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Heart Failure Self-Management

by Sandra Keavey, DHSc, DFAAPA, PA-C

Heart failure is a common condition. There are 5.8 million Americans living with heart failure. Heart failure is the leading cause of hospitalizations. As in most chronic conditions the patient has actions they can take to manage their condition at home. The goal is to decrease exacerbations and hospitalizations.

The medical management of these patients is complex. Each patient should have a Heart Failure Action Plan created by their health care provider. It is a systematic approach to evaluate the current status and respond accordingly.

The first step is to monitor how they are feeling. If they are in the green zone they will not that they breathing normally, not fatigued, have no ankle swelling, weight gain or chest pain. Responses in the green zone indicate the patient should continue their usual medication, follow a low-salt diet, keep a weight and blood pressure diary.

If their assessment response is the use of extra pillows, coughing more, dyspnea on exertion, increased ankle swelling or a weight gain of 2-3 pounds overnight or 5 pounds in the past week the patient is in the yellow zone. If this is the case, the patient should call their doctor’s office to discuss what adjustments to their medications are necessary.

The orange zone is a definite escalation of symptoms. Self-assessment indicates dyspnea at rest, persistent coughing, wheezing or chest tightness, paroxysmal nocturnal dyspnea, feelings of dizziness, light-headedness, or overwhelming fatigue. These responses should prompt a call and visit their doctor’s office that day.

When the patient feels persistently short of breath, is coughing up frothy sputum, has chest pain or pressure, is having a fast or irregular heart rhythm, feeling lightheaded or faints they are in the red zone. These patients should present to the emergency department or call 9-1-1.

Sample action plans are available from American Heart Association or can be searched for on Google. Action plans provide a mechanism to discuss with a patient who has heart failure chronic to manage their disease.


See Sandra Keavey, DHSc, DFAAPA, PA-C speak in 2018 at a Skin, Bones, Hearts & Private Parts event in Phoenix/Scottsdale, Myrtle Beach, Pensacola Beach, or Las Vegas.