Non-pharmacological Management and Patient Education in Heart Failure Patients
Non-pharmacological Management and Patient Education in Heart Failure Patients
European Cardiovascular Disease 2006
Published: June 2006
Published: June 2006
Heart failure (HF) has become a significant public health problem, with a rapidly rising incidence and prevalence that is predicted to continue to rise far into the 21st century.1 Overall, 1-2% of the adult population in developed countries worldwide suffers from HF but prevalence increases 10-fold in those over 75 years of age.2 Because the incidence of HF rises with age its prevalence will markedly increase as our population ages, placing a significant economic burden on society, consuming about 1-2% of the healthcare budget. Approximately 70% of this is spent on hospitalisations.1-3
The burden of HF affects the individual, their direct environment (such as family and friends), and society overall. HF is associated with a poor prognosis, with symptoms affecting daily functioning, and a treatment regimen that can have a major impact on the daily life of patients and their families.4 Despite some recent evidence of improving morbidity and mortality rates,4,5 pharmacological treatment does not impressively improve the high morbidity and mortality rates associated with chronic HF. There is still a lot to gain from non-pharmacological treatment and appropriate follow-up in terms of improving patient stability, functional capacity, mortality, and quality of life.
Improving Outcomes in HF
In general, healthcare providers aim their treatment at improving the survival and quality of life of patients.
However, it is known that HF patients are often readmitted due to worsening symptoms.6 There are many preventable and often interrelated factors contributing to readmission, such as:6,7
- inadequate or inappropriate medical treatment;
- discharge in unstable condition;
- inadequate knowledge of chronic HF and prescribed treatment;
- non-compliance with prescribed treatment;
- inadequate follow-up;
- problems with caregivers or extended care facilities;
- early clinical deterioration; and
- co-prescribed drugs.
It has been stated that 40-59% of readmissions would be avoided if there were better assessments, if nonpharmacological treatment was addressed, if rehabilitation was more adequate, if discharge was more carefully planned, if potential non-compliance problems with diet and medication were identified and if patients were instructed to seek medical attention when symptoms first occurred.6,7 In the updated European guidelines for the diagnosis and treatment of chronic HF, non-pharmacological treatment and adequate follow-up are recommended.4
Non-pharmacological Treatment and Patient Education
In the guidelines on HF treatment from the European Society of Cardiology (ESC),4 several educational topics are listed as important to include in patient education for patients with chronic HF and their close relatives. The following major areas in non-pharmacological management and patient education in HF patients can be identified:
Diet and Nutrition
Controlling the amount of salt in the diet (<2,000mg) is relevant in patients with advanced HF4,8 and a fluid restriction of 1,500–2,000ml should be advised to advanced HF patients.
It should also be advised that salt substitutes must be used with caution, as they may contain potassium. In large quantities, in combination with an angiotensinconverting enzyme (ACE) inhibitor, they may lead to hyperkalaemia.10
Alcohol consumption must be prohibited in suspected cases of alcoholic cardiomyopathy, but otherwise moderate alcohol intake is permitted.4 Other nutritional advice includes weight reduction in the overweight or obese (body mass index (BMI) >25) and prevention of malnutrition and cardiac cachexia.4,8
References:
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- Kannel W B, “Vital epidemiology clues in heart failure”, J Clin Epidemiol (2000);53: pp. 229–235 .
- McMurray J J, Petrie M C, Murdoch D R, Davie A P, “Clinical epidemiology of heart failure: public and private health burden”, Eur Heart J (1998); Suppl P: pp. P9–P16.
- Swedberg K, Dargie H, Drexler H et al., “Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology”, Eur Heart J (2005);26: pp. 1,115–1,140.
- Stewart S, MacIntyre K, Hole D A, Capewell S, McMurray J J V, “More malignant than cancer? Five-year survival following a first admission for heart failure in Scotland”, Eur J Heart Failure (2001);3: pp. 315–322.
- Tsuyuki R T, McKelvie R S, Arnold J M et al., “Acute precipitants of congestive heart failure exacerbations”, Arch Intern Med (2001);161: pp. 2,337–2,242.
- Opasich C, Rapezzi C, Lucci D et al., “Precipitating factors and decision-making processes of short-term worsening heart failure despite “optimal” treatment”, Am J Cardiol (2001);88, pp. 382–387.
- Heart Failure Association of America Executive Summary, “HFSA 2006 Comprehensive Heart Failure Practice Guideline”, J Card Fail (2006);12: pp. 10–38.
- Good C B, McDermott L, McCloskey B, “Diet and serum potassium in patients on ACE inhibitors”, JAMA (1995);274: p. 538.
- Hunt S A, Baker D W, Chin M H et al., “ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult”, Circulation (2001) 104: pp. 2,996–3,007.
- Cline C M, Bjorck-Linne A K, Israelsson B Y, et al., “Non-compliance and knowledge of prescribed medication in elderly patients with heart failure”, Eur J Heart Fail (1999);1: pp. 145–149.
- van der Wal M H, Jaarsma T, van Veldhuisen D J, “Non-compliance in patients with heart failure; how can we manage it?”, Eur J Heart Fail (2005);7: pp. 5–17.
- van der Wal M H, Jaarsma T, Moser D K, et al., “Compliance in heart failure patients: the importance of knowledge and beliefs”, Eur Heart J (2006);27: pp. 434–440.
- Yu D S, Thompson D R, Lee D T, “Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes”, Eur Heart J (2006);27: pp. 596–612.
