Transcription
Healing HeartsLiving Well with Heart Failurewww.mainehealth.org1Healing Hearts — Living Well with Heart Failure
For provider and patient to do during the visit:1. Review this guide together.2. Fill in the yellow spaces on this page and other pages.Name:With your doctor, fill in all the yellow areas below:MY HEARTCONTACT NUMBERSn My Heart pumps at %.Circle the name of doctor managingWater Pill and Target Weightn I have SYSTOLIC / DIASTOLIC heart failure.(circle one)Primary Care DoctorNameMY SALTPhoneEvery day, I should eat betweenand milligrams of salt (sodium).CardiologistNameMY FLUIDSPhoneEvery day, I should NOT drink more thanounces of fluids.SpecialistMY WATER PILL (DIURETIC)PhoneNameSpecialistNameNamePhoneMY WEIGHTMy Target Weight is pounds.I will call my doctor if my weight goes UP to pounds or more.I will call my doctor if my weight goes DOWN to pounds or less.QUESTIONS FOR MY DOCTOR
What isHeart Failure?nnnHeart failure is when the heartcannot pump the blood normally.nIt can make you feel weak, tiredor dizzy.nA heart that is working normallyfills completely with blood thenpumps out 65% of the blood.There are two kinds of heart failure:1. Systolic: The heart cannot pumpblood out well.It can cause water to leak out ofyour blood vessels. This water canget in your lungs and makes youshort of breath. It can cause yourlegs, feet and belly to swell.2. Diastolic: The heart does not fillwith blood well.What You Can Doto keep feeling good and to stay out of the hospital:nnnWeigh yourself each daynCheck your “Heart Failure Zone”every daynnTake your medicines correctlyevery day1Eat the right amount of saltDrink the right amount of fluidsExercise regularlyHealing Hearts — Living Well with Heart Failure
Check Your“Heart Failure Zone”Every DayHeart failure can cause you to feel bad, have swelling andbe short of breath. Doing your daily checkup can help youcatch these changes quickly so you can take action to feelbetter and stay out of the hospital.Each Day:1. Check how you feelnnnWeigh yourselfAre you short of breath?Do you have swelling?2. Find which Heart Failure Zone you are in usingthe Heart Failure Zone Chart.nnnWrite the dateWrite your weight in the “Weight” box for that dayMark the zone you are in (green, yellow or red)2Healing Hearts — Living Well with Heart Failure
Heart Failure Zone ChartWrite your weight and zone on the back of this page every day.My Target Weight is pounds.Every day, I will use this chart to check my weight, swelling, breathing, andenergy level. I will take action if ONE or MORE of these is in the yellow or red zone.Green ZoneYou are doing OKand in control.Yellow ZoneTake action–call today.Red ZoneTake action–call NOW!Dr.PhoneWEIGHT No change in myweight.SWELLING I do not haveswelling.My weight ispounds or more.My weight ispounds or more.My weight ispounds or less.My weight ispounds or less.I have swelling in my:I have swelling in my: foot, ankle or shin belly, I feel boatedor pants are tighter knee or thighBREATHING hands or faceI do not feel shortof breath.I feel short of breath orcough while:I feel short of breathor wheeze at rest.Breathing is normal. walking or talkingI feel less alert.Sleep is normal. eating bathing or dressingI need to sleep sittingup to breathe.I need to use morepillows when I sleep.ENERGY LEVEL My energy level isnormal.I am too tired to domost of my normalactivities.I am so tired that I canhardly do any of mynormal activities.Tear this page out and keep it next to your scale.Heart Failure practice tools available at www.mainehealth.org/hf3Healing Hearts — Living Well with Heart Failure
Daily Weight and Zone LogCheck your weight and heart failure zone every day.Write your weight each day and mark the zone you are in (instructions on other side of thispage). Tear this page out and keep it near your scale. Bring it when you visit your doctor.My Target Weight is pounds.I will call my doctor if my weight goes UP to pounds or more.I will call my doctor if my weight goes DOWN to pounds or less.DateWeightMy Zone ( )DateWeightMy Zone ( )For more copies of this chart you can make color photocopies, go to www.mainehealth.org/hfand print your own, ask your doctor or nurse to make copies, or make your own using a calendar.Heart Failure practice tools available at www.mainehealth.org/hf4Healing Hearts — Living Well with Heart Failure
