Nursing Guide to Congestive Heart Failure: Nursing Diagnosis, Interventions, & Care Plans

Congestive heart failure general overview 

Congestive heart failure, usually referred to simply as heart failure, is a complex clinical syndrome in which the heart isn’t able to pump sufficient blood to meet the body’s metabolic needs, or can do so only at the expense of increased filling pressures. Fluid backs up into the lungs and peripheral tissues, producing congestion, dyspnea, and edema. Heart failure isn’t a single disease but a final common pathway of many cardiovascular conditions. 

For nurses, heart failure is a core condition encountered in inpatient units, intensive care, EDs, primary care, home care, long-term care, and cardiac rehabilitation. It is a leading cause of hospitalizations and readmissions among older adults. Nursing care has a major impact on symptom control, prevention of exacerbations, self-management, and quality of life. 

Clinically, heart failure is often classified in two complementary ways: 

• By ejection fraction
• Heart failure with reduced ejection fraction (HFrEF)
• Heart failure with mildly reduced ejection fraction (HFmrEF)
• Heart failure with preserved ejection fraction (HFpEF)
• By functional limitation
• New York Heart Association (NYHA) class I to IV, ranging from no limitation of activity to symptoms at rest 

The term “congestive” emphasizes fluid overload, but not all patients are overtly congested at all times. Some present with fatigue, exercise intolerance, or subtle signs of poor perfusion. Nurses must be skilled at recognizing both obvious and early signs of decompensation to prevent hospitalizations and complications. 

Key features of heart failure from a nursing perspective: 

• Chronic, often progressive condition with intermittent acute decompensations
• High prevalence of comorbidities such as hypertension, coronary artery disease, diabetes, obesity, and chronic kidney disease
• Need for precise monitoring of fluid balance, weight, perfusion, and respiratory status
• Complex medication regimens that require careful titration and adherence
• Strong need for education, coaching, and psychosocial support for patients and caregivers 

Although heart failure cannot usually be cured, evidence-based therapies can significantly reduce mortality, hospitalizations, and symptoms when implemented and monitored effectively. 

Etiology and epidemiology 

Etiology and pathophysiology 

Heart failure results from structural or functional cardiac defects that impair ventricular filling, ejection of blood, or both. Common etiologic categories include: 

• Ischemic heart disease
  • Prior myocardial infarction or chronic coronary artery disease can cause loss of functional myocardium and ventricular remodeling.
  • Scarred or hibernating myocardium weakens contractility, leading to reduced ejection fraction.
• Hypertension
  • Chronic pressure overload leads to left ventricular hypertrophy, stiffness, and eventually systolic dysfunction.
  • Long-standing, uncontrolled hypertension is a major driver of HFpEF in older adults.
• Valvular heart disease
  • Aortic stenosis or regurgitation, mitral regurgitation, and other significant valvular lesions can cause volume or pressure overload.
  • Over time, chambers dilate or hypertrophy and ultimately fail.
• Cardiomyopathies
  • Dilated cardiomyopathy from genetic causes, viral myocarditis, toxins such as alcohol or certain chemotherapeutic agents, or peripartum cardiomyopathy.
  • Hypertrophic cardiomyopathy and restrictive cardiomyopathy also predispose to heart failure.
• Arrhythmias
  • Persistent tachyarrhythmias such as atrial fibrillation with rapid ventricular response or uncontrolled supraventricular tachycardia can lead to tachycardia induced cardiomyopathy.
  • Bradyarrhythmias may reduce cardiac output.
• Right sided and high output failure
  • Pulmonary hypertension, chronic lung disease, or pulmonary embolism can cause right ventricular failure.
  • High output states such as severe anemia, thyrotoxicosis, or arteriovenous fistulas may eventually overwhelm cardiac reserve. 

Heart failure pathophysiology involves neurohormonal activation. When cardiac output drops, the body initiates the sympathetic nervous system and renin angiotensin aldosterone system to continue perfusion. Initially compensatory, these mechanisms become maladaptive, causing vasoconstriction, sodium and water retention, ventricular remodeling, and further impairment of function. Modern heart failure therapies target these pathways. 

