The term “heart failure” is something of a misnomer. It makes it sound like the heart has stopped working, but that isn’t really the case. What congestive heart failure means is that the heart isn’t pumping efficiently enough to keep up with the body’s needs. “Heart inefficiency” might be a better term. With the proper treatment and lifestyle changes, many people with congestive heart failure can lead active lives for many years.

Understanding Congestive Heart Failure

A classification system devised by the American College of Cardiology and the American Heart Association categorizes congestive heart failure patients into four stages, from A (the person is at high risk for developing heart failure because of high blood pressure, coronary artery disease, or another medical condition) to D (the person has end-stage heart failure, requiring frequent hospitalizations or even hospice care).

At the earliest stage, someone may not even notice their heart failure, or it may seem to disappear once they start taking medication. Their heart failure might never progress past this point, especially if they take good care of themself. Or at later stages, they may have difficulty with everyday activities, like walking up stairs or carrying groceries. They may feel more fatigued than usual because their cells aren’t getting the nutrients they need. Fluid in their lungs can cause shortness of breath — especially when lying down — or it might accumulate in the legs or ankles, causing painful swelling.

How to Keep Heart Failure From Worsening

To keep heart failure from worsening, a patient must make major changes in their life: They’ll need to eat differently, remember to take their medications, keep as active as possible, and reduce stress. Some of these changes might require breaking habits acquired over many years. As a caregiver, you can help your loved one maximize their quality and length of life. Below are some ways to help.

Keep alert for worsening symptoms. Call the doctor immediately if you observe any of the following:

  • Sudden weight gain (three or more pounds in one or two days)
  • Increased swelling in the legs or ankles
  • Shortness of breath while at rest
  • A dry, hacking cough or wheezing
  • Dizzy or fainting spells
  • Increased fatigue or feeling unwell all the time
  • Abdominal pain or swelling

Easing Congestive Heart Failure with Diet and Exercise

Following a diet specifically designed for people with congestive heart failure can dramatically diminish the disease’s symptoms. The key to this diet is limiting salt, because too much sodium can lead to fluid retention, which worsens congestive heart failure symptoms. Although you should ask the doctor for specific dietary information, the following guidelines are some of the keys to a better diet. 

Cook with Less Salt

Reducing the sodium in a patient’s diet doesn’t mean condemning them to a lifetime of bland foods. Season with herbs, spices, and freshly ground pepper instead of salt. Citrus juices and vinegars can make a delicious base for marinating meat. For treats that are naturally low in sodium, stock up on plenty of fresh fruits and vegetables. Ask the doctor for a referral to a nutritionist who can offer more tips on preparing low-sodium foods.

Look for Sodium Content on Labels

Packaged foods, canned soups, and condiments are often loaded with sodium. Before buying, examine the nutritional information. Be sure to look at how many servings each package contains and how much sodium is in each serving. And don’t forget to check the ingredient list: If sodium or salt is listed in the first five ingredients, find an alternative. For example, look for low-sodium versions of canned vegetables.

Be a Salt Sleuth When Dining Out

Someone living with congestive heart failure doesn’t have to give up going out to restaurants, but they do need to watch what they order. Many restaurants are willing to accommodate special dietary needs; ask your waitperson if the cook can prepare foods without adding salt or MSG. Substitute steamed vegetables or fresh fruit for French fries or rice pilaf. Ask for salad dressing on the side, or request vinegar or lemon wedges instead.

Even if someone follows these suggestions, it may not be easy for them to change a lifetime of eating habits. Acknowledge that it’s difficult and listen to their concerns. Discuss what foods your loved one does and doesn’t like and involve them in meal planning. If they live alone, you might help them prepare large amounts of low-sodium foods that they like and freeze individual portions.

Keep Them Moving

It may seem counterintuitive, but if a person has congestive heart failure, they should stay as active as possible. Although strenuous exercise may overtax a heart that’s having difficulty pumping, moderate exercise can actually help the heart get stronger. Other health benefits of exercise include weight loss, lower cholesterol levels and blood pressure, and improved circulation.

If the person you’re caring for has always been a couch potato, it may be difficult to encourage them to get going. The good news is that even short bursts of moderate exercise can be beneficial. Simply parking farther away from the store or taking the stairs instead of the elevator can add more physical activity to their day. Housework and gardening are great ways for someone with congestive heart failure to get some exercise. You might also encourage them to join you in a morning walk around the neighborhood.

Of course, they need to avoid stressing their heart. Talk to their doctor about what activities they can safely enjoy, and what levels of exercise are appropriate. You might also ask for a referral to a cardiac rehabilitation program.