Water Pill GuideThis guide tells you how much diuretic or “water pill”to take each day.Please fill it out with your doctor and keep it with your medicines.Bring this guide and a list of your medicines to all your visits with your doctor.My Target Weight is pounds.My Doctor’s Name: Phone Number:If my morning weightis between:poundsandpoundsTake:If my morning weight is OVER:poundsINCREASE my water pillFOR ONE DAY ONLYTake:Morning Dose: mgIf my weight the nextmorning is STILL OVER:poundsOR if I have anysymptoms such astroubled breathing,fast heartbeat,chest pain or confusion:Afternoon Dose: mgCALL MY DOCTOR!If my morning weight is UNDER:If my weight the nextmorning is STILL UNDER:Morning Dose:mgAfternoon Dose:mgpoundsDECREASE water pillFOR ONE DAY ONLYTake:Morning Dose: mgAfternoon Dose: mgpoundsOR if I have anysymptoms such astroubled breathing,fast heartbeat,chest pain or confusion:CALL MY DOCTOR!If your symptoms are severe, call 911 or go to the emergency roomHeart Failure practice tools available at www.mainehealth.org/hfDoctor: Please see other side for instructions on using this ‘Water Pill Guide.’5Healing Hearts — Living Well with Heart Failure
Instructions for Provider: MaineHealth “Water Pill”Diuretic Self-Management GuideAssess patient or caregiver’s ability to understand and execute this protocol safely andaccurately. In order to prescribe this protocol, patients should:Water Pill Guiden Understand how to calculate ‘mg tablet strength’n Be on a maintenance loop diuretic dose in the moderate range*This guide tells you how much diuretic or “water pill”to take each day.Enter andpatient’sWeight:e.g., 150 poundsPlease fill it out with your doctorkeep itTargetwith yourmedicines.Bring this guide and a list of your medicines to all your visits with your doctor.150 pounds.My Target Weight isMy Doctor’s Name: Phone Number:Add 4 poundsto Target WeightIf my morning weightis between:154poundsand146Subtract 4pounds fromTarget WeightpoundsFurosemideTake:If my morning weight is OVER:154poundsINCREASE my water pillFOR ONE DAY ONLYFurosemideTake:80 mgMorning Dose:80 mgAfternoon Dose:If my weight the nextmorning is STILL OVER:154poundsOR if I have anysymptoms such astroubled breathing,fast heartbeat,chest pain or confusion:CALL MY DOCTOR!Multiply currentdose from leftcolumn by 2Morning Dose:Enter patient’scurrent regimene.g., Furosemide40 mgtwice daily40 mgAfternoon Dose:40 mgIf my morning weight is UNDER:poundsDECREASE water pillFOR ONE DAY ONLY146Take:20 mgMorning Dose:20 mgAfternoon Dose:If my weight the nextmorning is STILL UNDER:146poundsOR if I have anysymptoms such astroubled breathing,fast heartbeat,chest pain or confusion:CALL MY DOCTOR!Divide currentdose from leftcolumn by 2If your symptoms are severe, call 911 or go to the emergency roomHeart Failure practice tools available at www.mainehealth.org/hfDoctor: Please see other side for instructions on using this ‘Water Pill Guide.’*See mainehealth.org/hf for additional guidance. Patients on higher doses should be referred to theMaine Medical Center Advanced Heart Failure Program if a self-dosed diuretic protocol is desired.5HealingHearts— LivingWell with Heart FailureOral LoopDiureticDoseEquivalencyFurosemide40 mgBumetanide1 mgTorsemide20 mgHeart Failure practice tools available at www.mainehealth.org/hf6Healing Hearts — Living Well with Heart Failure
How to WeighYourself Each Day1. Get a good bathroom scale.3. Know your Target WeightTell your doctor or nurse if youcannot afford to buy a scale – theymay be able to help you get a scale.Ask your doctor what your TargetWeight is each time you visit. YourTarget Weight is where your heartis working best.Staying close to your TargetWeight will help you feel betterand stay out of the hospital.2. Weigh yourself each morning:After you go to the bathroom,before you eat breakfast, and beforeyou get dressed.My Target Weight is pounds.I will call my doctor if my weight goes UP to pounds or more.I will call my doctor if my weight goes DOWN to pounds or less.7Healing Hearts — Living Well with Heart Failure
How to TakeYour MedicinesTaking your medicines the way yourdoctor or nurse told you is important.Heart failure medicines help yourheart pump better and can help youfeel better and live longer.Take your medicinesnnnnTake each of your medicines,every day, at the right timesDo not skip doses of yourmedicines, even when you feel goodDon’t stop taking your medicines.If you think you are having sideeffects from your medicines, talk toyour doctor right away.If you are having trouble paying foryour medicine, talk to your doctor.To speak with others who canhelp you, call: MedAccess 1-877-275-1787 Consumers for AffordableHealthcare 1-800-965-7476Patients who take their medicines asthe doctor said live longer, feel betterand spend less time in the hospital.8Healing Hearts — Living Well with Heart Failure
