Your treatment plan may include several medications to manage symptoms. It’s important to know what each one does and to take them as directed every day.

• Set up a system. You could use a pill box with color-coded sections for different times of day.
• Ask people close to you to remind you, or set alarms on your phone.
• Put a reminder note on your medicine cabinet or refrigerator.
• Don’t skip doses, even when you feel good.
• Keep a list or save pictures of your pill bottles on your phone to help you track and refill prescriptions.
• Use a medication tracker like this one from the American Heart Association.
• If you have a side effect that you think might be related to your prescriptions, talk to your heart care team. Don’t stop taking the medication until you’ve discussed it with your provider.

When you have heart failure, it’s important to control how much salt, or sodium, you get each day. Too much salt can make your body act like a sponge, holding water that causes your legs to swell and fluid to collect in your lungs. This makes your heart work harder.

Many foods contain a lot of salt, even if they don’t taste salty. You may need to get used to eating differently. You can still prepare tasty meals, though. Our My Heart-Healthy Plate guide is a good place to start.

Your heart care team will help you understand how much salt is OK. Here’s how to track it:

• Aim to consume no more than a teaspoon a day, including from packaged foods and salt you add when cooking. If you eat three times a day, each meal should have no more than 500 to 1,000 mg of salt.

• Read food labels. Choose foods with less than 140 mg of sodium per serving, and be mindful of portion size. If you eat two servings, you’ll consume twice as much salt.
• Watch for salt sneaking into your diet. Common foods — bread, soup, salad dressing and cheese, for example — have more sodium than you might think. Others — such as cold cuts, takeout, frozen dinners and fast food — are almost always high in salt.
• Swap high-salt foods for items made without salt or for food labeled “low sodium” or “no salt added.”
• Replace salt with spices such as pepper, ginger, garlic, turmeric, cumin and oregano, or with a salt substitute such as Dash.
• If you’re eating at a restaurant or getting fast-food, make heart-healthy choices. Avoid fried foods. Ask for no cheese or condiments. Choose smaller servings. Get low-sodium dressing for your salad. Ask your server if menu items can be made without salt.

If these changes feel like a lot, take it day by day. To get started, try the American Heart Association’s three-week plan to reduce sodium.

It’s important to control how much liquid you drink when you have heart failure. That’s because your body often retains water — holding onto more fluid than it can handle.

You may need to drink less to counteract water retention. Your heart care team may also prescribe a diuretic, or “water pill,” to help control fluid in your body.

You can take these steps to limit fluid intake:

• Aim to have no more than eight cups of liquid a day from all sources. Beverages and ice cubes count, of course, but so do high-moisture foods such as ice cream, fruit and vegetables.
• Avoid alcohol. Drinking can raise your blood pressure, making your heart work harder. Your heart care team may recommend stopping entirely or drinking only occasionally.
• If you feel thirsty, suck on ice chips or a lozenge to keep your mouth from getting dry.

Exercise is safe for people with heart failure. In fact, being active is one of the best ways to care for your heart.

If you don’t have an exercise routine, start slowly with an activity you enjoy, such as taking a walk. If you’re already active, talk to your heart care team about whether to modify your routine based on your condition.

If you get too tired, dizzy, sweaty or have any other discomfort during exercise, rest or slow down. If these symptoms continue after resting, let your doctor know.

Exercise types:

You might consider exercises such as the following. Other activities such as light housework and gardening may also may help you stay in shape.

• Walking
• Golfing
• Swimming or water aerobics
• Biking
• Yoga
• Dancing

Exercise benefits:

Being active can reduce your heart failure symptoms and help you enjoy life. Benefits of regular exercise include:

• Lower blood pressure
• Better circulation
• Lower cholesterol
• Increased energy and muscle strength
• Improved mood/lower stress
• Better sleep

It’s important to pace yourself when exercising with heart failure. Warm up before exercise and cool down afterward. During exercise, you should be able to carry on a conversation. If you can’t, slow down or take a break.