Eliminate Smoking

If you, the patient, or another caregiver smokes, now is the time to stop. Smoking decreases lung function, which makes the symptoms of congestive heart failure worse. But recognize that it’s not easy to stop smoking. Here are a few ways you can help:

  • Ask your loved one what they think would make it easier for them to stop smoking. They may have suggestions you haven’t thought of.
  • Encourage them to talk about their feelings and what they’re going through. Smoking may be a comforting lifelong habit; let them mourn a little.
  • You may be tempted to nag or yell if they slip up, but it’s more effective to be supportive. Be positive and encouraging — and vent your own frustration to a friend instead.
  • Help them avoid situations that may trigger the desire to smoke. If they’re used to enjoying a cigarette after meals, try going for a short walk outside instead.
  • Be understanding as they go through withdrawal. Try not to take it personally if they’re especially irritable, short-tempered, and tired.
  • Quit smoking yourself. If you must smoke, don’t do it around the patient. Not only will your smoking make quitting more difficult for them, but the secondhand smoke may worsen their heart failure symptoms.

If they find it too difficult to quit on their own, talk to their doctor. Nicotine replacement therapy, support groups, and counseling may all be helpful.

Stay on Top of Medications

One of the most important things for managing congestive heart failure is to take medications consistently and according to instructions. Know which drugs the person you’re caring for needs to take and how often they should take them. Also find out what to do if they miss a dose.

If they live alone, you can fill a pillbox with the medications they should take each day of the week. You can also post a simple daily medication schedule on their refrigerator or in their bathroom so they can check off each dose as they take it.

If your loved one has difficulty following the schedule, you might want to call them at regular intervals to make sure they have taken their medications.

Make the Most of Doctors’ Appointments

Most patients have a lot of visits to different doctors. To get the most out of appointments, bring a notebook. One of the most important aspects of managing congestive heart failure is keeping track of symptoms, medication side effects, and other concerns. Writing down this information in a notebook will help you and the person in your care stay on top of any changes in their condition.

Other tips to get the most out of appointments include: 

  • Prepare a list of questions before each visit. Leave spaces for the answers.
  • Take notes during the appointment. If either of you doesn’t understand something, don’t be afraid to ask for an explanation.
  • If the person you’re caring for isn’t following treatment or lifestyle recommendations, make sure the doctor knows it. Trying to protect them isn’t in their best interest.
  • Do your best to understand all the doctor’s instructions before you leave, but don’t hesitate to call the office if you have questions later.

Manage Depression and Anxiety

Depression and anxiety are common in people with congestive heart failure. Feeling unwell, being unable to do some of the things they once enjoyed, and uncertainty about the future can all contribute to feelings of sadness. But if the person you’re caring for seems consistently unhappy, they may be depressed. Look out for these signs of depression, and if you notice any, notify their doctor:

  • Frequent crying episodes
  • Feelings of hopelessness or worthlessness
  • Poor appetite or increased appetite
  • Sleeping too much or not enough
  • Increased agitation and restlessness
  • Loss of interest in life
  • Expressing thoughts of dying or suicide

Depression is a serious problem that requires evaluation and treatment. But you may be able to help manage your loved one’s moods with these activities:

  • Help them stay active and connected by doing things they enjoy. Talk to the doctor about any physical restrictions your loved one may have and how to get around them.
  • Help them structure the day around activities that give them pleasure and a sense of purpose. For example, they could plan to meet friends for lunch, or enjoy a leisurely walk through the mall.
  • Try to stay positive and upbeat, but don’t foster unrealistic expectations. Instead of saying, “You’ll be hiking again in no time,” you might say, “If we keep walking together every day, you’ll probably notice that it gets a lot easier.”
  • Let them talk about his fears and concerns. If it’s difficult for you to listen to their feelings, you may want to find someone for your loved one to talk to — perhaps a therapist or some other mental health professional. A support group may also be helpful.

Help Your Loved One Help Themself

Whether your loved one lives alone, with you, or in a long-term care facility, you should encourage them to care for themselves as much as possible. Although you may be tempted to take care of everything for them, they’ll feel better about themself if you help them perform tasks on their own. As long as they’re able, they should be involved in managing their symptoms and making decisions about treatment. By taking on too much responsibility for your loved one, you risk taking away their independence (which can lead to depression) — and exhausting yourself in the process.

Keeping Comfortable

Symptoms of congestive heart failure, such as swelling and shortness of breath, can be very uncomfortable. Here are some ways you can help someone feel better:

  • Comfortable, nonbinding clothing and shoes may make it easier for your loved one to tolerate the leg and ankle swelling that often accompanies heart failure.
  • Support stockings, which you can purchase at your local drugstore, may alleviate leg swelling during the day.
  • Pillows that elevate a person’s head at night may help them breathe more easily while sleeping.
  • Limited amounts of salt and liquids can minimize the retention of fluids, significantly lessening their symptoms.

Plan for the Future

Depending on the severity of your loved one’s congestive heart failure, they may still have many years of active living ahead of them. But you both should realize that the condition could ultimately worsen. As the disease progresses, talk to your loved one about what end-of-life treatments they do and do not want. Find out at what point they want a do-not-resuscitate (DNR) order added to their medical chart. Talk to them about a living will and an advance health care directives. Although these conversations can be painful, it’s useful to remember that these are important decisions.

You should also discuss future plans with their doctor. Ask about their prognosis whenever their condition or treatment plan changes, and don’t hesitate to ask tough questions about what you can reasonably expect. Having as much information as possible will make it easier for everyone to make difficult choices.