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Heart failure self management

Leora Horwitz, MD, MHS
Harlan Krumholz, MD
Section Editor
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Heart failure (HF) is one of the most common causes of hospitalization, hospital readmission, and death. Due to the complexity and long-term nature of HF regimens, the need for careful diet and weight management, and the importance of intervention in the early phases of decompensation, patient self-management is crucial in avoiding hospitalizations [1]. Unfortunately, many patients lack self-care skills [2,3].  

This topic will review evidence for the value of self-management and strategies for educating patients about self-management of HF. The medical management of HF and treatment for acute decompensation are discussed separately. (See "Overview of the therapy of heart failure with reduced ejection fraction" and "Treatment of acute decompensated heart failure: General considerations" and "Treatment of acute decompensated heart failure in acute coronary syndromes".) Strategies for avoiding hospitalization are also discussed separately. (See "Strategies to reduce hospitalizations in patients with heart failure".)


Approximately 5.8 million Americans are living with heart failure (HF) [4]. In 2006, the HF hospitalization rate was 22.9 per 1,000 for men over age 64 and 19.6 per 1000 for women over age 64 [5], making HF the leading cause of hospitalization in this age group [6]. Furthermore, 27 percent of those who are hospitalized once with HF are typically readmitted within 30 days [6].

Chronic HF care requires patients to follow complex medical regimens, comply with diet and exercise recommendations, actively engage with clinicians, and modify medications and behavior according to symptoms. This “self-care” is quite complex. Standard HF medical regimens often include at minimum three distinct classes of medications, some of which may be taken multiple times a day. In addition, patients are expected to restrict salt intake, monitor their weight daily, be able to identify early warning signs of deterioration, and adjust diuretic use according to clinical changes. Patients and caregivers may find these activities difficult to perform without education and support.

The consequences of inadequate self-care are profound. Inability to manage medications or diet may account for as many as one in five admissions for HF [7]. Conversely, improved self-management skills may reduce the odds of readmission at one year by 40 percent [1]. Thus, assisting patients to manage their own care is an essential component of chronic HF management.


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Literature review current through: Sep 2016. | This topic last updated: Oct 15, 2015.
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