Heart Failure Nursing Diagnosis: A Comprehensive Guide for Healthcare Professionals

Introduction

Heart failure (HF), a complex clinical syndrome, arises from structural or functional cardiac disorders that impair the ventricle’s ability to fill or eject blood, thereby failing to meet the body’s metabolic demands. This condition is not a disease in itself but rather a consequence of various underlying cardiovascular issues. Predominantly, heart failure manifests due to compromised left ventricular myocardial function, leading to a cascade of symptoms such as dyspnea, fatigue, reduced exercise tolerance, and fluid retention, clinically evident as pulmonary and peripheral edema.[1]

Categorization of heart failure due to left ventricular dysfunction is crucial for guiding treatment strategies. It is primarily classified based on left ventricular ejection fraction (LVEF) into two main types: heart failure with reduced ejection fraction (HFrEF), where LVEF is 40% or less, and heart failure with preserved ejection fraction (HFpEF), characterized by an LVEF greater than 40%.[2] Understanding these classifications is essential for nurses to formulate accurate heart failure nursing diagnoses and implement effective care plans. This article aims to provide an in-depth guide for healthcare professionals, particularly nurses, on navigating the complexities of heart failure, focusing on nursing diagnoses, patient assessment, and management strategies.

Common Nursing Diagnoses for Heart Failure

Nursing diagnoses are crucial in outlining the specific health problems that nurses can address. For patients with heart failure, several key nursing diagnoses are frequently identified, reflecting the multifaceted nature of the condition:

• Decreased Cardiac Output: This diagnosis reflects the heart’s inability to pump sufficient blood to meet the body’s needs, leading to inadequate tissue perfusion and oxygenation.
• Activity Intolerance: Heart failure often results in fatigue and dyspnea, limiting a patient’s ability to perform daily activities.
• Excess Fluid Volume: Fluid overload is a hallmark of heart failure, leading to edema, pulmonary congestion, and increased cardiac workload.
• Risk for Impaired Skin Integrity: Edema and poor tissue perfusion increase the risk of skin breakdown and pressure ulcers.
• Ineffective Tissue Perfusion: Reduced cardiac output and circulatory congestion compromise blood flow to vital organs and tissues.
• Ineffective Breathing Pattern: Pulmonary congestion and edema can lead to shortness of breath and an altered breathing pattern.
• Impaired Gas Exchange: Fluid in the alveoli and reduced pulmonary blood flow interfere with oxygen and carbon dioxide exchange.
• Fatigue: A common and debilitating symptom due to reduced cardiac output, poor oxygenation, and metabolic changes.
• Anxiety: The chronic and life-threatening nature of heart failure, along with its symptoms and lifestyle restrictions, can induce significant anxiety.

These heart failure nursing diagnoses provide a framework for nurses to plan and deliver patient-centered care, addressing the most pressing needs and improving patient outcomes.

Causes of Heart Failure

Heart failure is a syndrome triggered by a wide array of cardiac disorders. These can broadly include conditions affecting the heart’s structural components, such as the pericardium, myocardium, endocardium, cardiac valves, and vasculature, or systemic conditions that impact cardiac metabolism.

The etiology of heart failure differs slightly between systolic dysfunction (HFrEF) and diastolic dysfunction (HFpEF). Common causes of systolic dysfunction include:

• Idiopathic Dilated Cardiomyopathy (DCM): A condition where the heart chambers enlarge and weaken without a clear identifiable cause.
• Coronary Heart Disease (Ischemic Heart Disease): Blockages in the coronary arteries reduce blood flow to the heart muscle, leading to damage and impaired function, often following a myocardial infarction.
• Hypertension: Chronic high blood pressure increases the workload on the heart, leading to hypertrophy and eventual failure.
• Valvular Heart Disease: Conditions like aortic stenosis or mitral regurgitation place extra strain on the heart, causing it to work harder and eventually fail.

For diastolic dysfunction (HFpEF), while some causes overlap with systolic dysfunction, additional factors are more prominent:

• Hypertrophic Obstructive Cardiomyopathy (HOCM): A genetic condition causing thickening of the heart muscle, which can obstruct blood flow and impair relaxation.
• Restrictive Cardiomyopathy: Characterized by stiffening of the heart muscle, restricting its ability to fill properly with blood.
• Conditions that lead to systemic inflammation and microvascular dysfunction: These include hypertension, diabetes, obesity, and aging, which are strongly associated with HFpEF.

Understanding the underlying causes of heart failure is crucial for tailoring treatment and addressing contributing factors, thereby impacting the Heart Failure Nursing Diagnosis and subsequent care plan.