Precipitating factors for decompensation 

Even in stable chronic heart failure, acute episodes are often triggered by: 

• Dietary indiscretion, especially excess sodium or fluid intake
• Missed or reduced doses of diuretics or other medications
• Uncontrolled hypertension
• Acute coronary syndromes
• Arrhythmias, particularly atrial fibrillation
• Pulmonary infections or systemic sepsis
• Worsening renal function
• Use of negative inotropic or sodium retaining drugs, such as some calcium channel blockers, NSAIDs, or thiazolidinediones
• Unmanaged anemia, thyroid disease, or sleep apnea 

Nurses help in identifying these triggers and educating patients on how to avoid them. 

Epidemiology 

Heart failure is a major global public health problem: 

• Prevalence increases with age and is highest in people 65 years and older.
• In many industrialized countries, one to two percent of the adult population has heart failure, with rates higher than 10 percent among those older than 70.
• It is one of the leading causes of hospitalization and readmission within 30 days for older adults.
• Mortality remains substantial, although it has improved with modern therapies. Many patients die within five years of diagnosis if not optimally treated. 

Risk factors mirror those for cardiovascular disease in general: 

• Hypertension
• Coronary artery disease and prior myocardial infarction
• Diabetes mellitus
• Obesity and metabolic syndrome
• Dyslipidemia
• Smoking
• Sedentary lifestyle
• Family history of cardiomyopathy or early cardiovascular disease 

These epidemiologic patterns highlight the importance of primary prevention as well as optimal management of established heart failure. 

ICD 10 code 

Heart failure diagnoses are primarily coded in ICD 10 within category I50. 

Common codes include: 

• I50.9 Heart failure, unspecified
  • Often used when documentation does not specify type, acuity, or side.
• I50.2x Systolic (congestive) heart failure
  • I50.20 Unspecified systolic heart failure
  • I50.21 Acute systolic heart failure
  • I50.22 Chronic systolic heart failure
  • I50.23 Acute on chronic systolic heart failure
• I50.3x Diastolic (congestive) heart failure
  • I50.30 Unspecified diastolic heart failure
  • I50.31 Acute diastolic heart failure
  • I50.32 Chronic diastolic heart failure
  • I50.33 Acute on chronic diastolic heart failure
• I50.4x Combined systolic and diastolic heart failure
  • I50.40 Unspecified combined systolic and diastolic heart failure
  • I50.41 Acute combined systolic and diastolic heart failure
  • I50.42 Chronic combined systolic and diastolic heart failure
  • I50.43 Acute on chronic combined systolic and diastolic heart failure
• I50.1 Left ventricular failure, unspecified 

In many coding systems, “congestive heart failure” maps to the appropriate I50.x code based on the details documented by the provider, such as acute versus chronic and systolic versus diastolic. 

Nurses don’t assign ICD 10 codes but can support accurate coding by clearly documenting: 

• The presence of heart failure
• Whether it is acute, chronic, or acute on chronic
• Whether function is described as systolic, diastolic, or combined when known
• Associated conditions, such as cardiomyopathy, valvular disease, or ischemic heart disease 

Typical reference sources for ICD 10 codes include: 

• World Health Organization. International statistical classification of diseases and related health problems, 10th revision (ICD 10) online browser.
• Centers for Medicare and Medicaid Services. ICD 10 CM official guidelines for coding and reporting.

Congestive heart failure diagnosis 

Clinical presentation 

Heart failure may present gradually with exertional symptoms or acutely with pulmonary edema. 

