Provide quality education and self-management plans to your patients

Providing a tailored education session on self-care for your patients, based on their personal capabilities, habits, and beliefs, may increase the likelihood of adherence to your treatment plan.

This reference document will guide you on how to convey important aspects of living with HF and self-care information to your patients. It suggests positive approaches for communicating this information to patients and is not a substitute for comprehensive patient-education hand-out material.

Step 1: Establish a clear routine to ensure delivery

Education about self-care should occur during the first visit when a patient is diagnosed with HF and be repeated regularly in subsequent visits to ensure that self-management is occurring.

Decide who in your practice (this can be more than one person) will present this information to patients and when during their visits. It may take at least 20 minutes to cover all aspects.

Be sure to document the treatment plan for symptom management for your patients, and make sure they understand what you’ve told them.

Step 2: Connect your treatment plan to the patient's goals and beliefs

Talk to your patients. Ask about their:

Feelings

• What does the diagnosis of heart failure mean to you?
• What do you feel will be some of the challenges of living with heart failure?

Commitment

• How do you want to spend your time in the next 3 to 6 months?
• Are you willing to take medications to help you do that?
• Are you willing to modify your diet and exercise habits?
• Are you willing to record your weight on a daily basis?

Challenges

• What interferes with your ability to make changes and stick to them?
• Would the cost of medications get in the way of taking them regularly? Motivators
• Do you have family, friends, or a community organization available if you need help?
• What are your goals? (eg, celebrate my 50th anniversary, play golf with my friends)

Step 3: Provide the basic education components for their self-management

• Definition of heart failure (linking disease, symptoms, and treatment) and patient's HF cause
• Recognizing signs and symptoms of a worsening condition and how to respond to them
• Indications and use of each medication (stressing that the medications work together to improve outcomes. For example ACE/ARB, beta-blockers, and diuretics can be used for blood pressure management, and they improve overall heart function.)
• How to modify risks for heart failure progression
• Specific diet and fluid restriction recommendations, including the importance of a low-sodium diet (≤ 1500 mg per day)
• The importance of monitoring one's weight on a daily basis
• The benefits of exercise and examples of activities
• Importance of treatment adherence and behavioral strategies to promote adherence
• Recommendations for alcohol intake
• Avoidance of tobacco and/or illicit drugs
• Avoidance/limited use of NSAIDs

Step 4: Help your patients set realistic goals to achieve their longer-term goals

Your Guidance on Goals	Examples for Your Patients
Focus recommendations on immediate behavior changes rather than long-term goals	Exercising every day, rather than losing 10 pounds in a month
Provide examples of activities that count as exercise and ask which they might enjoy	Light exercises: walking, gardening, playing darts, bowling, calisthenics, yoga Moderate exercises: speed walking, swimming, dancing
Guide the patient to one or two small, realistic changes he/she can begin immediately	Buy sodium-free foods Walk 10-20 minutes each day
Encourage the patient to create goals that involve positive action	Use lemon juice or herbs instead of salt for seasoning Have spouse, friend, or child join you for a walk or other activity

Step 5: Help your patients stay on track with their goals.

• Remind patients that treatment can help them reach their stated goals
• Make the recommended treatment plan clear, concrete, simple, and understandable
• At each visit, ask patients to describe the actions they will begin immediately
• Have patients tell you why those actions are important
• Update treatment plan as patients introduce lifestyle changes in their daily routine
• Watch for signs of depression and adjust treatment accordingly
• Refer patients to cardiac rehabilitation when helpful