Background
Heart failure (HF) happens when the heart is not strong enough to pump the needed blood with oxygen to the rest of the body. The CDC estimated that 5.7 million people in the U.S. have heart failure. The incidence of congestive heart failure (CHF) varies among races and across age groups. It is the cause of 55,000 deaths each year (CDC, 2012). The lifetime risk for someone to have CHF is 1 in 5.
Risk Factors
The major risk factors for HF are diabetes and MI. African American males are at higher risk than Caucasians. The risk of CHF in older adults doubles for those with blood pressures over 160/90. Seventy-five percent of those with CHF also have hypertension (AHA, 2012). Congestive heart failure often occurs within 6 years after a heart attack.
Warning Signs
Signs and symptoms of heart failure include shortness of breath (that also worsens when lying down), weight gain with swelling in the legs/ankles, and general tiredness. It is essential that older adults diagnosed with HF recognize signs of a worsening condition and report them promptly to their healthcare provider. Older adults may not have the typical symptoms but complain of other things like decreased appetite, weight gain of a few pounds, or insomnia (Amella, 2004).
Diagnosis
For in-home monitoring, daily weights at the same time of day with the same clothes on the same scale are essential. The physician or primary care provider will give guidelines for the person to call if the weight exceeds his or her threshold for weight gain. This is usually between 1 and 3 pounds. The decision regarding when to call the primary care provider is made based upon the severity of the HF and the relative stability/frailty of the person.
Treatment
Treatment for HF involves the usual lifestyle modifications discussed for promoting a healthy heart, as well as several possible types of medications. These include ACE inhibitors, diuretics, vasodilators, beta-blockers, blood thinners, angiotensin II blockers, calcium channel blockers, and potassium. Lifestyle changes, per recommendation of the primary care provider, may include (AHA, 2009):
Maintaining an appropriate weight
Limiting salt intake
Limiting caffeine and alcohol intake
Managing stress
Getting adequate rest
Engaging in physical activity as prescribed
Quitting smoking
Eating a heart-healthy diet
To minimize exacerbations, patient and family counseling should include teaching about the use of medications to control symptoms and the importance of regular monitoring with a health care provider (Agency for Healthcare Research and Quality [AHRQ], 2012; Hunt et al., 2009). With the proper combination of treatments such as lifestyle changes and medications, many older persons can still live happy and productive lives with a diagnosis of heart failure and minimize their risk of complications related to this disease.
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Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.
