GUIDE TO SAFE HEART FAILURE HOSPITAL DISCHARGE
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. Heart failure is progressive and can periodically worsen causing symptoms to become severe and sometimes require hospitalization to treat. During the hospital stay you will get medical treatment to stabilize your heart function and relieve symptoms. Typically, a stay of 4-5 days is normal but other problems or complications may lengthen your stay. Discharge from the hospital doesn’t mean you’re completely out of the woods. You have to be very careful during the days and weeks after discharge to be sure nothing happens that will send you back to the hospital. This quick guide supplements your discharge instructions and will help you avoid readmission.
What to Expect at Home
Hospitalization affects everybody differently. Things may not be as you expect when you get home. You will likely feel very tired and weakened. Your energy will slowly return. But you may need help taking care of yourself when you first get home. You may feel sad or depressed. All of these things are normal.
Monitoring Your Health at Home
Weigh yourself every morning on the same scale when you get up — before you eat but after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it. You can get a discharge daily log here.
Throughout the day, take the HealthCheck and rate on a scale of 1-3:
(1) No-I feel fine
- Is my energy level lower than normal?
- Do I get more short of breath when I am doing my everyday activities?
- Are my clothes or shoes feeling tight?
- Are my ankles or legs swelling?
- Am I coughing more often? Does my cough sound wet?
- Do I get short of breath at night or when I lie down?
Any answer of (2) or (3) should be logged in you CHFCare log and and if not better the following day then contact your CHFCare Team.
Diet and Fluids
Hospital food is getting better than it used to be, somewhat. Your tastes and feelings about food may be different when you get home. Hospital food tastes and (looks) the way it does because every single component of it is controlled depending on what your hospital doctor ordered. When you get home the foods you eat won’t taste the same initially but over a few days you will return to normal. The key dietary issues when you get home are salt and fluids. You have to be very careful because these too were tightly controlled in the hospital.
DO’s and DON’Ts
- DO limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.
- DON’T add any table salt to anything you eat-all your salt should be cooked in food and not added raw at the table
- DO eat a moderate amount of salt-your taste buds will tell you-if it tastes salty it probably has too much salt and should be avoided.
- DO realize that processed foods have a lot of salt and may not taste salty at all and should be limited in your diet
- DO take your diuretic, or water pill as prescribed.
- DON’T drink alcohol if you were just hospitalized for heart failure. Alcohol makes it harder for your heart muscles to work.
- DO stop smoking.
- DON’T let anybody smoke in your home or around you when you’re in public
- DO avoid fatty foods.
- DO stay away from fast-food restaurants.
- DO avoid high-sodium prepared and frozen foods.
- DO enjoy the pleasure of a good meal because it reduces stress, especially when shared with friends and family
When you’re leaving the hospital after treatment for heart failure you will be started on new medications or the dosages of your old medications may have changed. DO NOT take any of your old medications when you get home. Your discharge instructions should clearly tell you which medications are new, have changed, or which should be stopped. If they don’t please ASK your CHFCare MD or Nurse Practitioner. NEVER assume. If you’re not certain, please ASK-we don’t mind.
DO’s and DON’Ts
- DO have your entire drug prescriptions filled before you go home.
- DON’T take any other drugs or herbs without asking your provider about them first.
- DO take your drugs with only water.
- DO NOT take any medicine with grapefruit juice because your body reacts as if you are taking a second medicine. Grapefruit juice may cause you to get more or less of any medicine you take with it.
Even a short hospital stay can result in deconditioning and loss of strength and vigor. You may be referred to cardiac rehabilitation either at home or for a short stay in a facility. It is important to follow through on this recommendation because return to adequate physical activity will help prevent returning to the hospital.
DO’s and DON’Ts
- DO make sure your home is set up to be safe and easy for you for you to move around in and avoid falls .
- DO some physical activity every day-no matter how small, every little bit helps.
- DO make sure you avoid heavy lifting.
- DO pace yourself and gradually return to normal level of activity.
- DO make sure you know the warning signs of worsening heart failure and of a heart attack.
- DO ask your provider before starting sexual activity again.
- DON’T take sildenafil (Viagra), or vardenafil (Levitra), tadalafil (Cialis), or any herbal remedy for erection problems without checking with your CHFCare provider first because they may react with your medications and increase risk.
If you are unable to walk around very much, ask your provider for exercises you can do while you are sitting.
A heart failure hospitalization is a very serious life event and changes the nature of your heart failure. One hospitalization puts you at increased risk for another hospitalization, especially within the first 2-3 weeks after you are discharged. This is why it is very important to make sure you have a follow up visit with BOTH your primary care provider AND your CHFCare provider within 1-2 weeks of discharge. Research has shown that follow up visits after discharge prevent readmission to the hospital.
DO’s and DON’Ts
- DO ask before discharge if your primary care doctor is aware of your hospitalization and if an appointment has been made
- DO ask if your CHFCare follow up appointment has been made
- DO confirm your follow up appointments yourself 1-2 days after discharge
- DO answer the phone the hospital or your provider’s office call to see how you are doing and to make sure you are checking your weight and taking your medicines.
- DO get any lab tests or other diagnostic studies your hospital doctor ordered. You will likely need to have certain lab tests to check your sodium and potassium levels and monitor how your kidneys are working.
- DO bring your medication bottles and not just a list with you to your discharge follow up appointments
- DO bring any discharge papers you were given with you to your follow up appointment
When to Call the Doctor
You should feel free to call your primary care provider or CHFCare if you have any concerns or questions. But definitely call your if:
- You gain more than 2 pounds (lb) (1 kilogram, kg) in a day, or 5 lb (2 kg) in a week.
- You are more tired and weak.
- You are dizzy and lightheaded.
- You are more short of breath when you are doing your normal activities.
- You have new shortness of breath when you are sitting.
- You need to sit up or use more pillows at night because you are short of breath when you are lying down.
- You wake up 1 to 2 hours after falling asleep because you are short of breath.
- You are wheezing and having trouble breathing.
- You feel pain or pressure in your chest.
- You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
- You have swelling in your feet, ankles or legs.
- You have to urinate a lot, particularly at night.
- You have stomach pain and tenderness.
- You have symptoms that you think may be from your medicines.
- Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.
The first few days and weeks after discharge are the toughest and when you are most vulnerable to returning to the hospital. Staying on course means taking medications and keeping in touch with you CHFCare Team.