Common symptoms: 

• Dyspnea on exertion, progressing to dyspnea at rest in advanced cases
• Orthopnea: need for multiple pillows or sleeping in a chair due to breathlessness when lying flat
• Paroxysmal nocturnal dyspnea: sudden nighttime episodes of severe dyspnea that wake the patient
• Fatigue and weakness
• Lowered exercise tolerance
• Inflammation of legs, ankles, feet, or abdomen
• Rapid weight gain due to fluid retention
• Cough, often worse when lying down
• Early satiety and loss of appetite in advanced disease
• Decreased urine output during the day and nocturia 

Nurses obtain and monitor these symptoms frequently and are often the first to notice subtle worsening. 

Physical examination 

Key findings may include: 

• Elevated jugular venous pressure
• Hepatojugular reflux
• S3 gallop on cardiac auscultation
• Displaced apical impulse in ventricular dilation
• Bibasilar crackles or rales due to pulmonary congestion
• Diminished breath sounds with pleural effusions
• Peripheral edema
• Ascites and hepatomegaly in right sided failure
• Cool extremities, weak pulses, or delayed capillary refill in low output states 

Blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature are essential vital signs to trend. 

Diagnostic testing 

• Laboratory tests
  • B type natriuretic peptide (BNP) or N terminal pro BNP (NT proBNP) to help distinguish heart failure from other causes of dyspnea.
  • Basic metabolic panel to evaluate kidney function and electrolytes, especially potassium and sodium.
  • Liver function tests, complete blood count, thyroid stimulating hormone, and fasting lipids as clinically indicated.
• Imaging and cardiac tests
  • Chest radiograph for cardiac size, pulmonary congestion, interstitial edema, or pleural effusions.
  • Echocardiogram to assess ejection fraction, wall motion abnormalities, valvular function, chamber size, diastolic function, and pulmonary pressures.
  • Electrocardiogram to detect ischemia, arrhythmias, or prior infarction.
  • Stress testing or coronary angiography in selected patients to evaluate for ischemic heart disease.
• Classification and staging
  • New York Heart Association (NYHA) functional class I to IV based on symptom limitation.
  • American College of Cardiology and American Heart Association (ACC/AHA) stages A to D, which describe structural disease and risk status. 

Nurses should be familiar with these classifications because they guide treatment intensity and patient education. 

Differential diagnosis 

Conditions that may mimic or coexist with heart failure include: 

• Chronic obstructive pulmonary disease (COPD) and other chronic lung diseases
• Pneumonia
• Pulmonary embolism
• Nephrotic syndrome or renal failure with volume overload
• Cirrhosis with ascites
• Obesity and deconditioning
• Anemia and thyroid disease 

Nursing assessment of history, risk factors, and response to treatments, such as diuretics and bronchodilators, helps differentiate these conditions. 

Management 

Heart failure management aims to ease symptoms, enhance quality of life, slow disease progression, decrease hospitalizations, and prolong survival. Care is lifelong and multidisciplinary. 

Pharmacologic management 

For HFrEF in particular, guideline directed medical therapy often includes: 

• Renin angiotensin system blockers
  • Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are foundational therapies.
  • Angiotensin receptor neprilysin inhibitors (ARNIs), such as sacubitril/valsartan, are recommended for many patients with HFrEF as a replacement for ACE inhibitor or ARB, with appropriate washout period from ACE inhibitors.
  • Nurses monitor blood pressure, kidney function, and potassium, and watch for cough or angioedema with ACE inhibitors.
• Evidence-based beta blockers
  • Carvedilol, bisoprolol, and metoprolol succinate have proven benefits in HFrEF.
  • Initiated at low doses and slowly titrated.
  • Nurses assess heart rate, blood pressure, fatigue, and signs of worsening congestion during titration.
• Mineralocorticoid receptor antagonists
  • Spironolactone or eplerenone reduce mortality and hospitalizations in selected patients with HFrEF.
  • Close monitoring of potassium and renal function is essential.
• SGLT2 inhibitors
  • Originally developed for diabetes, agents such as dapagliflozin and empagliflozin improve outcomes in HFrEF and some patients with HFpEF, with or without diabetes.
  • Nurses monitor volume status, kidney function, and potential side effects like genital mycotic infections.
• Diuretics
  • Loop diuretics such as furosemide, bumetanide, or torsemide relieve congestion, improve symptoms, and are essential in acute decompensation.
  • Nurses carefully monitor daily weight, intake and output, electrolytes, renal function, and signs of dehydration.
• Other agents in selected patients
  • Vasodilators such as hydralazine plus isosorbide dinitrate, particularly in some populations or when ACE inhibitors or ARBs are not tolerated.
  • Ivabradine for patients with HFrEF and elevated heart rate despite maximal beta blockade.
  • Digoxin may be used for symptom relief and rate control in atrial fibrillation, with careful monitoring for toxicity. 

