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Table 12 Continued

Education topic Goal for the patient and caregiver Professional behaviour and educational tools

Consider and carefully discuss the benefits and deleterious effects

of sleep medication.

Fluids To avoid large volumes of fluid intake. A fluid restriction

of 1.52 L/day may be considered in patients with severe HF/hyponatraemia to relieve symptoms and congestion. To avoid dehydration: where fluids are restricted, increase

intake during periods of high heat/humidity and/or nausea/vomiting. Provide information and discuss the advantages and disadvantages

of fluid restriction. Advise to adapt fluid intake to weight, and in times of high heat

and humidity, nausea/vomiting. Adjust advice during periods of acute decompensation and con-

sider altering this advice towards end-of-life.

Healthy diet To be able to prevent malnutrition and know how to eat

healthily, avoiding excessive salt intake (>5 g/day) and maintaining a healthy body weight. Discuss current food intake, role of salt, role of micronutrients.

Discuss the need for supplementing in case of nutrient deficien-

cies but there is no clear role for routine micronutrient supplementation.321 Discuss maintaining a healthy body weight.

Alcohol To be able to abstain from or avoid excessive alcohol

intake, especially for alcohol-induced CMP. To restrict alcohol according to CV prevention guidelines. Tailor alcohol advice to aetiology of HF; e.g. abstinence in alco-

holic CMP. Inform and discuss alcohol intake according to CV prevention

guidelines (2 units per day in men or 1 unit per day in women)a.

Immunization To be aware of the need for immunization for influenza

and pneumococcal disease. Discuss benefits and possible barriers.

Advise on local immunization practice.

Smoking and recreational drugs To be aware of the consequences for health of smoking

and use of recreational drugs. Stop smoking (including e-cigarettes) and taking recrea-

tional drugs. Inform, discuss and help in decision making. Refer for specialist advice for smoking cessation and drug with-

drawal and replacement therapy. Consider referral for cognitive behavioural theory and

psychological support if patient wishes to stop smoking or taking drugs.

Travel, leisure, driving To be able to prepare travel and leisure activities accord-

ing to physical capacity. To be able to take an informed decision about driving. Inform and discuss practical issues related to long haul travel, stay-

ing abroad, exposure to sun (amiodarone effects), high humidity or heat (dehydration), and high altitude (oxygenation). Provide practical advice related to travel with medication/devices

(keep medicines in hand luggage, have a list with medication, device name/card and treating centres). Inform about local/national/international regulation related to

driving.

Sexual activity To be able to resume or adapt sexual activity according to

physical capacity. To recognize possible problems with sexual activity and

their relationship with HF or its treatment. Inform and discuss that sexual activity is safe for stable HF

patients. Provide advice on eliminating factors predisposing to sexual

problems. Discuss and provide available pharmacological treatment for sexual problems. Refer to specialist for sexual counselling when necessary.

Symptom monitoring and symptom selfmanagement Monitor and recognize change in signs and symptoms.

Being able to react adequately to change in signs and symptoms. Know how and when to contact a healthcare professional. Provide individualized information to support self-management

such as: In the case of increasing dyspnoea or oedema or a sudden unex-

pected weight gain of >2 kg in 3 days, patients may increase their diuretic dose and/or alert their healthcare team.

Living with HF Psychological issues To be able to live a good life with HF. To be able to seek help in case of psychological problems

such as depressive symptoms, anxiety or low mood which may occur in the course of the HF trajectory. Regularly communicate information on disease, treatment options

and self-care. Regularly discuss the need for support. Treat or referral to specialist for psychological support when

necessary.

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