Makes the heart work harder Can lead to heart attacks Ask your doctor or nurse about help to quit smoking

6 Tips to Stay Healthy Take Medications as Ordered by Your Doctor Go to Doctor Appointments Monitor (watch) Your Symptoms and Weight Adapt Diet (eating) and Fluids (drinking) Get Exercise as Directed Limit Alcohol, Caffeine and Tobacco 49

Credits The Hospital of Central Connecticut Shelley Dietz RN, MBA Qualidigm Anne Elwell, RN, MPH Michelle Pandolfi, MSW, LNHA University of Connecticut Heath Center Wendy Martinson RN, BSN Jason Ryan, MD, MPH

Special Thanks to: David Lazauski for sharing his experience as a patient living with heart failure University of Connecticut Health Center Dr. Jason Ryan for his dedication to teaching us all how to live well with heart failure

This material was prepared in collaboration with Qualidigm, the Medicare Quality Improvement Organization for Connecticut, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Pub #CT-800100-2011052 The views and opinions expressed here do not reflect the policy or position of the Centers for Medicare and Medicaid Services, nor of Qualidigm. Examples and information provided are for educational purposes only and should not be construed as medical advice. Any person with questions or concerns relating to any medical condition or treatment should consult with a qualified health care professional.