In HFpEF, treatment focuses on controlling blood pressure, managing comorbidities, diuretics for congestion, and selected disease modifying agents where evidence supports benefit. 

Nonpharmacologic management 

Nonpharmacologic strategies are crucial, and often nurse led: 

• Fluid and sodium restriction
  • Typical sodium recommendations are about 2 grams per day or individualized by provider.
  • Fluid restriction may be indicated in hyponatremia or severe volume overload.
• Daily weights
  • Patients are taught to weigh themselves every morning after voiding and before breakfast, in similar clothing and on the same scale.
  • Weight trends are vital for early detection of fluid retention.
• Physical activity and cardiac rehabilitation
  • Regular, supervised exercise improves functional capacity and quality of life when clinically appropriate.
  • Nurses encourage gradual, safe activity and monitor for symptoms.
• Vaccinations
  • Influenza and pneumococcal vaccines are recommended to reduce respiratory infections that can precipitate decompensation.
• Lifestyle modifications
  • Smoking cessation, moderation of alcohol intake, weight management, and treatment of sleep apnea. 

Acute decompensated heart failure 

In acute care settings, management focuses on stabilization: 

• Supplemental oxygen and, if needed, noninvasive ventilation to relieve dyspnea and improve oxygenation.
• Intravenous loop diuretics for rapid relief of fluid overload.
• Vasodilators such as nitroglycerin in selected patients with adequate blood pressure.
• Inotropes like dobutamine or milrinone for low output states with hypotension or end organ hypoperfusion.
• Monitoring in telemetry or intensive care units, depending on severity. 

Nurses are responsible for frequent assessment of respiratory status, vital signs, urine output, mental status, and response to therapy, and prompt reporting of any deterioration. 

Device therapy and advanced treatments 

In selected patients with reduced ejection fraction: 

• Implantable cardioverter defibrillators (ICDs) reduce risk of sudden cardiac death.
• Cardiac resynchronization therapy (biventricular pacing) can improve symptoms and survival in those with electrical dyssynchrony.
• Left ventricular assist devices (LVADs) may be used as bridge to transplant or destination therapy in advanced heart failure.
• Heart transplantation is considered for highly selected patients with end stage disease. 

Nurses caring for these patients require specialized knowledge about device function, monitoring, and complications. 

Nursing care plan 

A comprehensive nursing care plan addresses acute needs, chronic management, education, and psychosocial support. Plans should be individualized based on the severity of heart failure, comorbidities, and social context. 

Priority problems 

Common priority problems for patients with congestive heart failure include: 

• Impaired gas exchange related to alveolar fluid accumulation
• Decreased cardiac output related to impaired myocardial contractility or structural abnormality
• Excess fluid volume related to compromised regulatory mechanisms
• Activity intolerance related to imbalance between oxygen supply and demand
• Impaired tissue perfusion, cardiac and peripheral, related to decreased cardiac output
• Risk for electrolyte imbalance related to diuretic and renin angiotensin system blocker therapy
• Knowledge deficit related to complex regimen and self management needs
• Anxiety or fear related to dyspnea, new diagnosis, or hospitalization 

Sample goals 

• Patient will maintain oxygen saturation at or above an individualized target level, for example, 92 percent or greater, on prescribed oxygen or room air.
• Patient will demonstrate a reduction in signs of fluid overload, such as decreased edema and weight loss within ordered ranges.
• Patient will verbalize understanding of daily weight monitoring, medication regimen, and sodium restrictions before discharge.
• Patient will tolerate activity, such as walking in the hall, with minimal or manageable dyspnea.
• Patient will identify early warning signs of worsening heart failure and describe when to contact the provider. 

