Self‐care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology

Guidelines on heart failure (HF) stress the importance of lifestyle advice, although there is little evidence that such recommendations improve symptoms or prognosis. Patients experience symptoms of different intensities which impair their daily activities and reduce the quality‐of‐life. To cope with their clinical condition, many patients seek advice about lifestyle and self‐management strategies when in contact with medical care providers, particularly specialized HF services. Self‐care management is an important part of HF treatment, thus health professionals working with patients with HF have recognized the need for more specific recommendations on lifestyle advice. The present paper summarizes the available evidence, promotes self‐care management, and aims to provide practical advice for health professionals delivering care to HF patients. It also defines avenues of research to optimize self‐care strategies in a number of key areas to derive further benefits.

[1]  K. Swedberg,et al.  Recall of lifestyle advice in patients recently hospitalised with heart failure: A EuroHeart Failure Survey analysis , 2007, European journal of heart failure.

[2]  A. Strömberg,et al.  Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure. , 2008, Journal of clinical nursing.

[3]  V. Fialka-Moser,et al.  Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. , 2004, European heart journal.

[4]  H. Krumholz,et al.  Telemonitoring in patients with heart failure. , 2010, The New England journal of medicine.

[5]  I Harvey,et al.  Systematic review of multidisciplinary interventions in heart failure , 2005, Heart.

[6]  P. Ponikowski,et al.  Cachexia: a new definition. , 2008, Clinical nutrition.

[7]  William T. Abraham,et al.  Focused Update : ACCF / AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults , 2013 .

[8]  K. Swedberg,et al.  A pilot study of salt and water restriction in patients with chronic heart failure , 2010, Scandinavian cardiovascular journal : SCJ.

[9]  B. Psaty,et al.  Influenza vaccination is not associated with a reduction in the risk of recurrent coronary events. , 2002, American journal of epidemiology.

[10]  Simon Capewell,et al.  Heart failure in a cold climate. Seasonal variation in heart failure-related morbidity and mortality. , 2002, Journal of the American College of Cardiology.

[11]  H. Rubin,et al.  Complexity of program and clinical outcomes of heart failure disease management incorporating specialist nurse‐led heart failure clinics. A meta‐regression analysis , 2005, European journal of heart failure.

[12]  T. Rodríguez-Blanco,et al.  Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease. , 2008, European heart journal.

[13]  A. Clark,et al.  Prolonged electrical muscle stimulation exercise improves strength, peak VO2, and exercise capacity in patients with stable chronic heart failure. , 2009, Journal of cardiac failure.

[14]  Karl Swedberg,et al.  Nonpharmacologic measures and drug compliance in patients with heart failure: data from the EuroHeart Failure Survey. , 2007, The American journal of cardiology.

[15]  Sing Kai Lo,et al.  Does cognitive impairment predict poor self‐care in patients with heart failure? , 2010, European journal of heart failure.

[16]  E. Gurfinkel,et al.  Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. , 2004, European heart journal.

[17]  M. Piepoli,et al.  Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH) , 2004, BMJ : British Medical Journal.

[18]  R. Hubbard,et al.  Risk of myocardial infarction and stroke after acute infection or vaccination. , 2004, The New England journal of medicine.

[19]  S. Yusuf,et al.  Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. , 2001, Journal of the American College of Cardiology.

[20]  G. Tomlinson,et al.  Continuous positive airway pressure for central sleep apnea and heart failure. , 2005, The New England journal of medicine.

[21]  K. Dracup,et al.  Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans. , 2000, The American journal of cardiology.

[22]  D. W. Wright,et al.  Sexual self-concept, anxiety, and self-efficacy predict sexual activity in heart failure and healthy elders. , 2006, Heart & lung : the journal of critical care.

[23]  E. Perea-Millá,et al.  Association between long travel and venous thromboembolic disease: a systematic review and meta-analysis of case-control studies , 2007, Annals of Hematology.

