Tasks and points of attention for the pharmacy during the outpatient follow-up of a heart failure patient

Who to monitor as a patient with heart failure?

Known diagnosis of heart failure, possibly mentioned on the medication list.
Chronic use of a loop diuretic (furosemide, Lasix 40 mg = bumetanide , Burinex 1 mg per day or more) or specific treatment for heart failure (Entresto , Procoralan , etc.)

The recommended treatment and targets are different for HFrEF, HFmrEF and HFpEF. These are summarized in the table below.

Why? Read also : Prognostic benefits of the treatments.

In case of symptoms suspected of heart failure (shortness of breath during exercise or when lying down, swelling of the lower legs, etc.): refer the patient to a doctor.
In patients with known heart failure: recognizing symptoms and warning signs and refer to the doctor if need. Symptoms of cardiac decompensation, dehydration, hypotension?

Blood pressure, heart rate.
Sale and explanation of the use of a blood pressure monitor. Asymptomatic hypotension > 90 mmHg does not always require a dose reduction!

Review the most recent medication list, paying attention to recent adjustments (for example, during a recent hospitalization or consultation with the cardiologist).
Avoidance of delivery and/or taking medications to avoid: NSAIDs, effervescent tablets, etc.
Attention for any clinically relevant drug interactions.
Ensure continuity of the medication and, if necessary, offer a correct alternative in the event of a medication being out of stock, if needed in consultation with the doctor.

Salt restriction
Fluid restriction
- Limit to a maximum of 1.5 to 2 liters per day and drink according to thirst (especially if the patient must take a diuretic daily).
- In hot weather, additional fluid intake is allowed (provided that weight does not increase).
- In cases of severe diarrhoea or vomiting or very hot weather, diuretic intake may need to be reduced or discontinued in consultation with the doctor or heart failure nurse. After improvement, timely restarting or increasing these diuretics should also be discussed.
Encourage a healthy lifestyle:
- No smoking. Assistance from a tobacco specialist if necessary.
- Healthy and balanced diet.
- Exercise daily. Any effort that does not cause chest pain or shortness of breath is allowed. Discuss any physiotherapy or additional aids (walker, etc.) if needed.
- Limit alcohol (not daily, max. 1 drink per day). Alcohol can be toxic to the heart muscle.
- Raise awareness of vaccinations: flu, pneumococcus, COVID.