Heart failure - discharge

You were in the hospital to have your heart failure treated. Heart failure occurs when the muscles of your heart are weak or have trouble relaxing, or both.

Your heart is a pump that moves fluids through your body. As with any pump, if the flow out of the pump is not enough, fluids do not move well and they get stuck in places they should not be. In your body, this means that fluid collects in your lungs, abdomen, and legs.

While you were in the hospital:

• Your health care team closely adjusted the fluids you drank or received through an intravenous (IV) line. They also watched and measured how much urine you produced.
• You may have received medicines to help your body get rid of extra fluids.
• You may have had tests to check how well your heart was working.

Your energy will slowly return. You may need help taking care of yourself when you first get home. You may feel sad or depressed. All of these things are normal.

Weigh yourself every morning on the same scale when you get up -- before you eat but after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it.

Throughout the day, ask yourself:

• Is my energy level normal?
• Do I get more short of breath when I am doing my everyday activities?
• Are my clothes or shoes feeling tight?
• Are my ankles or legs swelling?
• Am I coughing more often? Does my cough sound wet?
• Do I get short of breath at night or when I lie down?

If you are having new (or different) symptoms, ask yourself:

• Did I eat something different than usual or try a new food?
• Did I take all of my medicines the right way at the right times?

Your health care provider may ask you to limit how much you drink.

• When your heart failure is not very severe, you may not have to limit your fluids too much.
• As your heart failure gets worse, you may be asked to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.

You will need to eat less salt. Salt can make you thirsty, and being thirsty can cause you to drink too much fluid. Extra salt also makes fluid stay in your body. Lots of foods that do not taste salty, or that you do not add salt to, still contain a lot of salt.

You may need to take a diuretic, or water pill.

Do not drink alcohol. Alcohol makes it harder for your heart muscles to work. Ask your provider what to do on special occasions where alcohol and foods you are trying to avoid will be served.

If you smoke, stop. Ask for help quitting if you need it. Do not let anybody smoke in your home.

Learn more about what you should eat to make your heart and blood vessels healthier.

• Avoid fatty foods.
• Stay away from fast-food restaurants.
• Avoid some prepared and frozen foods.
• Learn fast food tips.

Try to stay away from things that are stressful for you. If you feel stressed all the time, or if you are very sad, talk with your provider who can refer you to a counselor.

Have your entire medicine prescriptions filled before you go home. It is very important that you take your medicines the way your provider told you to. Do not take any other medicines or herbs without asking your provider about them first.

Take your medicines with water. Do not take them with grapefruit juice, since it may change how your body absorbs certain medicines. Ask your provider or pharmacist if this will be a problem for you.

The medicines below are given to many people who have heart failure. Sometimes there is a reason they may not be safe to take, though. These medicines may help protect your heart. Talk with your provider if you are not already on any of these medicines:

• Antiplatelet medicines (blood thinners) such as aspirin or clopidogrel (Plavix) to help keep your blood from clotting
• Anticoagulant medicines (blood thinners) such as warfarin (Coumadin) to help keep your blood from clotting
• Beta blocker and ACE inhibitor medicines as well as other medicines to lower your blood pressure and treat the heart muscle
• Statins or other medicines to lower your cholesterol

Talk to your provider before changing the way you take your medicines. Never just stop taking these medicines for your heart, or any medicines you may be taking for diabetes, high blood pressure, or other medical conditions you have.

If you are taking a blood thinner, such as warfarin (Coumadin), you will need to have extra blood tests to make sure your dose is correct. Some other blood thinners do not require this.

Your provider may refer you to a cardiac rehabilitation program. There, you will learn how to slowly increase your exercise and how to take care of your heart disease. Make sure you avoid heavy lifting.

Make sure you know the warning signs of heart failure and of a heart attack. Know what to do when you have chest pain, or angina.

Always ask your provider before starting sexual activity again. Do not take sildenafil (Viagra), or vardenafil (Levitra), tadalafil (Cialis), or any herbal remedy for erection problems without checking first.

Make sure your home is set up to be safe and easy for you for you to move around in and avoid falls.

If you are unable to walk around very much, ask your provider for exercises you can do while you are sitting.

Make sure you get a flu shot and COVID-19 vaccine on a schedule recommended by your provider (usually every year). You may also need a pneumococcal vaccine (pneumonia shot). Ask your provider about this.

Your provider may call you to see how you are doing and to make sure you are checking your weight and taking your medicines.

You will need follow-up appointments at your provider's office.

You will likely need to have certain lab tests to check your sodium and potassium levels and monitor how your kidneys are working.

Contact your provider if:

• You gain more than 2 pounds (lb) (1 kilogram, kg) in a day, or 5 lb (2 kg) in a week.
• You are very tired and weak.
• You are dizzy and lightheaded.
• You are more short of breath when you are doing your normal activities.
• You have new shortness of breath when you are sitting.
• You need to sit up or use more pillows at night because you are short of breath when you are lying down.
• You wake up 1 to 2 hours after falling asleep because you are short of breath.
• You are wheezing and having trouble breathing.
• You feel pain or pressure in your chest.
• You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
• Your have swelling in your feet, ankles or legs.
• You have to urinate a lot, particularly at night.
• You have stomach pain or tenderness.
• You have symptoms that you think may be from your medicines.
• Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.

Congestive heart failure - discharge; CHF - discharge; HF - discharge

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022;145(18):e895-e1032. PMID: 35363499 pubmed.ncbi.nlm.nih.gov/35363499/.

Lam CSP, Shah SJ, Solomon SD. Heart failure with preserved and mildly reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 51.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.