Non-drug management

doi:10.1136/bmj.320.7231.366

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C R Gibbs,
G Jackson,
G Y H Lip

Approaches to the management of heart failure can be both non-pharmacological and pharmacological; each approach complements the other. This article will discuss non-pharmacological management.

Non-pharmacological measures for the management of heart failure

Compliance—give careful advice about disease, treatment, and self help strategies
Diet—ensure adequate general nutrition and, in obese patients, weight reduction
Salt—advise patients to avoid high salt content foods and not to add salt (particularly in severe cases of congestive heart failure)
Fluid—urge overloaded patients and those with severe congestive heart failure to restrict their fluid intake
Alcohol—advise moderate alcohol consumption (abstinence in alcohol related cardiomyopathy)
Smoking—avoid smoking (adverse effects on coronary disease, adverse haemodynamic effects)
Exercise—regular exercise should be encouraged
Vaccination—patients should consider influenza and pneumococcal vaccinations

Counselling and education of patients

Effective counselling and education of patients, and of the relatives or carers, is important and may enhance long term adherence to management strategies. Simple explanations about the symptoms and signs of heart failure, including details on drug and other treatment strategies, are valuable. Emphasis should be placed on self help strategies for each patient; these should include information on the need to adhere to drug treatment. Some patients can be instructed how to monitor their weight at home on a daily basis and how to adjust the dose of diuretics as advised; sudden weight increases (>2 kg in 1-3 days), for example, should alert a patient to alter his or her treatment or seek advice.

Lifestyle measures

Urging patients to alter their lifestyle is important in the management of chronic heart failure. Social activities should be encouraged, however, and care should be taken to ensure that patients avoid social isolation. If possible, patients should continue their regular work, with adaptations to accommodate a reduced physical capacity where appropriate.

Self help strategies for patients with heart failure