[24]  J. Cleland,et al.  Self‐rated health and mortality in patients with chronic heart failure , 2009, European journal of heart failure.

[25]  R. Cody,et al.  Sodium and water balance in chronic congestive heart failure. , 1986, The Journal of clinical investigation.

[26]  J. Gaziano,et al.  Alcohol Consumption and Risk of Heart Failure in the Physicians' Health Study I , 2006, Circulation.

[27]  M. Drazner,et al.  Relation of lack of knowledge about dietary sodium to hospital readmission in patients with heart failure. , 2008, The American journal of cardiology.

[28]  F. Rodríguez‐Artalejo,et al.  The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. , 2004, European heart journal.

[29]  K. Swedberg,et al.  Standard medication information is not enough: poor concordance of patient and nurse perceptions. , 2007, Journal of advanced nursing.

[30]  S. Anker,et al.  Body composition changes in patients with systolic heart failure treated with beta blockers: a pilot study. , 2006, International journal of cardiology.

[31]  Shah Ebrahim,et al.  Exercise training for systolic heart failure: Cochrane systematic review and meta‐analysis , 2010, European journal of heart failure.

[32]  A. Katz Do ask, do tell: why do so many nurses avoid the topic of sexuality? , 2005, The American journal of nursing.

[33]  K. Newton,et al.  Return to work, sexual activity, and other activities after acute myocardial infarction. , 1994, Heart & lung : the journal of critical care.

[34]  J. Cleland,et al.  Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis , 2007, BMJ : British Medical Journal.

[35]  S. Adamopoulos,et al.  Effects of physical training in chronic heart failure , 1990, The Lancet.

[36]  Hans L Hillege,et al.  Effect of moderate or intensive disease management program on outcome in patients with heart failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). , 2008, Archives of internal medicine.

[37]  Keiji Fukuda,et al.  Influenza-associated hospitalizations in the United States. , 2004, JAMA.

[38]  Shah Ebrahim,et al.  Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) , 2007 .

[39]  P. Poole‐Wilson,et al.  Symptoms in patients with heart failure are prognostic predictors: insights from COMET. , 2005, Journal of cardiac failure.

[40]  Sheldon H Gottlieb,et al.  A randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. , 2002, Journal of the American College of Cardiology.

[41]  W. Toff,et al.  Fitness to fly for passengers with cardiovascular disease. , 2010, Heart.

[42]  P. Ponikowski,et al.  Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology , 2009, European journal of heart failure.

[43]  S. Anker,et al.  Cardiac cachexia: a systematic overview. , 2009, Pharmacology & therapeutics.

[44]  John G F Cleland,et al.  A comparison of patient and physician-rated New York Heart Association class in a community-based heart failure clinic. , 2008, Journal of cardiac failure.

[45]  Miriam J. Johnson,et al.  Measurement of breathlessness in clinical trials in patients with chronic heart failure: the need for a standardized approach: a systematic review , 2010, European journal of heart failure.

[46]  John G F Cleland,et al.  Predicting hospitalization due to worsening heart failure using daily weight measurement: analysis of the Trans‐European Network‐Home‐Care Management System (TEN‐HMS) study , 2008, European journal of heart failure.

[47]  P. Ponikowski,et al.  Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine , 2010, European journal of heart failure.

[48]  M. Domanski,et al.  Light-to-moderate alcohol consumption and prognosis in patients with left ventricular systolic dysfunction. , 2000, Journal of the American College of Cardiology.

[49]  M. Kotler,et al.  Sex and the heart: what is the role of the cardiologist? , 2001, European heart journal.

[50]  J. McMurray,et al.  Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. , 2004, Journal of the American College of Cardiology.

[51]  M. Piepoli,et al.  Exercise training in patients with chronic heart failure , 2004, BMJ : British Medical Journal.

[52]  Craig Ziegler,et al.  Impact of Symptom Prevalence and Symptom Burden on Quality of Life in Patients with Heart Failure , 2005, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[53]  R. Goldberg,et al.  Use of nonpharmacologic treatment approaches in patients with heart failure. , 2006, International journal of cardiology.

