Anatomy and blood flow from the body through the heart are described with the use of animation. Understanding basic anatomy aids the clinician in understanding signs and symptoms associated with heart failure (HF).

The definition, scope, and stages of HF are explored in this chapter. Systolic HF (HF with reduced ejection fraction) and diastolic HF (HF with preserved ejection fraction) are defined.

Any reduction in cardiac output is met by a series of compensatory mechanisms to maintain circulation. Responses by the sympathetic nervous system and the renin-angiotensin-aldosterone system are explained in this chapter.

Critical to systolic HF is treatment with medications that counteract the sympathetic nervous system and the renin-angiotensin-aldosterone system The medication classes of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor blocker-neprilysin inhibitors, and aldosterone antagonists are covered in this chapter, including important aspects of monitoring for adverse reactions.

Other medications, including diuretics and digoxin, are addressed in this chapter. Current recommendations for the management of patients with diastolic HF is also included.

Adherence to medications is essential in management of HF and reducing the risk for disease exacerbation and hospitalizations. Medication reconciliation and overall medication management strategies are addressed in this chapter.

While most patients will present with biventricular failure, it is helpful to examine the differences between the signs and symptoms of right- versus left-sided failure in the context of the weakening heart.

A comprehensive clinical assessment for signs/symptoms of worsening HF is essential. Vital signs, weight, and cardiopulmonary assessment are addressed. The importance of assessment of the impact of the disease on the patient and family is also emphasized.

Telemonitoring, including monitoring systems, video visits, and simple telephone follow-up calls, allow for assessment of key parameters such as weight and vital signs. Early detection of changes in condition and subsequent adjustments in treatment can reduce the risk for hospitalizations.

Exacerbation prevention strategies are described in this chapter. Good self-care begins with helping patients to monitor their symptoms. Weight monitoring and dietary guidelines are addressed along with medication management and general wellness recommendations.

Signs and symptoms of worsening HF that may be potentially managed in the home are differentiated from those that indicate the need for emergent care. The identification of medication side effects such as overdiuresis, hypotension, and cough are also highlighted.

Potential home medical management of worsening HF and medication issues is covered in this chapter. In addition to treatment, exploring factors with the patient that potentially contribute to symptoms is important to exacerbations.

This chapter will provide strategies for behavior modification and ways to facilitate patient buy-in for lifestyle changes in order to self-manage heart failure. Patients require education and guidance to make necessary changes. Therapists are equipped to assess patients and be the facilitators of needed changes.

Patients require assessment of vitals before and after activity to ensure there are no signs of decompensation and that the patient can tolerate the treatment. This chapter will discuss the difference between absolute and relative stability, as well as how to determine a cardiopulmonary baseline of the patient.

Research has shown that muscles require the correct amount of stimulus to get stronger and that without the overload, patients will not improve. This chapter will focus on the components of a multimodal exercise prescription and tools to use to determine the dose of exercise that is tailored to heart failure patients.

Heart failure patients demonstrate a lack of knowledge about successfully managing their disease. This chapter will reveal what information is lacking, why it’s missing, and ways patients ineffectively compensate, leading to a downward spiral to rehospitalizations. It will also provide methods to change the trajectory and promote independence.

Heart failure is not an isolated disease but one that has multiple causes and is coupled with other diseases. This medical complexity leads to multiple providers, medications, and symptoms, leaving the patient confused and overwhelmed. This chapter will discuss specific medical factors and provide a method to aid the patient in self-managing these barriers.

With the burdens of daily life and caring for an ill family member, caregivers can be overwhelmed with all the responsibilities. When adding the inadequacies of healthcare due to shortages and lack of good teaching skills, patients lack the support needed to be successful. This chapter will provide reasons for and interventions to address the social support and healthcare barriers.

Motivational interviewing (MI) is a complex communication technique that has a significant effect on self-management abilities for patients with heart failure. Understanding of the concepts of MI will provide clinicians with a basis to implement the techniques. This chapter will provide an overview of the concepts of MI, primarily the OARS technique.

Motivational interviewing effectively improves the self-management behaviors in patients with heart failure when compared with traditional health education. This chapter will show the contrast between MI and a conventional approach in the following areas: closed- versus open-ended questions, a provider-specific plan versus a patient-specific plan, a rigid plan versus a flexible plan, and a general versus focused follow-up.

Heart failure patients are required to follow a medication protocol, prescribed diet, and physical activity program. According to research, these patients demonstrate low self-care behaviors and implementing motivational interviewing methods with heart failure patients can improve a patient’s ability to self-manage. This course will provide examples of MI questions and potential conversations specific to areas of concern for heart failure patients.