Risk Factors for Heart Failure

Several risk factors significantly increase the likelihood of developing heart failure. Identifying and managing these risk factors is a vital aspect of preventative and ongoing care for patients. Key risk factors include:

• Coronary Artery Disease (CAD): CAD reduces blood supply to the heart muscle, weakening it over time.
• Myocardial Infarction (Heart Attack): Damage to the heart muscle from a heart attack is a leading cause of heart failure.
• Hypertension: Uncontrolled high blood pressure is a major stressor on the heart.
• Diabetes Mellitus: Diabetes can damage blood vessels and the heart muscle itself.
• Obesity: Excess weight increases the heart’s workload and is associated with other risk factors like hypertension and diabetes.
• Smoking: Smoking damages blood vessels and increases the risk of CAD and hypertension.
• Alcohol Use Disorder: Excessive alcohol consumption can directly damage the heart muscle, leading to alcoholic cardiomyopathy.
• Atrial Fibrillation: This irregular heart rhythm can lead to inefficient heart function and heart failure.
• Thyroid Diseases: Both hyperthyroidism and hypothyroidism can strain the heart.
• Congenital Heart Disease: Structural heart defects present from birth can lead to heart failure later in life.
• Aortic Stenosis: Narrowing of the aortic valve restricts blood flow from the heart.
• Family history of cardiomyopathy: Genetic predispositions can increase risk.

Nurses play a crucial role in educating patients about these risk factors and promoting lifestyle modifications to mitigate them. This preventative approach is as important as managing the condition once it develops and directly informs the heart failure nursing diagnosis by highlighting areas for patient education and lifestyle adjustments.

Assessment of Heart Failure

A thorough assessment is fundamental in diagnosing heart failure and determining its severity. The assessment includes recognizing symptoms related to fluid overload and reduced cardiac output.

Symptoms due to excess fluid accumulation include:

• Dyspnea (Shortness of Breath): Initially exertional, progressing to rest dyspnea.
• Orthopnea: Shortness of breath when lying flat, often relieved by sitting up or using pillows.
• Edema: Swelling in the ankles, legs, abdomen (ascites), and sacral area.
• Hepatic Congestion: Right upper quadrant pain due to liver enlargement and congestion.
• Abdominal Distension: From ascites and bowel edema.

Symptoms due to reduced cardiac output manifest as:

• Fatigue and Weakness: Especially pronounced with physical exertion.
• Dizziness and Lightheadedness: Due to reduced cerebral perfusion.
• Exercise Intolerance: Difficulty performing usual physical activities.
• Cognitive Impairment: In severe cases, due to reduced blood flow to the brain.

The presentation of heart failure can be acute, subacute, or chronic.

• Acute and subacute presentations (days to weeks): Characterized by rapid onset of shortness of breath at rest or exertion, orthopnea, paroxysmal nocturnal dyspnea (sudden nighttime breathlessness), and right upper quadrant discomfort due to acute hepatic congestion. Palpitations might occur if arrhythmias develop.

• Chronic presentations (months): Fatigue, anorexia, abdominal distension, and peripheral edema may be more prominent than dyspnea. Anorexia arises from poor splanchnic circulation, bowel edema, and nausea from hepatic congestion.

Characteristic physical findings include:

• Pulsus Alternans: Alternating strong and weak peripheral pulses, indicating severe left ventricular dysfunction.
• Displaced Apical Impulse: Laterally displaced beyond the midclavicular line, suggesting left ventricular enlargement.
• S3 Gallop: A low-frequency sound in early diastole, a sensitive indicator of ventricular dysfunction.
• Peripheral Edema: Pitting edema in dependent areas.
• Pulmonary Rales (Crackles): Indicating fluid in the lungs.
• Jugular Venous Distension (JVD): Elevated jugular venous pressure reflecting increased central venous pressure.

New York Heart Association (NYHA) Functional Classification

The NYHA classification is used to categorize the severity of heart failure based on symptoms:

• Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitations.
• Class II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, dyspnea, or palpitations.
• Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, dyspnea, or palpitations.
• Class IV: Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest.

This comprehensive assessment is crucial for formulating an accurate heart failure nursing diagnosis and guiding the subsequent evaluation and management strategies.

Evaluation and Diagnostic Tests for Heart Failure

Several diagnostic tests are employed to evaluate heart failure, confirm the diagnosis, determine the underlying cause, and assess the severity of the condition. These tests include:

• Electrocardiogram (ECG): To detect signs of myocardial infarction, ischemia, arrhythmias (like atrial fibrillation), and ventricular hypertrophy.
• Chest X-ray: To identify cardiomegaly (enlarged heart), pulmonary congestion, pleural effusions, and Kerley B-lines (indicating interstitial edema).