Don’t run out of pillsnnnMake a PlanMake sure you always have enoughmedicine left in your pill bottles.Don’t let your medicine bottlesrun out.A plan will help you remember whento take your medicines every day.nCheck the number of refills youhave left every time you pick upyour medicine bottles. If the labelsays No Refills or Refills: 0,call your doctor right away toget more refills.nnGet all your pills from the samepharmacy every time.n9Keep an updated list of yourmedicines that says how many pillsto take and when to take them.Keep all your medicines in oneplace—maybe next to yourtoothbrush, at your bedside,or in the kitchen.Some people use a pill box to holdtheir pills for each day of the week.This can help you remember if youhave taken your pills that day.If you are going out of the house fora long time, bring enough medicinewith you.Healing Hearts — Living Well with Heart Failure
Partner With YourDoctor to Manage YourMedicinesWhat To DonnWhy To Do ItBring all of your pill bottlesand your medicine list to eachdoctor visit.nShow your doctor how andwhen you take your pills.n10This will help your doctor decideif you should stop or change anyof your pills.This way you and your doctor canwork together to keep you safe andmake sure you don’t run out of pills.Healing Hearts — Living Well with Heart Failure
Other Thingsto Know AboutYour MedicinesnnGeneric medicines cost less andare as effective as brand-namemedicines.Vitamins, other drugs and healthfood supplements:nKeep an updated list of yourmedicines and allergies with youat all times.nn11Talk with your doctor before youtake any other medicines, drugs orsupplements.Some of these may cause problemswith your medicines or may beharmful.Even drugs like aspirin, Tylenol,Motrin, Aleve, ibuprofen, vitaminsand cold medicines, herbs andsupplements and many others mightcause problems with your medicines.Healing Hearts — Living Well with Heart Failure
How to Eat the RightAmount of SaltnnnnnnSalt is also called “sodium” and isfound in many foods.Eating the right amount of saltwill help you feel better.Many foods you eat have salt evenif you can’t see it or taste it or youhave not added it yourself.nnChoose foods that are low in salt.Don’t add salt when you cook.Take the salt shaker off the table.nTake in between 2000 and 2500milligrams (mg) of sodium each dayunless your doctor recommends adifferent amount for you.Salt makes your body hold water,sort of like a sponge.Eating too much salt can make yourlegs, feet and belly swell up andmake you hold water in your lungs,making you short of breath.Low salt does not mean no salt.Your body and heart need some saltto work normally.RememberMost of the sodium we eat comesfrom prepared or packaged foodsand eating out. Fresh foods arenaturally low in sodium.12Healing Hearts — Living Well with Heart Failure
When you eat at home:nnnnnWhen you eat out:Don’t add salt to food when youcook or eat.nnSeason foods with herbs, vinegar,lemon juice and seasoningswith no salt.nnMake your own or choose low-saltsauces, salad dressings, breadsand desserts.nAvoid “instant” foods that comein a bag or box.nAsk for food cooked with no salt.Avoid butter, cheese and sauces.Avoid fried foods — choose grilled,baked or steamed foods.Choose oil and vinegar or lemonjuice as salad dressing.Avoid or limit fast food.Avoid bacon, sausage, ham, hotdogs, bologna and other deli meats.Rinse canned foods (even cannedfish) before cooking andeating them.13Healing Hearts — Living Well with Heart Failure
CHOOSE these low-salt foods:FruitFresh FishFresh LeanPoultry and MeatsYogurtFrozen VegetablesLemon, Olive Oiland VinegarDried BeansFresh VegetablesUnsalted NutsWhole oatsGraham CrackersEggs14Healing Hearts — Living Well with Heart Failure
AVOID or LIMIT these high-salt foods:Fast FoodFrozen MealsHot Dogs, Bacon,Smoked MeatPizzaCheeseCanned Beansand VegetablesInstantHot CerealsCanned OrPotted MeatSauces andDressingsSnack FoodsCanned andSmoked FishCanned Soup15Healing Hearts — Living Well with Heart Failure
Reading a Food LabelThere are many hiddensources of salt in the foods we eat, so it is important to read food labels.SAMPLE FOOD LABELStep 1Look at theserving sizeStep 2Look at thesodium perserving Calories This food has 30mgof sodium in ½ cup.Amount Per Serving%Daily Value*Total Fat 0 Sodium 1 Total Carbohydrate 1 8 Protein This food is agood choice!Watch howmuch you eat. nChoose foods called: Low sodium No salt added Sodium freennCount your mg of sodium asthe day goes on.Take in between 2000 and 2500 milligrams(mg) of sodium each day unless your doctorrecommends a different amount for you.16Healing Hearts — Living Well with Heart Failure
