Education Topics for Heart Failure Education

Understanding heart failure (HF) management

Objectives

At the end of the session, the participant will be able to:

Understand what HF is
Recall the methods of monitoring HF
Identify signs and symptoms of worsening HF
State which action is necessary when fluid overload is detected

Facilitator

This session may be facilitated by a specialist HF/cardiac nurse, physiotherapist or pharmacist.

Course content

To include the following information:

Topic	Content	Resources
Introduction	What is heart failure (HF)? Relate the heart to the function of a pump Clarify the difference between ‘heart failure’ and a ‘heart attack’ Outline tests for diagnosing HF (echocardiography, ECG, angiogram)	National Heart Foundation of Australia. Living well with chronic heart failure Available: To download To order by e-mail: health@heartfoundation.org.au To order by phone: (+61) 1300 36 27 87 This resource is also available from the Patient information section
Causes of heart failure	Causes of HF are different for different people Cardiomyopathy Heart attack Viral infection Alcohol Family history Other causes Hypertension Valve disease Arrhythmias
Symptoms of heart failure	Variety of symptoms and contributing factors, different for different people: (e.g., shortness of breath, sudden weight gain, swelling (ankles, abdomen), fatigue, decreased exercise tolerance, palpitations, chest pain) Relate symptoms to the individual’s experience
Monitoring	Daily weight Detect sudden weight gain (2kg in 2 days) Symptoms Note changes as above
Management - ongoing	Fluid restriction 1.5-2 litres/day Tips for maintaining fluid restriction Salt restriction Tips for reducing salt intake Regular exercise/activity Refer to exercise specialist/HF rehab program Role of medications Health behaviour modification Smoking cessation Reduce alcohol consumption
Management of fluid overload	Contact health practitioner or seek early medical review if signs and symptoms of fluid overload May have an individualised Action Plan

Medications for heart failure

Objectives

At the end of the session, the participant will be able to:

Identify the use, effects and side effects of common medications used to manage HF
Describe how to use medicines safely
Identify medicines which should be avoided by people with HF

Facilitator

This session may be facilitated by a pharmacist or specialist HF nurse.

Course content

To include the following information:

Topic	Content	Resources
Introduction	General medication advice Access to medicines Pharmaceutical Benefits Scheme Over-the-counter medicines
Medicines for HF How they work Side effects	Diuretics ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) Beta-blockers Aldosterone blockers Digoxin
Helping you get the most out of your medicines	How to use your medicines Consumer medicines information (CMI) Keeping a medicines list Compliance aids / dose administration aids such as Webster-pak®	External links: Making wise choices about medicines Managing your medicines Keeping a medicines list I might have heart failure, what do I need to know Introducing medicines for heart failure Take an active role in managing your heart failure Finding good information about medicines Understanding drug interactions Medicine and side effects
Medicines to avoid	Medicines to avoid in HF

Nutrition, diet and heart failure

Scientific evidence to support the content and structure of the nutrition component of a HF program is limited.

Objectives

At the end of the session, participants should be able to:

Define a healthy and balanced diet
Identify the importance of maintaining weight within the healthy weight range
Identify specific nutritional issues common in HF and strategies for dietary management of these
Identify the quantity and quality of foods and fluids that influence fluid retention

Facilitator

This session may be facilitated by a dietitian or a specialist HF nurse.

Course content

To include the following information:

Topic	Content	Resources
Introduction	Importance of a healthy, balanced diet for people with HF Importance of maintenance of healthy weight for height (i.e., Body mass Index (BMI))	BMI range chart for adults
Healthy diet	Define food groups and importance of ensuring variety across and within food groups Suggested alcohol intake for people with HF	Australian Guide to Healthy Eating
Lifestyle and dietary modifications	Fluid intake Daily weight measurement Sodium intake Food label reading Principles of food fortification – high protein, high energy Healthy cooking methods Serving sizes	Nutrition Education Materials Online (NEMO): Weight control resources The Baker Institute fact sheets Australian Alcohol Guidelines
Summary and discussion	Individualisation of dietary management strategies depending on weight status, fluid status and other comorbidities	See resources above

Activities of daily living and heart failure

Objectives

By the end of the session, the participant will:

Know techniques and strategies to continue daily activities while managing their health condition
Understand sleep management strategies
Know what to consider when undertaking specific activities such as driving
Understand the benefits of relaxation
Have experienced a relaxation exercise

Facilitator

This session may be facilitated by an occupational therapist or specialist HF nurse.

