MANAGEMENT OF HEART-FAILURE .2. COUNSELING, EDUCATION, AND LIFE-STYLE MODIFICATIONS

Objective-This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction. Data Sources.-We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. Study Selection and Data Synthesis.-Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, <0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes leg, hemodynamics) were not reviewed. Conclusion.-Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.