• Blood Tests:
  • Cardiac Troponin (T or I): To rule out acute myocardial infarction as a cause of heart failure.
  • Complete Blood Count (CBC): To assess overall health and rule out anemia or infection.
  • Serum Electrolytes (Sodium, Potassium, etc.): Electrolyte imbalances can exacerbate heart failure and are important to monitor, especially with diuretic use.
  • Blood Urea Nitrogen (BUN) and Creatinine: To assess renal function, which is often impaired in heart failure and affected by medications.
  • Liver Function Tests (LFTs): To evaluate liver congestion and function.
  • Brain Natriuretic Peptide (BNP) or N-terminal pro-BNP (NT-proBNP): Elevated levels are highly indicative of heart failure and correlate with severity. BNP is often considered more diagnostically valuable than other initial tests when combined with history and physical exam findings.
• Transthoracic Echocardiogram (TTE): The cornerstone of heart failure evaluation. It assesses:
  • Left Ventricular Ejection Fraction (LVEF): To classify heart failure as HFrEF or HFpEF.
  • Ventricular Size and Function: To identify dilated or hypertrophic cardiomyopathy.
  • Valvular Function: To detect valvular stenosis or regurgitation.
  • Diastolic Function: To assess filling pressures and diastolic dysfunction, particularly important in HFpEF.
  • Wall Motion Abnormalities: To detect areas of ischemia or infarction.

These evaluations provide critical data for confirming the heart failure nursing diagnosis, determining the etiology, guiding medical management, and monitoring disease progression.

Medical Management of Heart Failure

The medical management of heart failure aims to alleviate symptoms, improve quality of life, reduce hospitalizations, and prolong survival. Pharmacological and device therapies are central to this management.

Pharmacological Management:

Several classes of medications are used to manage heart failure, often in combination, based on the patient’s type of heart failure, symptoms, and comorbidities:

• Diuretics (e.g., Furosemide, Torsemide): To reduce fluid overload and alleviate symptoms like edema and dyspnea. Primarily used for symptom control rather than improving survival.
• Beta-blockers (e.g., Metoprolol, Carvedilol, Bisoprolol): To reduce heart rate, blood pressure, and improve long-term outcomes in HFrEF. Shown to improve survival.
• Angiotensin-Converting Enzyme Inhibitors (ACEIs) (e.g., Enalapril, Lisinopril) and Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan): To block the renin-angiotensin-aldosterone system (RAAS), reduce vasoconstriction, and improve outcomes in HFrEF. ACEIs have proven survival benefits. ARBs are used for patients intolerant to ACEIs.
• Angiotensin Receptor-Neprilysin Inhibitor (ARNI) (e.g., Sacubitril/Valsartan): Combines an ARB with a neprilysin inhibitor, providing superior outcomes compared to ACEIs in HFrEF. Should not be given within 36 hours of an ACEI dose.
• Hydralazine and Isosorbide Dinitrate: A combination therapy particularly beneficial for African Americans with persistent NYHA class III to IV HFrEF despite optimal medical therapy. Improves survival in this population.
• Mineralocorticoid Receptor Antagonists (MRAs) or Aldosterone Antagonists (e.g., Spironolactone, Eplerenone): To block aldosterone, reduce sodium and water retention, and improve outcomes in HFrEF. Improves survival when used in conjunction with other guideline-directed medical therapy.
• Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors (e.g., Dapagliflozin, Empagliflozin): Initially developed for diabetes, these drugs have shown significant benefits in reducing hospitalizations and cardiovascular mortality in both HFrEF and HFpEF, regardless of diabetes status.
• Digoxin: To control heart rate in atrial fibrillation and improve symptoms, but does not improve survival.

Device Therapy:

• Implantable Cardioverter-Defibrillator (ICD): For primary or secondary prevention of sudden cardiac death in patients at high risk of ventricular arrhythmias.
• Cardiac Resynchronization Therapy (CRT): Biventricular pacing to improve symptoms and survival in selected patients with HFrEF, sinus rhythm, and prolonged QRS duration, indicating conduction delays. Often combined with an ICD (CRT-D).
• Ventricular Assist Device (VAD): Used as a bridge to transplant or as destination therapy for patients with severe heart failure refractory to medical management.
• Cardiac Transplant: Reserved for end-stage heart failure in carefully selected patients.

Medical management is dynamic and tailored to the individual patient, requiring continuous assessment and adjustments. Nurses play a vital role in monitoring medication effectiveness, side effects, and patient adherence, contributing significantly to the effectiveness of the heart failure nursing diagnosis and care plan.

Nursing Management and Care Plan for Heart Failure

Nursing management is integral to the comprehensive care of patients with heart failure. A well-structured nursing care plan addresses the various needs of these patients, focusing on:

• Relieving Fluid Overload Symptoms:

  • Administering diuretics as prescribed and monitoring their effectiveness.
  • Restricting fluid intake as ordered (typically 2 L/day).
  • Monitoring daily weight and intake/output to assess fluid balance.
  • Elevating legs when sitting to reduce peripheral edema.
  • Assessing for signs of dehydration or electrolyte imbalances from diuretic therapy.

• Relieving Symptoms of Anxiety and Fatigue:

  • Providing emotional support and reassurance to alleviate anxiety related to their condition.
  • Encouraging relaxation techniques and stress management strategies.
  • Planning rest periods to manage fatigue and conserve energy.
  • Monitoring and addressing factors contributing to fatigue, such as anemia or sleep disturbances.

