A multidisciplinary program for the close monitoring of patients with reduced or preserved cardiac pump function through medication, lifestyle adjustments, and regular check-ups.
Indication
- Heart failure with reduced ejection fraction (HFrEF, EF ≤ 40%)
- Heart failure with preserved ejection fraction (HFpEF, EF ≥ 50%)
- Heart failure with mildly reduced ejection fraction (HFmrEF, EF 41-49%)
- Post-discharge follow-up after an acute heart failure episode
- Ischemic or non-ischemic cardiomyopathies
- Heart failure due to valvular disease, hypertension, or diabetes
- Recurrent edema, shortness of breath, and reduced exercise tolerance
Preparation
- Up-to-date list of all medications and doses
- Recent echocardiogram, ECG, BNP/NT-proBNP, and blood test results
- A logbook of daily weight, urine output, and blood pressure
- Information about salt and fluid intake, smoking, and alcohol use
How it's performed
- Detailed examination, with assessment of shortness of breath, edema, fatigue, and exercise capacity
- ECG, echocardiography, and when needed, blood tests (NT-proBNP, kidney function, electrolytes)
- Adjustment of foundational therapy according to guidelines: ACE inhibitor/ARB or ARNI (sacubitril/valsartan), beta-blocker, mineralocorticoid receptor antagonist (MRA), and SGLT2 inhibitor
- Additional evaluation for device therapy (ICD, CRT) in patients with low EF
- Recommendations on salt restriction, fluid balance, weight monitoring, and physical activity
- Vaccinations (influenza, pneumococcus, COVID-19) and management of comorbidities (DM, COPD, anemia)
Post-procedure
- Outpatient visit every 3-6 months in stable patients; more frequently after treatment changes
- Daily weight monitoring; consult the physician if weight increases by more than 2 kg in 2-3 days
- Cardiac rehabilitation program and regular aerobic exercise
- Criteria for emergency presentation during acute exacerbations and a clear action plan
- Co-management of associated kidney disease, diabetes, and sleep apnea
Risks
- Medication side effects: hypotension, changes in kidney function, hyperkalemia
- Fluid imbalance, worsening edema, or dehydration
- Arrhythmias (atrial fibrillation, ventricular arrhythmias)
- Acute heart failure episodes and the need for hospitalization
- Disease progression and possible need for advanced therapies (devices, transplantation)
FAQ
Can I live for many years with heart failure?
Modern quadruple medical therapy (ACE-i/ARB/ARNI, beta-blocker, MRA, SGLT2i) combined with lifestyle measures meaningfully improves both life expectancy and quality of life.
How much fluid and salt can I have per day?
Generally, daily fluid intake of 1.5-2 liters and less than 5 g of salt is recommended; the precise amount is determined by the physician based on the individual and disease stage.
Is it harmful for me to exercise?
On the contrary, physician-approved cardiac rehabilitation and regular aerobic exercise reduce symptoms and improve quality of life.
Can I stop my medications on my own?
No. Sudden discontinuation of heart failure medications increases the risk of acute episodes and hospitalization; any change should be made together with your physician.
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