[54]  C. Holly Structured telephone support or telemonitoring programmes for patients with chronic heart failure , 2011 .

[55]  S. Brophy,et al.  Interventions for latent autoimmune diabetes (LADA) in adults. , 2011, The Cochrane database of systematic reviews.

[56]  G. Kempen,et al.  The impact of a self‐management group programme on health behaviour and healthcare utilization among congestive heart failure patients , 2009, European journal of heart failure.

[57]  D. J. Veldhuisen,et al.  Depressive symptoms and outcomes in patients with heart failure: data from the COACH study , 2009, European journal of heart failure.

[58]  C. O’loughlin,et al.  Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability. , 2007, Journal of cardiac failure.

[59]  L. Stevenson,et al.  Sexual function in patients with advanced heart failure. , 1996, Heart & lung : the journal of critical care.

[60]  R. Califf,et al.  Relationship between depressive symptoms and long-term mortality in patients with heart failure. , 2007, American heart journal.

[61]  P. Armstrong,et al.  Patient and informal caregivers’ knowledge of heart failure: necessary but insufficient for effective self‐care , 2009, European journal of heart failure.

[62]  J. Soriano,et al.  Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease. , 2008, Proceedings of the American Thoracic Society.

[63]  John G.F. Cleland,et al.  Structured Telephone Support or Telemonitoring Programs for Patients with Chronic Heart Failure (Protocol) , 2008 .

[64]  E. Barrett-Connor,et al.  Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). , 2005, The American journal of cardiology.

[65]  S. Knowles,et al.  Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[66]  A. Strömberg,et al.  Heart Failure Management Programmes in Europe , 2006, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[67]  R. Halfens,et al.  Are nurses able to assess fatigue, exertion fatigue and types of fatigue in residential home patients? , 2002, Scandinavian journal of caring sciences.

[68]  Abdissa Negassa,et al.  Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study , 2003, The Lancet.

[69]  L. Appel,et al.  State of the science: promoting self-care in persons with heart failure: a scientific statement from the American Heart Association. , 2009, Circulation.

[70]  C. Yancy,et al.  The heart failure and sodium restriction controversy: challenging conventional practice. , 2008, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[71]  L. Nordgren,et al.  Symptoms Experienced in the Last Six Months of Life in Patients with End-Stage Heart Failure , 2003, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[72]  C. Schneider,et al.  ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. , 2008, European heart journal.

[73]  J. McMurray,et al.  Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study). , 2003, European heart journal.

[74]  Shah Ebrahim,et al.  European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) , 2012, International Journal of Behavioral Medicine.

[75]  N. Haddour Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). , 2008 .

[76]  Fuentes,et al.  Prevention and Management of Cardiovascular Events during Travel. , 1996, Journal of travel medicine.

[77]  P. Fenner Fitness to travel - assessment in the elderly and medically impaired. , 2007, Australian family physician.

[78]  F. Rutten,et al.  Compliance with non-pharmacological recommendations and outcome in heart failure patients. , 2010, European heart journal.

[79]  Thomas Schweizer,et al.  Telemedical Interventional Monitoring in Heart Failure (TIM‐HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design , 2010, European journal of heart failure.

[80]  J. Denollet,et al.  Patient‐rated changes in fatigue over a 12‐month period predict poor outcome in chronic heart failure , 2009, European journal of heart failure.

[81]  C. Reynolds,et al.  The Bypassing the Blues Treatment Protocol: Stepped Collaborative Care for Treating Post-CABG Depression , 2009, Psychosomatic medicine.

[82]  Stephan von Haehling,et al.  Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure. , 2007, Cardiovascular research.

[83]  A. Rigby,et al.  Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. , 2005, Journal of the American College of Cardiology.

[84]  R. Sanderman,et al.  Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study. , 2010, Journal of the American College of Cardiology.