• Promoting Physical Activity:

  • Encouraging regular, moderate exercise within the patient’s tolerance level, as recommended by healthcare providers.
  • Gradual increase in activity levels to improve exercise tolerance.
  • Educating on the importance of physical activity and providing guidance on safe exercise practices.

• Increasing Medication Compliance:

  • Educating patients and families about medications, including purpose, dosage, frequency, and potential side effects.
  • Simplifying medication regimens when possible.
  • Using reminder systems or tools to improve adherence.
  • Addressing barriers to medication compliance, such as cost, complexity, or side effects.

• Decreasing Adverse Effects of Treatment:

  • Monitoring for side effects of medications, such as electrolyte imbalances, hypotension, or renal dysfunction.
  • Implementing strategies to minimize side effects, such as administering medications with food or adjusting timing.
  • Educating patients on potential side effects and when to report them.

• Teaching Patients About Dietary Restrictions:

  • Educating on sodium restriction (typically 2-3 g/day) to reduce fluid retention.
  • Providing guidance on reading food labels and identifying high-sodium foods.
  • Consulting with a dietitian for personalized dietary plans.

• Teaching Patient About Self-Monitoring of Symptoms:

  • Instructing patients to monitor for worsening symptoms, such as increased shortness of breath, weight gain, edema, or fatigue.
  • Educating on recognizing signs and symptoms that require prompt medical attention.

• Teaching Patients About Daily Weight Monitoring:

  • Instructing patients on how to weigh themselves daily at the same time and record their weight.
  • Educating on the significance of weight changes as an indicator of fluid balance and heart failure status.
  • Providing guidelines on when to report weight changes to their healthcare provider (e.g., weight gain of 2-3 pounds in 1-2 days).

The nursing care plan is dynamic and requires regular evaluation and adaptation based on the patient’s changing condition and response to treatment. Effective nursing management significantly enhances patient outcomes and quality of life, directly impacting the overall success of the heart failure nursing diagnosis and treatment strategy.

When to Seek Help for Heart Failure

Prompt medical attention is crucial when patients with heart failure experience worsening symptoms. Patients should be educated to seek help in the following situations:

• Worsening Symptoms of Fluid Overload:

  • Sudden weight gain (2-3 pounds in 1-2 days).
  • Increased swelling in ankles, legs, or abdomen.
  • Increased shortness of breath or orthopnea.
  • Persistent cough or wheezing.

• Worsening Hypoxia:

  • Increased shortness of breath or difficulty breathing.
  • New or worsening cyanosis (bluish discoloration of lips or nails).
  • Significant decrease in oxygen saturation.

• Uncontrolled Tachycardia or Bradycardia:

  • Rapid heart rate (over 120 bpm) or slow heart rate (under 50 bpm), especially if associated with symptoms like dizziness or lightheadedness.
  • Palpitations or irregular heartbeats.

• Change in Cardiac Rhythm:

  • New onset of irregular heartbeat or palpitations.
  • Documented arrhythmia on home monitoring devices.

• Change in Mental Status:

  • New confusion, disorientation, or decreased alertness.
  • Sudden dizziness or lightheadedness.

• Decreased Urinary Output Despite Diuretic Therapy:

  • Significant decrease in urine production despite taking diuretics as prescribed.
  • May indicate worsening renal function or reduced cardiac output.

Educating patients and their families about these warning signs empowers them to seek timely medical care, potentially preventing serious complications and hospitalizations. This is a critical component of effective heart failure nursing diagnosis and patient management.

Monitoring Heart Failure Patients

Regular monitoring is essential for patients with heart failure to track disease progression, assess treatment effectiveness, and detect early signs of decompensation. Monitoring includes:

• Vital Signs: Frequent monitoring of blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
• Telemetry Monitoring: Continuous monitoring of heart rate and rhythm, especially in acute care settings or for patients at high risk of arrhythmias.
• Symptom Assessment: Regular and thorough assessment for heart failure symptoms, including dyspnea, edema, fatigue, cough, and chest pain.
• Daily Weight Monitoring: Crucial for detecting fluid retention or loss.
• Fluid Balance Monitoring: Intake and output monitoring to assess diuretic effectiveness and fluid status.
• Electrolyte Monitoring: Regular blood tests to monitor serum electrolytes, especially potassium and sodium, particularly in patients on diuretics, ACEIs/ARBs/ARNIs, and MRAs.
• Renal Function Monitoring: Periodic BUN and creatinine levels to assess kidney function, especially in patients on RAAS inhibitors and diuretics.
• BNP/NT-proBNP Monitoring: Serial measurements may be used to assess disease progression and response to therapy, though their routine use for monitoring is still debated.
• Echocardiography: Periodic echocardiograms to reassess LVEF, ventricular function, and valvular status, typically performed annually or as clinically indicated.

Consistent monitoring allows for timely adjustments in treatment plans and interventions, contributing to improved outcomes and better management of the heart failure nursing diagnosis.

