Quality Care for Congestive Heart Failure
The standard treatment plan for congestive heart failure
- 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
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
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
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
- 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
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
- 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
- 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
- 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.