Drink the RightAmount of LiquidsYour doctor may recommend thatyou limit how much fluid you drinkeach day. Balancing how much youdrink, along with reducing salt, canhelp you feel better. This is especiallyimportant if you take heart failuremedicine and still have swelling orare short of breath. Extra fluid causesmore work for your heart.To lose extra fluid, you need todrink less and pee more.Fluids include water, juice, milk, soup,ice cream, and more. Anything withfluid in it can count.(Remember: Do not drink alcohol!)How to keep track of how muchyou drink each daynnnn17Keep two 1-quart (or 32 ounce)pitchers handy in the kitchen.Start with the pitchers emptyeach day.Each time you have a drink, pourthat same amount of water intothe pitchers.When the pitchers start to get full,it is time to limit the amount youdrink that day.Healing Hearts — Living Well with Heart Failure
Exercising is Important!Why should I exercise?nBe safeBeing more active is one of thebest things you can do for yourheart failure.nn Beingfit makes less work foryour heart.nnMoving more can help you havemore energy and feel more upbeat.nWays you can exercise:nnnnnnStart slowly, with 10 minutes a day.Your body needs time to buildendurance!Know that routine exercise WILLget easier.Talk to your doctor to make a planthat is right for you.Cardiac RehabWalk—it is easy, fun and free.Use a stationary bike.Ask your doctor about cardiacrehab. Cardiac rehab can help youexercise safely and lower your risk offuture heart problems.Sweep, vacuum or dust.Important!nMow the lawn, work in the garden.Go to an exercise class.Exercise with a friend or a partner.If you have any of these symptomsthat do not go away with rest,call 911.nnnchest painsevere shortness of breathdizzinessTalk with your doctor aboutany changes in how you feelwhen you exercise.18Healing Hearts — Living Well with Heart Failure
What About Tobaccoand Alcohol?Quitting TODAY is the most important thing you can do for your heart.Don’t smoke oruse tobacco productsnnDo not drink any alcoholnSmoking, secondhand smoke andother tobacco products make yourheart and lungs work harder.Drinking alcohol can weakenyour heart.If you smoke, talk to your doctor ornurse about getting help to quit.You can get help to quit fromthe Maine Tobacco Helpline,1-800-207-1230.19Healing Hearts — Living Well with Heart Failure
Living Wellwith Heart FailureHeart Failure is a serious illness and itoften gets worse over time. It is important to think about what “living well”with Heart Failure means to you andto plan ahead. Talk with your doctorsand healthcare team about your futurehealthcare and what matters to you.The goal is for you and your family tohave the best quality of life possible.This type of planning is part of advancecare planning.Five steps to help you planfor your care:Talk with your loved ones so theyunderstand your wishes for care. Thatway, if you become more ill, and can’tspeak for yourself, your loved ones canhelp your healthcare team care for youin the way you want. It is best to startplanning for your future care early,when you are doing okay. Completingan advance care planning document canhelp ensure your wishes for careare honored.2. Talk with your doctor, healthcareteam, and loved ones about yourfuture healthcare and goals1. Think about what “living well”means to younnnnnnAsk your doctor about palliative care.Palliative care, which focuses on qualityof life, may improve your quality of lifeand may even lead to a longer life.20What gives your life meaning?What matters to you?For instance, think about a goodday: What would you be doing?Who would you talk to?What would you do?What fears or worries do you haveabout your Heart Failure?When you get sicker, what kindof treatments would you want if itmight help you live longer?What are the treatments foradvanced heart failure?What role can Palliative Care playin your care?Healing Hearts — Living Well with Heart Failure
