Bridgewater Community Healthcare NHS Foundation Trust PROOF

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2 Name: Address: Your Heart Failure team Nurses Name Nurses Office Tel Number NHS non-emergency advice line 111 In an emergency 999 The Heart Failure Service operates Monday to Friday from 9am to 5pm (excluding Bank Holidays) 1 If found please return to: Long Term Conditions Boston House Frog Lane Wigan WN6 7LB

3 What is heart failure? Your heart is a muscle pump. Every time your heart beats it pumps blood around your body. Your blood contains oxygen and nutrients (food) needed to keep your body working. If your heart is not pumping as well as it should, then it cannot keep up with your body's need for oxygen, especially during exercise. This is called chronic heart failure. Other names used are congestive heart failure, and CHF. In most cases, heart failure cannot be cured, but taking medicines and changing some everyday habits may help you feel and function better. Part of your doctors and nurses job is to adjust your medication as appropriate, to make sure your heart works to your best advantage. This booklet will also help you to understand your condition and to maintain health. What causes heart failure? There are many causes. Some of the more common are: Heart attack (myocardial infarction) High blood pressure (hypertension) Heart muscle or heart valve disease Infection of the heart muscle (myocarditis) Rapid heart beat (atrial fibrillation) Excessive alcohol consumption over a long period Sometimes it is not easy to know what caused your heart failure. 1 1

4 How will I feel? The most common symptoms of heart failure are: Shortness of breath. This may be more common when you are doing physical exercise (such as walking or climbing upstairs) or when you are lying flat in bed. You may wake up in the middle of the night because you are finding breathing difficult. Your doctor may call this dyspnoea. Swollen feet, ankles or legs. This is due to a build-up of fluid. Your doctor may call this congestion or oedema. Tiredness or weakness. What happens next? Chronic heart failure is a serious illness and you will need to take tablets on a daily basis for the rest of your life to make you feel better and to improve your prognosis (disease outcome). Different medicines are available for heart failure. Your doctor will decide on the most suitable treatment for you, and this will be explained to you by your nurse or doctor. These medications may be reviewed periodically because new tablets that have shown benefits in research trials are often used by doctors in hospitals and General Practice. It is very important that you take your medicine regularly and as directed by your doctor. If you do not do this, your heart failure will almost certainly get worse. However, if your treatment gives you side effects - get in touch with your doctor straight away. 2

5 It is important for you to check your condition regularly. This will help you know if your heart failure is getting worse. Things to check include: Weight Weigh yourself every morning and make a note of this. Make sure you weigh yourself after going to the toilet but before breakfast and before you get dressed. Always use the same scales. If your weight starts to go up quickly and you have put on more than 3 pounds (1-1 1 /2kg) in a week tell your doctor or nurse as soon as possible. This may mean you have a build-up of water in your body. Breathing Tell your doctor if you are experiencing any breathing difficulties such as:- finding it more difficult to breathe during the day waking up more often at night with breathlessness waking up during the night coughing - also report any expectorant that is frothy yellow or green increasing breathlessness on lying flat Ankles and feet Tell your doctor or nurse if your ankles, feet or stomach are more swollen than usual Visit your Out-patient clinic regularly If you feel worse... If you think your heart failure is getting worse, you should immediately let your medical services know. On the next page is a guide to the steps for doing this. 3 3

6 Steps to assistance if you are feeling unwell Start by contacting your nurse. If you cannot get through, for example, if it s after hours then contact your GP, NHS non-emergency advice line or your local Accident and Emergency Service. 4

7 1 Medicines for Heart Failure As there are a number of good medicines for the treatment of heart failure, your doctor will decide on the most suitable ones for you and may give you one or more of these different types: Diuretics These tablets are also known as water tablets. Diuretics help your body to get rid of any build-up of water by making you pass water (urine) more often. They reduce ankle swelling and make you feel less breathless. Some diuretics make you pass large amounts of urine very soon after taking the tablets, but you may take the tablets at a time to suit your daily routine. Sometimes diuretics may cause your body to lose too much of important substances called electrolytes. Your blood will be tested to check this. If any electrolyte is low you will receive specific advice and treatment. ACE inhibitors This stands for angiotensin converting enzyme inhibitors. These tablets work by relaxing your blood vessels, making it easier for the heart to pump blood through them. ACE inhibitors are started at a low dose which is gradually increased over time. Your doctor may regularly check how well your kidneys are working whilst your dose is being increased. Side effects of ACE inhibitors include cough or dizziness. Angiotensin II antagonists Angiotensin is a naturally occurring substance in our bodies. However, for some people it increases blood pressure unacceptably. As with ACE inhibitors (above) Angiotensin II antagonists work by relaxing the blood vessels - allowing more blood flow. These tablets do not give the cough some people get on ACE inhibitors. Digoxin Some patients may be given digoxin in addition to diuretics and ACE inhibitors. This medicine makes your heart beat more strongly. It also makes sure your heart does not beat too fast. If the dose is too high, you may feel sick (nauseated). Contact your doctor as soon as possible if this happens. 5 5

