Heart failure - discharge

  • Description
    • Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. When symptoms become severe, a hospital stay may be necessary. This articles discusses what you need to do to take care of yourself when you leave the hospital.

  • Alternative Names
    • Congestive heart failure - discharge; CHF - discharge; HF - discharge

  • When you Were in the Hospital
    • You were in the hospital to have your heart failure treated. Heart failure occurs when the muscles of your heart are weak or have trouble relaxing, or both.

      Your heart is a pump that moves fluids through your body. As with any pump, if the flow out of the pump is not enough, fluids do not move well and they get stuck in places they should not be. In your body, this means that fluid collects in your lungs, abdomen, and legs.

      While you were in the hospital:

      • Your health care team closely adjusted the fluids you drank or received through an intravenous (IV) line. They also watched and measured how much urine you produced.
      • You may have received medicines to help your body get rid of extra fluids.
      • You may have had tests to check how well your heart was working.
  • What to Expect at Home
    • Your energy will slowly return. You may need help taking care of yourself when you first get home. You may feel sad or depressed. All of these things are normal.

  • Checking Yourself at Home
    • Weigh yourself every morning on the same scale when you get up -- before you eat but after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it.

      Throughout the day, ask yourself:

      • Is my energy level normal?
      • Do I get more short of breath when I am doing my everyday activities?
      • Are my clothes or shoes feeling tight?
      • Are my ankles or legs swelling?
      • Am I coughing more often? Does my cough sound wet?
      • Do I get short of breath at night or when I lie down?

      If you are having new (or different) symptoms, ask yourself:

      • Did I eat something different than usual or try a new food?
      • Did I take all of my medicines the right way at the right times?
  • Diet and Fluids
    • Your health care provider may ask you to limit how much you drink.

      • When your heart failure is not very severe, you may not have to limit your fluids too much.
      • As your heart failure gets worse, you may be asked to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.

      You will need to eat less salt. Salt can make you thirsty, and being thirsty can cause you to drink too much fluid. Extra salt also makes fluid stay in your body. Lots of foods that DO NOT taste salty, or that you DO NOT add salt to, still contain a lot of salt.

      You may need to take a diuretic, or water pill.

      DO NOT drink alcohol. Alcohol makes it harder for your heart muscles to work. Ask your provider what to do on special occasions where alcohol and foods you are trying to avoid will be served.

      If you smoke, stop. Ask for help quitting if you need it. DO NOT let anybody smoke in your home.

      Learn more about what you should eat to make your heart and blood vessels healthier.

      • Avoid fatty foods.
      • Stay away from fast-food restaurants.
      • Avoid some prepared and frozen foods.
      • Learn fast food tips.

      Try to stay away from things that are stressful for you. If you feel stressed all the time, or if you are very sad, talk with your provider who can refer you to a counselor.

  • Taking Your Heart Drugs
    • Have your entire drug prescriptions filled before you go home. It is very important that you take your drugs the way your health care provider told you to. DO NOT take any other drugs or herbs without asking your provider about them first.

      Take your drugs with water. DO NOT take them with grapefruit juice, since it may change how your body absorbs certain medicines. Ask your provider or pharmacist if this will be a problem for you.

      The drugs below are given to many people who have heart failure. Sometimes there is a reason they may not be safe to take, though. These drugs may help protect your heart. Talk with your provider if you are not already on any of these drugs:

      Talk to your provider before changing the way you take your medicines. Never just stop taking these drugs for your heart, or any drugs you may be taking for Diabetes, high blood pressure, or other medical conditions you have.

      If you are taking a blood thinner, such as warfarin (Coumadin), you will need to have extra blood tests to make sure your dose is correct.

  • Activity
    • Your provider may refer you to cardiac rehabilitation program. There, you will learn how to slowly increase your exercise and how to take care of your heart disease. Make sure you avoid heavy lifting.

      Make sure you know the warning signs of heart failure and of a heart attack. Know what to do when you have chest pain, or angina.

      Always ask your provider before starting sexual activity again. DO NOT take sildenafil (Viagra), or vardenafil (Levitra), tadalafil (Cialis), or any herbal remedy for erection problems without checking first.

      Make sure your home is set up to be safe and easy for you for you to move around in and avoid falls.

      If you are unable to walk around very much, ask your provider for exercises you can do while you are sitting.

  • Follow-up
    • Make sure you get a flu shot every year. You may also need a pneumonia shot. Ask your provider about this.

      Your provider may call you to see how you are doing and to make sure you are checking your weight and taking your medicines.

      You will need follow-up appointments at your provider's office.

      You will likely need to have certain lab tests to check your sodium and potassium levels and monitor how your kidneys are working.

  • When to Call the Doctor
    • Call your provider if:

      • You gain more than 2 pounds (lb) (1 kilogram, kg) in a day, or 5 lb (2 kg) in a week.
      • You are very tired and weak.
      • You are dizzy and lightheaded.
      • You are more short of breath when you are doing your normal activities.
      • You have new shortness of breath when you are sitting.
      • You need to sit up or use more pillows at night because you are short of breath when you are lying down.
      • You wake up 1 to 2 hours after falling asleep because you are short of breath.
      • You are wheezing and having trouble breathing.
      • You feel pain or pressure in your chest.
      • You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
      • Your have swelling in your feet, ankles or legs.
      • You have to urinate a lot, especially at night.
      • You have stomach pain and tenderness.
      • You have symptoms that you think may be from your medicines.
      • Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.
  • References
    • Januzi JL, Mann DL. Clinical assessment of heart failure. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 23.

      Mann DL. Management of patients with heart failure with reduced ejection fraction. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 25.

      Mant J, Al-Mohammad A, Swain S, Laramée P; Guideline Development Group. Management of chronic heart failure in adults: synopsis of the National Institute for Health and Clinical Excellence guideline. Ann Intern Med. 2011;155(4):252-259. PMID: 21844551

      Riegel B, Moser DK, Anker SD, et al. State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. Circulation. 2009;120(12):1141-1163. PMID: 19720935

      Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-e327. PMID: 23741058