nnnWill you want cardiopulmonaryresuscitation (CPR), breathingmachines, and life support if yourheart stops or if you stop breathing?nWhere will you want to be cared forwhen your heart disease gets worse?5. As Heart Failure is oftenprogressive and your goals for caremight change, be sure to updateyour Advance Directive or POLSTWho else should be part of thisconversation, such as chaplain, caremanager or others who care for you?n3. Choose a health care agent, alsocalled a medical power of attorneyor health care proxynnDiscuss your wishes and share acopy with your health care agent,your doctor, your loved ones, andthe hospital where you want toreceive care.nWho do you want to make medicalchoices for you if you cannot speakfor yourself?nWhen your health conditionschange or your Heart Failureworsens.If your health care agent changes.When there are changes inyour family.Talk with your health care agentabout what matters to you and whatyour future goals are.4. Write down your goals andwishes and share them with yourhealthcare team and loved onesnAsk your healthcare team aboutcompleting an Advance Directiveor Physician Orders for LifeSustaining Treatment (POLST) todocument your wishes.21Healing Hearts — Living Well with Heart Failure
What Else Will HelpMe Live Well WithHeart Failure?Keep your doctors’ visitsGet a flu shotBe sure to keep all your doctors’appointments and partner with yourdoctor to plan your care.nnnnnBy learning more about heartfailure, you and your doctor canbetter manage your care.nWhen you see the doctor, bring alist of your medications and yourweight records.Get a flu shot every year andpneumonia shots as directed byyour doctor.When you have heart failure,the flu can be deadly.A flu shot will help you to notget the flu.To find outmore about:Keep your doctors’ visits even whenyou are feeling well.nHeart health resources,including local, state, nationaland on the internetGo to www.mainehealth.org22Healing Hearts — Living Well with Heart Failure
Additional HeartFailure InformationTo learn more about other treatment options for advanced heart failure,such as defibrillators, heart pumps, and heart transplant, call theMaine Medical Center Heart Failure Program at 207-662-4824.More information on heart failure is available at www.mainehealth.org/hf.Know what your pills do for youYou will be taking medications as part of your heart failure treatment.Some of these medications can make you live longer and improve your heartfunction. Other medications are to make you feel better.Kind of MedicationAngiotensin ConvertingEnzyme Inhibitors(ACE-I’s) andAngiotensin ReceptorBlockers (ARB’s)Beta-BlockersWater Pills, also calleddiureticsAldosterone AntagonistsWhat it DoesCommon NamesHelp your heart return to a Lisinoprilnormal shape so it can work EnalaprilbetterLosartanLower your heart rate andblood pressure to make lesswork for your heart. Makeyour heart pump better tohelp you live longerHelp you feel better bymaking you “pee” (urinate)more, to get rid of extra saltand waterHelp you live osemide eHealing Hearts — Living Well with Heart Failure
Notes24Healing Hearts — Living Well with Heart Failure
Notes25Healing Hearts — Living Well with Heart Failure
Copyright 2018 by MaineHealth. All rights reserved. The material contained in this publication may be displayed, copied,distributed or downloaded for personal or noncommercial uses, provided such materials are not altered or modified and a referenceto MaineHealth is provided.Inquiries should be directed to:Richard Veilleux, MPH, MBA, Program ManagerMaineHealth Cardiovascular Service LineEmail: MHCVSL@mainehealth.orgThis publication and the materials and information contained herein have been produced for informational purposes as a service topatients, their families and the general public and are provided “as is” without a warranty of any kind, either expressed or implied.MaineHealth shall not be liable for direct, indirect, special, incidental or consequential damages related to the user’s decision to usethis publication or any material or information herein.This guide is designed to help you and your family better manage heart failure.The goal of the MaineHealth Heart Failure Program is to help patients with heart failure have better health outcomesby supporting better patient care, education and support.Thank you to the MaineHealth Heart Failure and Healing Hearts at Home Workgroups and especially the leadership ofDr. Joseph Wight, Dr. Esther Shao and Maryanna Arsenault.Special thanks to the University of North Carolina and their partners for permitting use of elements of their publication“Caring for Your Heart, Living Well with Heart Failure” in the development of this publication.To download practice tools go to www.mainehealth.org/hf.www.mainehealth.org
1 Healing Hearts—Living Well with Heart Failure n Weigh yourself each day n Check your "Heart Failure Zone" every day n Take your medicines correctly every day n Eat the right amount of salt n Drink the right amount of fluids n Exercise regularly What You Can Do to keep feeling good and to stay out of the hospital: n Heart failure is when the heart cannot pump the blood normally.