Coordination of Care for Heart Failure

Effective management of heart failure requires a multidisciplinary approach involving a team of healthcare professionals. Coordination of care is paramount for optimizing patient outcomes and involves:

• Interprofessional Team: Collaboration among primary care physicians, cardiologists, emergency department physicians, radiologists, cardiac nurses, internists, cardiac surgeons, pharmacists, dietitians, and social workers.
• Treatment of Underlying Causes: Addressing and managing the underlying conditions contributing to heart failure, such as hypertension, CAD, valvular disease, or diabetes.
• Guideline-Directed Medical Therapy (GDMT): Healthcare providers must be knowledgeable about current heart failure guidelines and ensure patients receive evidence-based treatments.
• Risk Factor Modification: Aggressive management of modifiable risk factors, including smoking cessation, weight management, blood pressure control, diabetes management, and lipid management.
• Patient Education: Nurses play a central role in educating patients and families about medication management, lifestyle modifications, self-monitoring, and when to seek help.
• Medication Compliance: Strategies to improve patient adherence to prescribed medications, including education, simplification of regimens, and addressing barriers to compliance.
• Lifestyle Modifications: Education and support for adopting heart-healthy lifestyles, including dietary sodium and fluid restriction, regular exercise, and smoking cessation.
• Home Health and Community Resources: Utilizing home health services for monitoring and support in the home setting. Connecting patients with community resources, such as support groups and cardiac rehabilitation programs.
• Regular Follow-up: Ensuring patients have regular follow-up appointments with their healthcare providers to monitor their condition and adjust treatment as needed.

Effective coordination of care ensures a holistic and patient-centered approach, improving patient outcomes, reducing hospital readmissions, and enhancing quality of life. This interdisciplinary strategy is crucial for successful management of heart failure nursing diagnosis and care.

Health Teaching and Health Promotion for Heart Failure

Patient education is a cornerstone of heart failure management. Comprehensive health teaching and health promotion are essential to empower patients to actively participate in their care and improve their outcomes. Key areas for patient education include:

• Medication Management:

  • Detailed explanation of each medication, including its purpose, dosage, timing, and potential side effects.
  • Importance of taking medications as prescribed and not stopping or changing doses without consulting their healthcare provider.
  • Strategies for managing side effects and when to report them.
  • Use of medication organizers or reminder systems to enhance compliance.

• Dietary Sodium Restriction:

  • Importance of limiting sodium intake to 2-3 grams per day.
  • Guidance on reading food labels and identifying high-sodium foods.
  • Tips for low-sodium cooking and meal planning.
  • Resources for low-sodium recipes and meal ideas.

• Fluid Restriction:

  • If prescribed, education on limiting daily fluid intake to 2 liters or as specified by their healthcare provider.
  • Strategies for managing thirst and adhering to fluid restrictions.
  • Understanding which beverages count towards fluid intake.

• Daily Weight Monitoring:

  • How to properly weigh themselves daily at the same time, using the same scale, and wearing similar clothing.
  • Importance of recording daily weights and recognizing significant weight changes.
  • When and how to report weight changes to their healthcare provider.

• Symptom Recognition and Self-Monitoring:

  • Education on recognizing worsening heart failure symptoms, such as increased shortness of breath, edema, fatigue, or cough.
  • Instructions on monitoring symptoms and keeping a symptom diary.
  • When and how to seek prompt medical attention for worsening symptoms.

• Lifestyle Modifications:

  • Importance of regular, moderate physical activity as tolerated.
  • Smoking cessation counseling and resources.
  • Alcohol moderation or abstinence, as advised by their healthcare provider.
  • Stress management techniques.
  • Importance of sleep apnea treatment if diagnosed.

• Risk Factor Management:

  • Education on managing underlying risk factors such as diabetes, hypertension, obesity, and hyperlipidemia.
  • Encouragement to adhere to treatment plans for these conditions.

Effective health teaching and health promotion not only improve patient compliance and self-management skills but also contribute to reduced hospital readmissions and improved quality of life. This patient-centered approach is integral to successful heart failure nursing diagnosis and long-term management.

Discharge Planning for Heart Failure Patients

Discharge planning is a critical phase in the care continuum for patients with heart failure. Effective discharge planning ensures a smooth transition from hospital to home and reduces the risk of readmission. Key components of discharge planning include:

• Medication Reconciliation and Education:

  • Review of all discharge medications, ensuring the patient and family understand each medication’s purpose, dosage, frequency, and potential side effects.
  • Providing a written medication list and schedule.
  • Verifying that patients have prescriptions filled and understand how to obtain refills.

• Dietary and Fluid Restriction Reinforcement:

  • Reviewing dietary sodium and fluid restrictions.
  • Providing written dietary guidelines and resources.
  • Addressing any questions or concerns about dietary modifications.

• Activity and Exercise Recommendations:

  • Providing clear guidelines on recommended activity levels and exercise.
  • Advising on gradual resumption of activities and avoiding overexertion.
  • Referring to cardiac rehabilitation programs if appropriate.

