Maintain treatment goals:
•
Nutrition
Meet with dietitian for low-sodium consult; recommend <1500-2000 mg sodium per day (per physician recommendation) and try to keep meals equal in sodium
• Exercise
Review home exercises guidelines with patient; exercise within cardiac rehab recommendations (see listed references for more detailed exercise guidelines)
•
Labs
Make sure labs are current and review with patient: lipids, glucose, and metabolic panel
Help arrange f/u if needed; make sure labs are current if medication/health status changes
•
Blood Pressure
Monitor each visit at rest and assess for appropriate exercise response
•
Medications
Check for diuretic, B-blocker, and ARB/ACE inhibitor prescription; provide education on compliance and medications; refer to pharmacist for medication management consult as necessary
• Alcohol and tobacco use
Assess for use; refer for cessation assistance if needed
• Sleep
Assess for sleep apnea/C-PAP compliance
• Weight
Make sure patient checks weight and records daily; report to MD if increases 3 pounds in 1 day or 5 pounds in 1 week
• Signs/symptoms
Provide education on CHF signs/symptoms and when to call MD/seek medical attention
• Appointment
Make sure patient is scheduled to f/u with PCP or cardiologist within 1-2 weeks of newly diagnosed CHF
• Advanced care planning
Provide resources for completing healthcare directive; make sure code status is up to date
• Home care
Assess need for possible home care if you suspect patient would benefit from assistance; provide resources
• Fluid restrictions
Assess whether specific fluid restriction has been advised by MD; instruct patient to “drink to thirst”
• Psychosocial
Evaluate for depression and social support; provide referral if needed
Annual assessment of complications: (Should verify that patient is having these done yearly)
•
Targeted annual history and physical exam
•
Cardiovascular and cerebrovascular complication assessment
•
Renal assessment
•
Special considerations
Treatment and referral for complications: (Contact physician if problems arise that need attention)
•
Cardiovascular and cerebrovascular disease
•
Nephropathy
• Peripheral vascular disease
•
Weight gain, congestion, increased dyspnea
•
Lower extremity edema, wounds, weeping, cellulitis
Treatment goals not met:
• Consider referral to specialist (cardiology, nephrology)
• Assess patient adherence (biggest problems are understanding and adherence)
•
Re-evaluate for depression
•
Re-address specific treatment goals that are not being met

References
American Association of Cardiovascular and Pulmonary Rehabilitation (2004). Guidelines for cardiac rehabilitation and secondary prevention programs (4 th
ed.) .
Champaign, IL: Human Kinetics.
American College of Sports Medicine (2010).
ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription
(6 th ed.). Baltimore,
MD: American College of Sports Medicine.
American Heart Association (2012). Heart failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-
Failure_UCM_002019_SubHomePage.jsp
Cleveland Clinic (2012). Heart failure - care & treatment. Retrieved from http://my.clevelandclinic.org/heart/disorders/heartfailure/hf treatement.aspx
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS,
Silver MA, Stevenson LW, Yancy CW. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing
Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). American College of Cardiology Web
Site. Available at: http://www.acc.org/clinical/guidelines/failure//index.pdf.
Mayo Clinic (2012). Heart failure - lifestyle & home remedies. Retrieved from http://www.mayoclinic.com/health/heart-failure/DS00061/
DSECTION=lifestyle-and-home-remedies