What lifestyle modifications should I recommend to patients with chronic heart failure to improve their quality of life?

To improve the quality of life for patients with chronic heart failure, you should recommend several lifestyle modifications:

• Exercise and Physical Activity:
  • Offer a personalised, supervised exercise-based cardiac rehabilitation programme, provided the patient's condition is stable ¹,². This programme should include psychological and educational components ¹,². Exercise-based rehabilitation can improve functional capacity and perceived quality of life, and reduce hospital admissions ¹.
  • Advise patients to undertake regular physical activity sufficient to increase their exercise capacity, aiming for 20 to 30 minutes a day to the point of slight breathlessness, increasing gradually ³.
  • Caution against exercise in water for people with New York Heart Association class III and IV heart failure, as water immersion can create enhanced preload associated with abnormal cardiac responses ¹.
• Diet and Weight Management:
  • Advise patients to eat healthily and maintain a healthy weight ¹.
  • Assess their nutritional status at clinical review ¹. If their body mass index (BMI) is under 18.5 kg/m², consider referring them for dietetic advice ¹. If their BMI is over 30 kg/m², provide advice on achieving a healthy weight ¹.
  • Recommend a Mediterranean-style diet, which includes more bread, fruit, vegetables, and fish, less meat, and replacing butter and cheese with products based on plant oils ³.
  • Offer individual consultations to discuss diet and provide tailored advice ³.
• Psychological Well-being and Support:
  • Screen for depression and anxiety, as depression is common in heart failure and associated with worse clinical status and poor prognosis ¹. If depression co-exists, treatment should consider the potential risks and benefits of drug therapy ¹.
  • Ensure patients are offered personalised information, education, support, and opportunities for discussion throughout their care to help them understand their condition and be involved in their management ¹. This includes understanding the cause of heart failure, why symptoms occur, important prognostic factors, and the indications, dosing, and effects of their medications ¹.
• Other Important Considerations:
  • Reassure patients with stable heart failure that they can undertake normal sexual activity that does not provoke undue symptoms ¹.
  • Ensure patients are offered an annual influenza vaccine and a once-only pneumococcal vaccination ¹.
  • Provide general information regarding driving regulations and travel advice ¹.