• Smoking Cessation Support:

  • Offering continued support and resources for smoking cessation.
  • Referrals to smoking cessation programs or counseling.

• Symptom Monitoring and Action Plan:

  • Reinforcing education on recognizing worsening heart failure symptoms.
  • Providing a written action plan outlining what to do if symptoms worsen, including contact information for healthcare providers and when to seek emergency care.

• Follow-up Appointments:

  • Scheduling follow-up appointments with primary care physicians and cardiologists.
  • Ensuring patients understand the importance of follow-up care and have appointment information.

• Home Health Referral:

  • Arranging for home health nursing visits for patients who require ongoing monitoring, medication management, or support at home.

• Community Resources:

  • Connecting patients with community resources, such as support groups, heart failure associations, and local services.

• Psychosocial Support:

  • Assessing psychosocial needs and providing referrals for counseling or support services if needed.

Nurse-driven education at discharge has been shown to significantly improve medication compliance and patient outcomes in heart failure. Comprehensive discharge planning is essential for ensuring patients are well-prepared to manage their condition at home, thereby improving their long-term health and reducing hospital readmissions. This thorough approach underscores the importance of effective heart failure nursing diagnosis and continuous care management.

Conclusion

Heart failure is a complex and chronic condition requiring comprehensive and coordinated care. Accurate heart failure nursing diagnosis is the foundation for effective nursing interventions and patient management. By understanding the pathophysiology, causes, risk factors, assessment findings, and management strategies outlined in this guide, nurses can play a pivotal role in improving the lives of patients with heart failure. Through patient education, symptom management, medication adherence promotion, and coordinated care, nurses contribute significantly to enhancing patient outcomes, reducing hospitalizations, and improving the quality of life for individuals living with heart failure. The focus on continuous learning and adaptation of care strategies is essential in this ever-evolving field of healthcare.