[85]  Inger Ekman,et al.  Adherence to medication according to sex and age in the CHARM programme , 2009, European journal of heart failure.

[86]  I. Ekman,et al.  Self‐assessed symptoms in chronic heart failure — Important information for clinical management , 2007, European journal of heart failure.

[87]  J. Coyne,et al.  Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls. , 2009, Journal of cardiac failure.

[88]  J. Swan,et al.  Effectiveness of a videotape for sexual counseling after myocardial infarction. , 2004, Research in nursing & health.

[89]  S. Stewart,et al.  Detecting early clinical deterioration in chronic heart failure patients post‐acute hospitalisation—a critical component of multidisciplinary, home‐based intervention? , 2002, European journal of heart failure.

[90]  K. Nichol,et al.  Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. , 1998, Archives of internal medicine.

[91]  Harlan M Krumholz,et al.  Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. , 2002, Journal of the American College of Cardiology.

[92]  Shah Ebrahim,et al.  European guidelines on cardiovascular disease prevention in clinical practice , 2004 .

[93]  B. Marić,et al.  A systematic review of telemonitoring technologies in heart failure , 2009, European Journal of Heart Failure.

[94]  A. Simonds,et al.  A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction , 2007, European journal of heart failure.

[95]  M. Gott,et al.  Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people. , 2003, Family practice.

[96]  A. Strömberg,et al.  Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity , 2008, Scandinavian cardiovascular journal : SCJ.

[97]  H. Krumholz,et al.  Telemonitoring for patients with chronic heart failure: a systematic review. , 2007, Journal of cardiac failure.

[98]  B. Riegel,et al.  Nonpharmacologic care by heart failure experts. , 2006, Journal of cardiac failure.

[99]  M. Mehra,et al.  Sexual activity and chronic heart failure. , 2007, Mayo Clinic proceedings.

[100]  B. Krämer,et al.  Diuretic treatment and diuretic resistance in heart failure. , 1999, The American journal of medicine.

[101]  P. Ponikowski,et al.  Wasting as independent risk factor for mortality in chronic heart failure , 1997, The Lancet.

[102]  K. Fox,et al.  A randomised study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure. , 2003, European heart journal.

[103]  W. Kraus,et al.  Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. , 2009, JAMA.

[104]  Haya R Rubin,et al.  Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. , 2004, JAMA.

[105]  W. Kraus,et al.  Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. , 2009, JAMA.

[106]  M. Ehnfors,et al.  The Phenomena of Participation and Non-Participation in Health Care-Experiences of Patients Attending a Nurse-Led Clinic for Chronic Heart Failure , 2004, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[107]  A. Strömberg,et al.  Development and testing of the European Heart Failure Self‐Care Behaviour Scale , 2003, European journal of heart failure.

[108]  S. Anker,et al.  The effects of a high-caloric protein-rich oral nutritional supplement in patients with chronic heart failure and cachexia on quality of life, body composition, and inflammation markers: a randomized, double-blind pilot study , 2010, Journal of cachexia, sarcopenia and muscle.

[109]  V. Gurevich,et al.  Autoimmune Nature of Influenza Atherogenicity , 2005, Annals of the New York Academy of Sciences.

[110]  L. Rechardt,et al.  Physical training in chronic heart failure , 2000 .

[111]  T. Aoyama,et al.  Sleep apnoea induces cardiac electrical instability assessed by T‐wave alternans in patients with congestive heart failure , 2009, European journal of heart failure.

[112]  K. Swedberg,et al.  Exploring symptoms in chronic heart failure , 2005, European journal of heart failure.

[113]  G. Fonarow,et al.  A smoker's paradox in patients hospitalized for heart failure: findings from OPTIMIZE-HF. , 2008, European heart journal.

[114]  F. Sarullo,et al.  Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? , 2008, Clinical science.

[115]  Inger Ekman,et al.  Reasons for seeking acute care in chronic heart failure , 2007, European journal of heart failure.