Patient Education Patient Education

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:

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

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:

How to be medicinewise

Managing your medicines

Medicines List

Medimate

NPS Medicinewise
Medicines to avoid Medicines to avoid in HF  

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

Summary and discussion Individualisation of dietary management strategies depending on weight status, fluid status and other comorbidities  

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:

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:

These resources are also available from the Patient information section

Relaxation

Relaxation and stress response

Benefits of relaxation

Relaxation exercises

Breathing techniques

Visual imagery
 

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]

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 (a guide for patients)
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., Heartmoves, Lungs in Action, walking programs, other community programs)

Home exercise diary

Pedometer

Lungs in Action

Heartmoves
Specific conditions

Exercise and diabetes

Other relevant conditions (e.g., respiratory, peripheral vascular disease)
 

FITT = frequency, intensity, time and type of exercise

  • Scott J, Thompson DR. Assessing the information needs of post-myocardial infarction patients: a systematic review. Patient Educ Couns 2003;50:167-177.

    scott-j-thompson-dr.-2003
  • Boyde M, Tuckett A, Peters R, et al. Learning style and learning needs of heart failure patients (The Need2Know-HF patient study). Eur J of Cardiovasc Nurs 2009;8:316-322.

    boyde-m-tuckett-a-peters-r-et-al.-2009
  • Beattie J, Goodlin S (Eds.). Supportive Care in Heart Failure. Oxford ; New York: Oxford University Press, 2008

    beattie-j-goodlin-s-eds..-2008