References

1.Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW., ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 03;145(18):e895-e1032. [PubMed: 35363499]
2.Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016 Jun;13(6):368-78. [PMC free article: PMC4868779] [PubMed: 26935038]
3.CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987 Jun 04;316(23):1429-35. [PubMed: 2883575]
4.Lind L, Ingelsson M, Sundstrom J, Ärnlöv J. Impact of risk factors for major cardiovascular diseases: a comparison of life-time observational and Mendelian randomisation findings. Open Heart. 2021 Sep;8(2) [PMC free article: PMC8438838] [PubMed: 34518286]
5.Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep. 2019 Nov 19;9(1):17022. [PMC free article: PMC6863880] [PubMed: 31745178]
6.Kim KH, Pereira NL. Genetics of Cardiomyopathy: Clinical and Mechanistic Implications for Heart Failure. Korean Circ J. 2021 Oct;51(10):797-836. [PMC free article: PMC8484993] [PubMed: 34327881]
7.Rezkalla SH, Kloner RA. Viral myocarditis: 1917-2020: From the Influenza A to the COVID-19 pandemics. Trends Cardiovasc Med. 2021 Apr;31(3):163-169. [PMC free article: PMC7965406] [PubMed: 33383171]
8.Muchtar E, Blauwet LA, Gertz MA. Restrictive Cardiomyopathy: Genetics, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy. Circ Res. 2017 Sep 15;121(7):819-837. [PubMed: 28912185]
9.Shams P, Ahmed I. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 30, 2023. Cardiac Amyloidosis. [PubMed: 35593829]
10.Brown KN, Pendela VS, Ahmed I, Diaz RR. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 30, 2023. Restrictive Cardiomyopathy. [PubMed: 30725919]
11.Matta AG, Carrié D. Epidemiology, Pathophysiology, Diagnosis, and Principles of Management of Takotsubo Cardiomyopathy: A Review. Med Sci Monit. 2023 Mar 06;29:e939020. [PMC free article: PMC9999670] [PubMed: 36872594]
12.Bairashevskaia AV, Belogubova SY, Kondratiuk MR, Rudnova DS, Sologova SS, Tereshkina OI, Avakyan EI. Update of Takotsubo cardiomyopathy: Present experience and outlook for the future. Int J Cardiol Heart Vasc. 2022 Apr;39:100990. [PMC free article: PMC8913320] [PubMed: 35281752]
13.Ahmad SA, Brito D, Khalid N, Ibrahim MA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 22, 2023. Takotsubo Cardiomyopathy. [PubMed: 28613549]
14.DeFilippis EM, Beale A, Martyn T, Agarwal A, Elkayam U, Lam CSP, Hsich E. Heart Failure Subtypes and Cardiomyopathies in Women. Circ Res. 2022 Feb 18;130(4):436-454. [PMC free article: PMC10361647] [PubMed: 35175847]
15.Wong CM, Hawkins NM, Jhund PS, MacDonald MR, Solomon SD, Granger CB, Yusuf S, Pfeffer MA, Swedberg K, Petrie MC, McMurray JJ. Clinical characteristics and outcomes of young and very young adults with heart failure: The CHARM programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity). J Am Coll Cardiol. 2013 Nov 12;62(20):1845-54. [PubMed: 23850914]
16.Sciomer S, Moscucci F, Salvioni E, Marchese G, Bussotti M, Corrà U, Piepoli MF. Role of gender, age and BMI in prognosis of heart failure. Eur J Prev Cardiol. 2020 Dec;27(2_suppl):46-51. [PMC free article: PMC7691623] [PubMed: 33238736]
17.Volpe M, Gallo G. Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC). Front Cardiovasc Med. 2023;10:1136340. [PMC free article: PMC10040794] [PubMed: 36993998]
18.Kim DY, Kim SH, Ryu KH. Tachycardia induced Cardiomyopathy. Korean Circ J. 2019 Sep;49(9):808-817. [PMC free article: PMC6713829] [PubMed: 31456374]
19.Anakwue RC, Onwubere BJ, Anisiuba BC, Ikeh VO, Mbah A, Ike SO. Congestive heart failure in subjects with thyrotoxicosis in a black community. Vasc Health Risk Manag. 2010 Aug 09;6:473-7. [PMC free article: PMC2922308] [PubMed: 20730063]
20.Schoenenberger AW, Schoenenberger-Berzins R, der Maur CA, Suter PM, Vergopoulos A, Erne P. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clin Res Cardiol. 2012 Mar;101(3):159-64. [PubMed: 22057652]
21.DiNicolantonio JJ, Liu J, O’Keefe JH. Thiamine and Cardiovascular Disease: A Literature Review. Prog Cardiovasc Dis. 2018 May-Jun;61(1):27-32. [PubMed: 29360523]
22.Reddy YNV, Melenovsky V, Redfield MM, Nishimura RA, Borlaug BA. High-Output Heart Failure: A 15-Year Experience. J Am Coll Cardiol. 2016 Aug 02;68(5):473-482. [PubMed: 27470455]
23.Chayanupatkul M, Liangpunsakul S. Cirrhotic cardiomyopathy: review of pathophysiology and treatment. Hepatol Int. 2014 Jul;8(3):308-15. [PMC free article: PMC4160726] [PubMed: 25221635]
24.Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW., American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020 Mar 03;141(9):e139-e596. [PubMed: 31992061]
25.Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993 Oct;22(4 Suppl A):6A-13A. [PubMed: 8376698]
26.Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P., American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017 Mar 07;135(10):e146-e603. [PMC free article: PMC5408160] [PubMed: 28122885]
27.Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, Brauer M, Kutty VR, Gupta R, Wielgosz A, AlHabib KF, Dans A, Lopez-Jaramillo P, Avezum A, Lanas F, Oguz A, Kruger IM, Diaz R, Yusoff K, Mony P, Chifamba J, Yeates K, Kelishadi R, Yusufali A, Khatib R, Rahman O, Zatonska K, Iqbal R, Wei L, Bo H, Rosengren A, Kaur M, Mohan V, Lear SA, Teo KK, Leong D, O’Donnell M, McKee M, Dagenais G. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020 Mar 07;395(10226):795-808. [PMC free article: PMC8006904] [PubMed: 31492503]
