I was discharged with diagnosis of heart failure, or fluid overload. Now what?
July 07, 2023
Heart failure is a condition that occurs when the heart cannot pump blood as well as it should; this leads to inadequate blood flow to vital organs such as the kidneys and congestion (buildup of fluid) in other parts of the body like the lungs and the legs. The term “heart failure” is misleading because the heart does not completely fail or stop beating, but the pump cannot simply keep up with the demands.
When you are discharged from the hospital with heart failure or fluid overload, you should be looking for discharge instructions that address six topics related to heart failure management: activity level, diet, discharge medications, follow-up appointments, weight monitoring and procedures to follow if symptoms worsen.
It is important to stay active after hospital discharge. Having heart failure does not mean you have to restrict your activities. In fact, exercise is important to help strengthen the heart. Depending on your heart function you may continue to exercise at home or become qualified for a cardiac rehab program. Moderate exercise helps decrease the risk of needing another hospitalization for heart failure.
Structured cardiac rehabilitation programs have been proven to improve patient outcomes. You may ask your physician or case manager to see if you qualify.
Diet and lifestyle changes are important to manage your heart failure symptoms. The most important change is salt intake, as the more salt intake, the more water retention and swelling. This simple guide should be used if no specific ones were given to you:
- Check food labels, and limit salt and sodium to 1,500 to 2,000 milligrams per day.
- Replace salt and other high-sodium seasonings with other seasonings that have no salt or are low in sodium (such as Mrs. Dash or lime or lemon).
- Reduce your salt gradually to give your taste buds time to adjust.
- Ask for food cooked with no salt when you eat out at restaurants.
- The recommended total fluid intake is 1,500 mL (6 cups) per day.
You should avoid foods that are high in sodium, fat, and cholesterol, such as many cheeses, deli meats, smoked meats and fish, rich desserts, and processed foods.
Medicines used to treat heart failure come from different classes of drugs. You may be prescribed any number of these drugs depending on the assessment of your condition by your physicians.
In addition to diuretics that help with decongestion and help your body get rid of excess fluid by increasing urination (examples: Lasix, Demadex, and Bumex), the four pillars of heart failure treatment are described below:
- renin angiotensin inhibitors alone (Lisinopril or Losartan) or in combination with a neprilysin inhibitor (Entresto), relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart. Entresto also increases another hormone in the body called natriuretic peptide that helps regulate blood pressure and fluid balance.
- Beta blockers reduce the workload on your heart and help your heart muscle contract more effectively. Examples include carvedilol (Coreg), and metoprolol (Lopressor).
- Mineralocorticoid receptor antagonists (MRAs) help your body get rid of excess fluid. They work by blocking the action of a hormone called aldosterone which causes the body to retain salt and water, which can increase blood pressure and put extra strain on the heart. Examples include spironolactone (Aldactone) and eplerenone (Inspra)
- Sodium-glucose transporter 2 inhibitors (Farxiga, Jardiance, and Invokana) block sodium and glucose reabsorption in the kidney and help you get rid of salt and water. The exact way they work to improve heart failure outcomes is not fully understood, but it is thought to be related to their effects on reducing blood pressure, improving glucose control, and reducing inflammation.
Latest guidelines recommend simultaneous drug treatment for heart failure patients with these four drug classes to gain the most benefit from the combination. Work with your medical team to maximize the dosages of these medications as you tolerate.
You should also make a follow-up appointment as directed with your primary doctor. Depending on the type and severity of heart failure you have, your healthcare provider may recommend that you see a cardiologist or other specialist. If you need help with these appointments let your medical team know.
It is important to monitor your symptoms, weight, and blood pressure every day. Note and remember our weight on the day of discharge. Getting a scale if you don’t have one, and investing in a blood pressure machine has good healthy returns. If you experience any of the following symptoms, contact your healthcare provider immediately: sudden weight gain (2-3 pounds in one day or 5 pounds in one week), swelling in your feet, ankles or legs that does not go away with rest or medication, shortness of breath at rest or with minimal exertion, persistent coughing or wheezing.
The American Heart Association offers more to help patients understand their diagnosis and treatment plan.