Course content

To include the following information:

Topic	Content	Resources
Introduction	Energy conservation in the context of HF and keeping active
Energy conservation	The principles of saving energy Tips to make tasks easier Equipment that helps maintain independence How to grade activities to suit abilities and tolerances	Demonstration of aids and equipment
Specific activities	Driving: Recommended driving guidelines Driving restrictions Work: Considerations for working within abilities Travel: Insurance Medication management Managing flights Eating out Managing fluid intake Sexual activity: Recognising level of exertion	Ausroads. Assessing fitness to drive National Heart Foundation of Australia. Living well with chronic heart failure (see pages 18-19) Available: To download To order by e-mail: health@heartfoundation.org.au To order by phone: (+61) 1300 36 27 87 These resources are also available from the Patient information section
Managing sleep	Sleep disturbance and HF Normal sleep Strategies to improve sleep	Demonstrate use of pillows and timing of diuretic National Heart Foundation of Australia. Living well with chronic heart failure (see page 7) Available: To download To order by e-mail: health@heartfoundation.org.au To order by phone: (+61) 1300 36 27 87 These resources are also available from the Patient information section
Relaxation	Relaxation and stress response Benefits of relaxation Relaxation exercises Breathing techniques Visual imagery

Psychological aspects of heart failure

Objectives

At the end of the session, the participant will be able to:

Understand the psychological aspects of HF
Identify stress, anxiety and depression
Understand a range of coping skills to assist living with HF, and to manage stress, anxiety and depression

Facilitator

This session may be facilitated by a psychologist, social worker, mental health worker or specialist HF nurse.

Course content

To include the following information:

Topic	Content	Resources
The experience of living with HF for the patient and family	Personal experience Requires patient and family to adapt to change Coping with physical and emotional ups and downs Heart illness is a family affair Self-management of illness	Group discussion See sections on ‘For caregivers’ and ‘Living with heart failure’ at heartfailurematters.org
Adjustment, grief and coping with change	Describe and normalise the experience of adjustment and grief Recognise it can occur at any time during the illness Describe acceptance Strategies to deal with change and adjustment	See section on ‘Dealing with stress, worry, and anxiety’ in An everyday guide to living with heart failure
Symptoms of depression, stress and anxiety	Describe symptoms of depression, stress and anxiety, particularly as they relate to HF The importance of managing these problems to improve heart health, self-management of illness, involvement in activities and relationships, quality of life	See book on Taking care of yourself and your family See section on ‘Dealing with stress, worry, and anxiety’ in An everyday guide to living with heart failure
The importance of support and reducing social isolation	Identify social isolation as a risk factor for heart disease Describe the benefits of support Building a strong support system – identify supports, how they can help, planning support	Group discussion
Managing changing relationships	Discuss how roles and relationships can change Assess needs and expectations Emotional reactions Communication	Group discussion See section on ‘Managing the changing relationships’ in An everyday guide to living with heart failure See sections on ‘For caregivers’ and ‘Living with heart failure’ at heartfailurematters.org
Managing stress, anxiety and depression	Maintaining healthy lifestyle – good diet, exercise, sleep pattern Relaxation Support Problem solving Engaging in helpful, constructive thinking Engaging in enjoyable and meaningful activities Helping others Medication	See book on Taking care of yourself and your family See sections on ‘For caregivers’ and ‘Living with heart failure’ at heartfailurematters.org
Accessing help for psychological difficulties	Discuss with GP Talk to HF team or other medical team

Further useful information about this topic is found in the book Supportive Care in Heart Failure.[#beattie-j-goodlin-s-eds..-2008]

Exercise and heart failure

Objectives

At the end of the session, the participants will understand the:

Difference between physical activity and exercise
Benefits of keeping active
General principles of exercise
Benefits of both aerobic and resistance training
Limitations specific to HF and exercise, and principles of self-management
Factors impacting upon exercise adherence and strategies to enhance these
Exercise limitations imposed by co-morbid medical conditions

Facilitator

This session may be facilitated by a physiotherapist, exercise physiologist or specialist HF nurse.

Course content

To include the following information:

Topic	Content	Resources
Physical activity and exercise	Definition of physical activity versus exercise	Physical activity and heart failure Physical activity and heart failure for Australian Aboriginals and Torres Strait Islanders
Benefits of keeping active	Deconditioning cycle General benefits of exercise
Physical activity guidelines	Warm up and cool down FITT principle Recommended exercise intensity (Borg scale) Home exercise	Rating of Perceived Exertion (Borg scales)
Safety issues	Self-monitoring Management of symptoms Precautions and when to cease exercise Effect of medications on exercise	Examples of scenarios (e.g., chest pain, unreasonable shortness of breath, dizziness)
Exercise adherence	Identifying barriers and facilitators to exercise Tools to enhance adherence Alternative exercise options (e.g., Lungs in Action, walking programs, other community programs)	Home exercise diary Pedometer and other wearable devices Lungs in Action
Specific conditions	Exercise and diabetes Other relevant conditions (e.g., respiratory, peripheral vascular disease)

FITT = frequency, intensity, time and type of exercise

Patient Education

Understanding heart failure (HF) management

Medications for heart failure

Nutrition, diet and heart failure

Activities of daily living and heart failure

Psychological aspects of heart failure

Exercise and heart failure

References