28.Opie LH, Commerford PJ, Gersh BJ, Pfeffer MA. Controversies in ventricular remodelling. Lancet. 2006 Jan 28;367(9507):356-67. [PubMed: 16443044]
29.Kemp CD, Conte JV. The pathophysiology of heart failure. Cardiovasc Pathol. 2012 Sep-Oct;21(5):365-71. [PubMed: 22227365]
30.Ait Mou Y, Bollensdorff C, Cazorla O, Magdi Y, de Tombe PP. Exploring cardiac biophysical properties. Glob Cardiol Sci Pract. 2015;2015:10. [PMC free article: PMC4448074] [PubMed: 26779498]
31.Abassi Z, Khoury EE, Karram T, Aronson D. Edema formation in congestive heart failure and the underlying mechanisms. Front Cardiovasc Med. 2022;9:933215. [PMC free article: PMC9553007] [PubMed: 36237903]
32.Prausmüller S, Arfsten H, Spinka G, Freitag C, Bartko PE, Goliasch G, Strunk G, Pavo N, Hülsmann M. Plasma Neprilysin Displays No Relevant Association With Neurohumoral Activation in Chronic HFrEF. J Am Heart Assoc. 2020 Jun 02;9(11):e015071. [PMC free article: PMC7428996] [PubMed: 32427034]
33.Docherty KF, Vaduganathan M, Solomon SD, McMurray JJV. Sacubitril/Valsartan: Neprilysin Inhibition 5 Years After PARADIGM-HF. JACC Heart Fail. 2020 Oct;8(10):800-810. [PMC free article: PMC8837825] [PubMed: 33004114]
34.Obokata M, Reddy YNV, Borlaug BA. Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: Understanding Mechanisms by Using Noninvasive Methods. JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 2):245-257. [PMC free article: PMC6899218] [PubMed: 31202759]
35.Kao DP, Lewsey JD, Anand IS, Massie BM, Zile MR, Carson PE, McKelvie RS, Komajda M, McMurray JJ, Lindenfeld J. Characterization of subgroups of heart failure patients with preserved ejection fraction with possible implications for prognosis and treatment response. Eur J Heart Fail. 2015 Sep;17(9):925-35. [PMC free article: PMC4654630] [PubMed: 26250359]
36.Harjola VP, Mullens W, Banaszewski M, Bauersachs J, Brunner-La Rocca HP, Chioncel O, Collins SP, Doehner W, Filippatos GS, Flammer AJ, Fuhrmann V, Lainscak M, Lassus J, Legrand M, Masip J, Mueller C, Papp Z, Parissis J, Platz E, Rudiger A, Ruschitzka F, Schäfer A, Seferovic PM, Skouri H, Yilmaz MB, Mebazaa A. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail. 2017 Jul;19(7):821-836. [PMC free article: PMC5734941] [PubMed: 28560717]
37.King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam Physician. 2012 Jun 15;85(12):1161-8. [PubMed: 22962896]
38.Ali AS, Rybicki BA, Alam M, Wulbrecht N, Richer-Cornish K, Khaja F, Sabbah HN, Goldstein S. Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J. 1999 Dec;138(6 Pt 1):1133-9. [PubMed: 10577445]
39.Klein L, O’Connor CM, Leimberger JD, Gattis-Stough W, Piña IL, Felker GM, Adams KF, Califf RM, Gheorghiade M., OPTIME-CHF Investigators. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation. 2005 May 17;111(19):2454-60. [PubMed: 15867182]
40.Kelder JC, Cramer MJ, van Wijngaarden J, van Tooren R, Mosterd A, Moons KG, Lammers JW, Cowie MR, Grobbee DE, Hoes AW. The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure. Circulation. 2011 Dec 20;124(25):2865-73. [PubMed: 22104551]
41.Rørth R, Jhund PS, Yilmaz MB, Kristensen SL, Welsh P, Desai AS, Køber L, Prescott MF, Rouleau JL, Solomon SD, Swedberg K, Zile MR, Packer M, McMurray JJV. Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail. 2020 Feb;13(2):e006541. [PubMed: 32065760]
42.Hacker M, Hoyer X, Kupzyk S, La Fougere C, Kois J, Stempfle HU, Tiling R, Hahn K, Störk S. Clinical validation of the gated blood pool SPECT QBS processing software in congestive heart failure patients: correlation with MUGA, first-pass RNV and 2D-echocardiography. Int J Cardiovasc Imaging. 2006 Jun-Aug;22(3-4):407-16. [PubMed: 16328851]
43.Jain S, Londono FJ, Segers P, Gillebert TC, De Buyzere M, Chirinos JA. MRI Assessment of Diastolic and Systolic Intraventricular Pressure Gradients in Heart Failure. Curr Heart Fail Rep. 2016 Feb;13(1):37-46. [PubMed: 26780916]
44.Cahill TJ, Ashrafian H, Watkins H. Genetic cardiomyopathies causing heart failure. Circ Res. 2013 Aug 30;113(6):660-75. [PubMed: 23989711]
45.Peterson PN, Rumsfeld JS, Liang L, Albert NM, Hernandez AF, Peterson ED, Fonarow GC, Masoudi FA., American Heart Association Get With the Guidelines-Heart Failure Program. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program. Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):25-32. [PubMed: 20123668]
46.Lam CSP, Mulder H, Lopatin Y, Vazquez-Tanus JB, Siu D, Ezekowitz J, Pieske B, O’Connor CM, Roessig L, Patel MJ, Anstrom KJ, Hernandez AF, Armstrong PW., VICTORIA Study Group. Blood Pressure and Safety Events With Vericiguat in the VICTORIA Trial. J Am Heart Assoc. 2021 Nov 16;10(22):e021094. [PMC free article: PMC8751950] [PubMed: 34743540]
47.Armstrong PW, Pieske B, Anstrom KJ, Ezekowitz J, Hernandez AF, Butler J, Lam CSP, Ponikowski P, Voors AA, Jia G, McNulty SE, Patel MJ, Roessig L, Koglin J, O’Connor CM., VICTORIA Study Group. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020 May 14;382(20):1883-1893. [PubMed: 32222134]
48.Lucas C, Johnson W, Hamilton MA, Fonarow GC, Woo MA, Flavell CM, Creaser JA, Stevenson LW. Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure. Am Heart J. 2000 Dec;140(6):840-7. [PubMed: 11099986]
49.Rider I, Sorensen M, Brady WJ, Gottlieb M, Benson S, Koyfman A, Long B. Disposition of acute decompensated heart failure from the emergency department: An evidence-based review. Am J Emerg Med. 2021 Dec;50:459-465. [PubMed: 34500232]