Rehabilitation program:

OHSU offers a cardiac rehabilitation program to help you learn about heart failure, exercise and other lifestyle changes under the supervision of our heart care experts. As you gain strength and confidence, you’ll be able to safely stick to a routine on your own.

Monitoring your weight is important with heart failure because it can help show if you’re retaining water. You can work with your heart care team to set a target weight, the weight at which you feel healthiest.

It’s best to weigh yourself at the same time every day, and to keep a log of the number.

• Use your own scale at home.
• Wear the same or similar clothes each time.
• Log your weight:
   
  • When you get up in the morning
  • After using the bathroom
  • Before you get dressed or eat breakfast

Your weight log will help your team develop a plan in case your weight changes quickly or you notice fluid buildup. This may include taking a diuretic or changing your diet.

Tobacco use such as smoking or vaping weakens your heart and lungs. It can also make heart failure worse. If you smoke, make a plan to quit. Your heart care team can help you find tools, including smoking-cessation programs, to help.

Secondhand smoke can also affect your heart and lungs. To lower your risk, avoid places where other people smoke.

Knowing you have heart failure can cause stress and depression. These are common — and manageable.

It’s important to address your feelings because stress and anxiety can raise your blood pressure, making your heart work harder. Depression can make you less motivated to make lifestyle changes, to stick to your medication schedule, or to stop smoking and drinking.

Talk with your heart care team if you feel anxious or depressed. They can suggest options to help you cope, such as:

• Spending time with supportive friends and family
• Taking up a hobby or activity you enjoy
• Doing mindful breathing exercises or meditation to quiet your mind
• Exercising — it’s a natural antidepressant
• Keeping a journal of how you feel
• Avoiding stressful settings or taking on too many responsibilities
• Joining a support group
• Seeing a mental health counselor
• Taking medication to help manage your moods

As you commit to self-managment, you’ll learn to listen to your body. If your symptoms get worse, you’ll be able to identify changes and get support quickly.

Regular follow-up visits with your heart care team will help you adjust your treatment plan to help you feel your best. Consider this list of questions to ask your doctor as you work together.

To track your daily symptoms, follow the American Heart Association’s self-management guide for heart failure. Its green, yellow and red zones can help you know:

• When to keep up the good work on diet and exercise
• When to contact your care team
• When to seek medical help right away

Living with a chronic (ongoing) illness is different for everyone. With some planning, you can make sure your treatment reflects your needs and values.

One tool to help clearly express your wishes is an advance care document. You can outline what you’d like to happen at stages of treatment if you become unable to say.

Advance care planning includes:

• Anticipating health care decisions you may have to make
• Understanding your options and deciding on preferences
• Discussing your goals with your family and your heart care team
• Detailing your plans in a document called an advance directive
• Updating the advance directive if your wishes change

Palliative care can also support you and your family. This is not the same as hospice care for the sickest patients. Palliative care services provide an extra layer of support for patients and families dealing with serious illness — at any stage of care.

OHSU’s expert palliative care providers are doctors, nurses, physician associates, chaplains and social workers. They specialize in helping you manage pain, emotional issues and details of your medical care, including advance care planning. Their goal is to improve quality of life for you and your family.

• Cardiac Rehabilitation Program
• Center for Preventive Cardiology
• OHSU patient and family services
• OHSU mindfulness class
• Mended Hearts support group at the Center for Women’s Health

• AHA Support Network
• WomenHeart
• Go Red for Women
• Mended Hearts

• Oregon Heart Failure Guide, OHSU and American Heart Association
• Heart Failure, American Heart Association
• Heart Failure Society of America Patient Hub
• CardioSmart, American College of Cardiology
• Heart Failure Patient Education Handout, Centers for Disease Control and Prevention

• Caregiver Support, American Heart Association
• Care for the Caregiver, American Association of Heart Failure Nurses
• Family Care Navigator, Family Caregiver Alliance