8 Warfarin Warfarin helps prevent blood clotting. Normally blood vessels are smooth inside, allowing a free flow. In heart failure these vessels can be damaged leading to blood clots which, within vessels, can be serious. Warfarin helps avoid this. With warfarin, always follow the dosage exactly as given to you. Also, if you are on this treatment, you should always check with your doctor or nurse before taking any medication you buy from the chemist, as some of these can affect the action of warfarin, or interact if the two are taken together. Beta-blockers These tablets work by slowing your heartbeat and reducing the work that you heart has to do. Some beta-blockers also relax your blood vessels, making it easier for the heart to pump blood through them. You may feel dizzy or tired when you are on these tablets. Procoralan (Ivabradine) This tablet also works by slowing your heartbeat and reducing the work that your heart has to do. This treatment can be given instead of or as well as betablockers. Sacubitril/Valsartan This is a combination tablet to help treat heart failure. Your doctor or nurse may recommend you start on it. It is a tablet that is used in place of (not in addition to) an ACE inhibitor or angiotensin II receptor antagonist. The medicine works in two ways to help improve the hearts ability to pump blood around the body: It increases the body s natural defences against heart failure. It blocks the body s natural system which has a harmful effect on the heart. 6

9 Watching your weight Weigh yourself every morning and note this on the card below. Make sure you weigh yourself after going to the toilet but before breakfast and before you get dressed. Always use the same scales. If your weight starts to go up quickly and you have put on more than 2lbs in 24 hours, or 3lbs in a week Tell your nurses or doctor as soon as possible. This may mean that you have a build up of water in your body. DATE WEIGHT DATE WEIGHT 1 7 7

10 DATE WEIGHT DATE WEIGHT 8

11 Diary of Clinic Visits DATE WEIGHT NOTES 1 9

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13 Helping Yourself Drink Less Alcohol Large quantities of alcohol can actually be the cause of heart failure. Even moderate amounts can make your heart failure worse. Patients who are advised by their doctors to stop alcohol intake because of heart or liver problems are advised not to take alcohol at all. However some patients who drink beer, the extra volume of fluid can make your shortness of breath worse. Wine or spirits have less volume than beers. If you are worried about alcohol intake, discuss this with your nurse or doctor. They will give you further advice. Stop smoking Smoking is bad for your heart and your lungs. For your own benefit you need to stop smoking immediately and permanently. If you would like help with stopping smoking contact: Smokefree NHS Healthy Routes Keep Active Your nurse or doctor may be able to tell you how much exercise you should do. Walking, swimming, cycling, golfing and dancing are all good forms of exercise. Keeping active may help you feel better. Check with your doctor before you start any regular exercise. Flu and Pneumonia Jabs Flu (Influenza) or pneumonia may make people with heart failure very unwell. Make sure you get immunised against this. You will need a jab every winter. Please ensure that you see your practice nurse to arrange these vaccinations. Avoid infection Do stay away from friends or people with chest infections. Have plenty of fresh air. Also, eating a healthy diet that includes fruit and vegetables helps ward off infections. Take your medicine! Always take your medicine regularly, as your doctor or nurse has told you. If you do not, your heart failure may get worse. 11

14 Eating Healthily Eating healthily will help you to feel better and may help you to lose weight if you need to. This sheet gives you some guidance on which foods you can eat and which you should cut down. See over the page for more information on salt. Have more Fresh vegetables (not cooked with salt) and salad Fresh fruit Fresh fish Fresh poultry (chicken/turkey) Lean meat Wholemeal bread Pasta Rice Semi-skimmed or skimmed milk Have less High-fat foods Full-fat milk, cream, cheeses Cakes and biscuits. Sweets High-sodium foods (foods high in salt): bacon, cheese, crisps, corned beef, ham, pizza, salad dressings, sausages, tinned soups, ready meals Avoid Alcohol Smoking Adding salt to food Drinking too much fluid - no more than 2 litres 3 ½ pints) per day 12

15 Eat less salt Salt - as sodium, our common table salt - attracts water. Salt in our bodies does the same thing. In heart failure, an accumulation of water in the body is bad because it puts an additional strain on the heart, and when the heart cannot cope, the fluid pools and swells ankles, legs and other parts of the body. So: Less salt means less water Less water means less stress on the heart Less stress on the heart assists in controlling heart failure On average we consume ten times the amount of salt necessary for basic health. Here are three guidelines: For health, there is enough natural salt in the food you eat Don't add salt when cooking Leave the salt pot off the table 'Sea salt' is exactly the same as 'table salt' in terms of health benefits - not good. See the next section in this booklet, called 'Eating Healthily', for more information on this - including good foods to eat and foods to avoid. But here's a quick guide: AVOID OK Cheese, bacon, salted nuts, crisps, sausages fruit, fresh fish, lean meat and poultry, pasta and rice (cooked without salt) and vegetables (cooked without salt) 1 13

