Quality Care for Congestive Heart Failure

The standard treatment plan for congestive heart failure (CHF) includes:

• Tests on the left ventricle of your heart
• An ACE inhibitor
• Instructions on how to care for yourself at home
• If you smoke, advice on how to stop smoking

The Centers for Medicare & Medicaid Services and Joint Commission for the Accreditation of Healthcare Organizations have determined that the treatments listed above are indicators of quality care for congestive heart failure. Look for and expect these treatments at the hospital.

Testing the left ventricle for LVSD

After CHF is diagnosed, the hospital should test for left-ventricular systolic dysfunction (LVSD), one of the most common forms of heart failure. LVSD involves the weakening of the left side of the heart due to a heart attack or clogged arteries, and it generally causes breathing difficulties.

What to expect: A doctor might use one or more of the following tests:

• Electrocardiograms (ECG)—This test measures the rhythm of the heartbeat. It detects the electrical signals that the heart produces. To perform the test, small discs are placed on the patient’s skin. The discs pick up electrical signals from the heart.

• Echocardiograms—This test uses sound waves to record blood flow in the heart. The sound waves are sent through the patient’s skin. If the doctor needs to see a clearer image, the sound waves can be sent through the esophagus, a tube that normally carries food to the stomach; this method requires the patient to take medication to relax and numb the body.

• Radionuclide angiography—A tiny amount of a radioactive substance, called a radionuclide, is injected into an arm vein to “tag” the blood cells so their progress through the heart can be traced with a scanner. A special camera records the heart at work so the doctor can evaluate the heart's pumping function and the volume of blood pumped out with each heartbeat.

• Cardiac catheterization—This test examines coronary arteries by sending a liquid visible to x-rays, called contrast material, through the coronary arteries or chambers of the heart for observation. To perform the test, a doctor passes a small tube, or catheter, through the patient’s blood vessel and into the heart.

Treating Congestive Heart Failure

Treating CHF can reduce fatigue, shortness of breath, and swelling of tissue, while enhancing your energy level, ability to exercise, and feeling of well-being. Everyone's situation is different, so some treatments that fit one person are not appropriate for another. You and your family should talk with your doctor about the most appropriate medical or surgical treatment options.

What to expect: Doctors treat patients with CHF by recommending proper diet and modified daily activities. Doctors may also prescribe one or more of the following medications:

• ACE inhibitors (angiotensin-converting enzyme inhibitors)—help open the arteries and lower blood pressure, improving blood flow. If you have LVSD, you should be prescribed an ACE inhibitor when you are discharged from the hospital, unless there is a reason to not prescribe it, such as an allergy. Commonly used ACE inhibitor names are captopril, enalapril, lisinopril, ramipril, and fosinopril. Not everyone can take ACE inhibitors, but you should ask your doctor or nurse about this if one is not prescribed for you.
• Diuretics—or “water pills" to help keep fluid from building up in your body and lungs, which helps you breathe easier.
• Beta blockers—help to improve blood pressure and may help prevent some heart rhythm problems.
• Digoxin─Also called “digitalis,” digoxin helps the heart pump better.
• Lipid-lowering drugs—to help lower cholesterol in patients to decrease the likelihood of new buildup.
• Anti-hypertensive medications─these drugs lower blood pressure and help prevent heart failure or prevent it from worsening.

People with heart failure often need to limit daily activities and visit their physician frequently. Many treatments can help prevent or slow down the progress of CHF and enable you to live longer and more comfortably. You must follow the doctor’s instructions for rest, diet, medication, and modified daily activities.  If you do not follow the recommended treatment, you may need several medications and hospital stays.

In some cases, the doctor finds a cause that is treatable—such as heart valve problems, coronary artery disease, irregular heartbeats, and alcohol abuse. In these cases, you should follow the doctor’s advice to reverse the cause.

Learning how to care for yourself

When you are leaving the hospital after treatment for CHF, a hospital provides you with written instructions or educational material to continue your progress. Follow your discharge instructions carefully.

What to expect: Instructions should include the following health and lifestyle recommendations:
 

• Level of daily activity—You may need to change your daily routine to avoid behavior that will make your symptoms worse. Typical activities people may have questions about include work, sports, leisure, sex, and household chores.
• A heart-healthy diet—You may improve your condition by eating more healthful foods. Moderate restrictions on salt, for example, sometimes apply. Ask your doctor to refer a dietician or other professional to help improve your diet.
• Instruction about medications—Upon discharge, your doctor should provide you a list of your medications, what they are used for, their potential side effects, your prescribed doses, and the times you should take them.
• An appointment for a follow-up exam—Schedule a follow-up appointment, where you can confirm that your medications are working and detect early warning signs of new problems.
• Daily weight monitoring—At home, you should weigh yourself every morning at the same time on the same scale. Keep a daily record of your weight. Call your doctor if you gain two or more pounds overnight or five pound in a week.
• Instructions on what to do if symptoms worsen—Discharge instructions should tell you what to do and whom to contact if your symptoms worsen. Some problems that should be included are:
• You gain two or more pounds overnight or five pounds in a week.
• Your ankles or feet swell more than usual.
• You start coughing at night or have a frequent dry cough.
• Breathing becomes difficult.
• You have a “black-out” spell.

Learning how to stop smoking

Smoking increases your chances of developing heart disease.  By quitting smoking, you can slow the progress of damage to the heart arteries, thereby lowering the risk of future heart attacks and heart failure.

What to expect: If you smoke, you should receive counseling during a hospital stay on how to quit smoking. The hospital staff may tell you about classes, group sessions, reading materials, or medications available to help you.