Self Monitoring and Heart Failure

If you have heart failure (HF) and have been treated for it with medications, surgical procedures or medical devices, chances are you have been given instructions on how to manage your care at home. HF is a common reason for hospitalization, hospital readmission, and death worldwide.¹ Heart failure, a chronic condition, requires long term lifestyle management. This includes diet and weight management, fluid intake and blood pressure monitoring, a program for physical activity and a strict medication regimen.^1-3

Many people who manage their heart failure condition well do a good job of routinely monitoring their condition. Self-reported information can lead to early intervention in cases of worsening HF.^1,3 Knowing what information to monitor and what kinds of changes to note are important educational tools that should be shared between you and your healthcare team. Good self-monitoring can benefit your overall health and enhance quality of life.²

Self-monitoring at home

The American Heart Association recommends regular monitoring for everyone with high blood pressure and other cardiac conditions to help provide information that can enhance a provider’s determination of whether HF treatments are effective.⁴ Also called home monitoring, tracking your blood pressure, medications, weight, fluid intake and other measurements of treatment compliance can help providers to manage your overall health and response to treatment.

What should I monitor?

• Escalation of HF symptoms
• Medication tracking
• Blood Pressure
• Exercise
• Daily weight
• Diet
• Sodium, fat, and fluid intake
• Breathing difficulty
• Smoking
• Changes in mental health

Monitoring can be complex. HF treatment can involve significant lifestyle changes requiring adjustments to many aspects of life.² For example, people with heart failure often take multiple medications taken multiple times a day.¹ Developing a tracking system to be sure you take all of your medications as prescribed can be a helpful reminder not to skip a dose. For example, some patients use pill boxes, phone alarms, medication calendars, or a combination of all three. Noting any changes to your diet can be helpful especially if you are instructed to restrict fluids and salt intake.^2-3

One tip is to monitor your daily weight.^2-3 Weighing yourself at the same time each day wearing the same clothes and on the same scale can help you evaluate any sudden changes due to fluid retention. For example, try weighing yourself first thing every morning after you go to the bathroom.

Just like weighing yourself, taking blood pressure readings at the same time each day is another important measurement to monitor.^2,4 Most doctors recommend an automatic, cuff-style, bicep (upper-arm) monitor.⁴ Use the monitor to take your blood pressure twice a day or as directed by your health care team. Take 2 or 3 readings to be sure you are doing it correctly each time.⁴ Log your results and follow your doctor’s instructions about what to do if your blood pressure changes.

Reporting these and other changes to your health care team may help identify early warning signs of heart failure decline. Treating heart failure is most effective when there are collaboration and communication between patients and providers.² Treatment decisions may be modified based on clinical change noted in part by self-monitoring.^1-2

How should I monitor

People choose different ways to collect and report their information. Some people journal, either keeping a paper or online narrative of the information they are tracking. There are medication checklists, symptom trackers, and almost everything you need is available on paper and in an app.² Whatever method you choose needs to be comfortable for you or your caregivers.

When should I call a doctor

Although keeping a daily record can feel time-consuming and even annoying, tracking your routine and your results can help you notice small but meaningful changes. When monitoring how well you are complying with diet and exercise recommendations, medications and blood pressure checks, you are more likely to actively engage with your healthcare team.

Always bring your records to your medical visits. The information you share with your providers can offer a more complete picture of how you are doing under varying circumstances. This can help them to evaluate medication effectiveness and to potentially modify medications and behavior in response to your reported symptoms. Remember, only your healthcare team can prescribe changes to your treatment plan.² Even if you feel well or your numbers are good, don’t stop taking your medications or change your diet or return to bad habits like smoking or drinking too much alcohol.³ If you are doing well it means your treatment is effective.

The importance of teamwork

Good heart failure care requires often complex therapeutic regimens. Heart failure literature emphasizes strategies for educating patients about managing chronic heart failure. Self-monitoring can be complex, and many find compliance difficult. If you have questions, talk with your healthcare team. With education and professional support, you can achieve significant benefits from good self-care, monitoring, and reporting.^2-3