16 How you can reduce your salt intake On average we consume about 10 times more salt than we need every day. The following examples show the average sodium/salt content in ready prepared food which you should look out for when buying ready-made meals: FOOD SODIUM CONTENT (PER 100g) SALT CONTENT (PER 100g) Bacon Baked Beans Bread medium sliced Brown Sauce Cheddar Cheese Chicken curry Chocolate biscuit Cornflakes Cornish Pasty Cream cracker Crisps Crumpets Digestive Biscuit Eggs Fish in white sauce Granary bread Gravy/stock Ham Meat/fish pate Oven chips Pasta with sauce Plain scones Roast chicken Salad Cream Salted peanuts Sausages Shepherd s pie Spaghetti in tomato sauce Steak and kidney pie Stilton cheese Tomato ketchup Tomato soup Vegetable extract spread

17 Helping Yourself Watch what you eat Your heart has to work harder if you are overweight. If you need to lose weight: Try to eat less fat. Choose fish, lean meat and poultry Eat more high fibre foods such as wholemeal bread, pasta, fresh fruit and vegetables Try to eat fewer biscuits, sweets, cakes and sweet things IMPORTANT - Watch your fluid intake Diuretics (water tablets) help your body get rid of any build-up of water by making you pass water (urine) more often. This may make you thirsty, but you should try to restrict your fluid (water) intake to about 2 ½ to 3 ½ pints (1 ½ to 2 litres) per day - spread out as evenly as you can over a 24-hour period - so take a glass of water to bed with you at night. Points to note about fluid intake: if the weather is unusually hot or you are exercising more than normal. or you have diarrhoea or your urine is darker than normal - See your nurse or doctor about safely increasing your fluid intake

18 Helping Yourself Air Travel The British Heart Foundation (BHF) say that in general if a patient can manage a flight of stairs without stopping and without significant symptoms while holding a conversation, he or she should be fit to fly. However, patients who suffer from significant heart failure who require oxygen at home would not be fit to fly. Possible risks of Sexual Activity Patients and partners who are worried about possible risks of sexual activity may wish to seek guidance from a health care professional who can discuss these issues with you. Breathlessness on exertion and the inability to lie flat may limit activity. Summer Heat Waves When there are excessive temperatures continually above normal, extra fluid should be taken as 2 glasses of water a day. Please continue to monitor your dry weight and contact your doctor if you are worried. Diarrhoea The other time fluid may be lost from your body is if you are suffering from diarrhoea. For every loose motion, please take a small cup of water to replace any fluid lost. 16

19 The Emotional Impact of Living with Heart Failure. Receiving a diagnosis of heart failure can be frightening for you and your family. At first, people often feel very unsure about what this diagnosis means and/or how things may progress, and they can fear for their future. Speaking to your doctor and heart failure nurse specialist, and reading and following the advice in this booklet, will help you to understand what heart failure is and help you become involved in the decisions about your treatment. Overall this will help you feel you have more control over your condition. Living with heart failure can be emotionally difficult. As shown throughout this booklet, there are lots of positive things you can do with your activity levels and diet, etc. to help minimise the impact that heart failure has on your life. However, because of the symptoms you may experience (tiredness; breathless, etc) living your life normally can be difficult, and you may feel the loss of the things you used to do/enjoy. Adjusting emotionally to the diagnosis and what this means to you, and living with the uncertainty that heart failure can bring, can also be very challenging. As such feelings of anxiety and low mood or depression can be common and are very understandable. Over time, you may find that these feelings subside as you gain more understanding about heart failure, and begin to take more control over your condition. If you are feeling these emotions it is important that you speak to your heart failure nurse specialist, who will be able to help reassure you. In some cases, your nurse may feel that a referral to a GP counsellor or Clinical Psychologist is indicated, to help you adjust to and manage these feelings further. Palliative Care Palliative care aims to improve the quality of life of people whose illness cannot be cured. It focuses on controlling symptoms and offering emotional support for you and your family. This support may be provided at home, in clinic, in hospital or at a hospice. If you would like to discuss palliative care please ask you heart failure nurse

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23 This space is reserved for any written questions that you may have for your doctor, nurse or pharmacist. 1

24 Printing costs funded by a Medical & Educational Grant from Servier Laboratories Ltd Printed by Gemini Print (Wigan) Ltd - (01942)