Nursing considerations for congestive heart failure

Nurses caring for individuals with heart failure should bear in mind: 

• Careful fluid management
  • Monitor intake and output closely, including insensible losses in some settings.
  • Use weight trends to guide diuretic adjustments in coordination with providers.
• Oxygenation and respiratory status
  • Assess respiratory rate, work of breathing, lung sounds, and oxygen saturation frequently.
  • Watch for orthopnea and paroxysmal nocturnal dyspnea.
• Hemodynamic effects of medications
  • Many medications for heart failure reduce blood pressure and heart rate.
  • Assess for symptomatic hypotension, dizziness, near syncope, or bradycardia.
• Renal function and electrolytes
  • Heart failure and its therapy often affect kidney function.
  • Diuretics and renin angiotensin system blockers can lead to hyponatremia, hyperkalemia, or hypokalemia.
  • Nurses should review laboratory values regularly and report significant changes.
• Older adults and frailty
  • Many patients are older with frailty, cognitive impairment, and high fall risk.
  • Nursing care should emphasize safety, simplified regimens, and involvement of caregivers.
• Polypharmacy and transitions of care
  • Reconciliation of medications at admission, transfer, and discharge is essential.
  • Clear, accurate discharge instructions help prevent readmissions.
• Palliative care and goals of care
  • Advanced heart failure is a life limiting condition.
  • Symptom management, advance care planning, and palliative care involvement should be integrated early, not only at the very end of life. 

Assessment of congestive heart failure

Nursing assessment for congestive heart failure is ongoing and systematic. 

Subjective assessment 

Ask about: 

• Breathlessness at rest and with activity, and how this compares with baseline.
• Ability to complete daily living activities and instrumental activities.
• Orthopnea, paroxysmal nocturnal dyspnea, or need to sleep upright.
• Chest discomfort or pressure, palpitations, or near syncope.
• Swelling of feet, legs, abdomen, or rings and shoes feeling tight.
• Appetite, early satiety, nausea, or abdominal fullness.
• Fatigue, sleep quality, and mood.
• Adherence to medications, diet, and fluid restrictions.
• Use of alcohol, tobacco, and recreational drugs.
• Recent illnesses, medication changes, or dietary indiscretions. 

Objective assessment 

Include: 

• Vital signs, paying special attention to blood pressure trends, heart rate and rhythm, respiratory rate, and oxygen saturation.
• Weight daily, at the same time and with similar clothing.
• Lung auscultation for crackles, wheezes, or diminished breath sounds.
• Cardiac auscultation for murmurs, S3 gallop, or irregular rhythm.
• Jugular venous distention and hepatojugular reflux.
• Peripheral edema and its distribution.
• Abdominal girth and signs of ascites or hepatomegaly.
• Capillary refill, temperature, and color of extremities.
• Urine output and characteristics.
• Review of laboratory data and imaging reports. 

Assessment findings should be documented clearly and communicated promptly, especially when changes suggest worsening status. 

Nursing diagnosis or risk for congestive heart failure

Examples of nursing diagnoses relevant to congestive heart failure include: 

• Decreased cardiac output related to impaired myocardial contractility, as evidenced by hypotension, tachycardia, fatigue, and reduced ejection fraction.
• Excess fluid volume related to compromised regulatory mechanisms, as evidenced by edema, pulmonary crackles, weight gain, and jugular venous distention.
• Impaired gas exchange related to increased alveolar capillary membrane fluid, as evidenced by dyspnea, hypoxemia, and abnormal breath sounds.
• Activity intolerance related to imbalance between oxygen supply and demand, as evidenced by fatigue, dyspnea on exertion, or abnormal heart rate response.
• Impaired tissue perfusion (cardiac or peripheral) related to decreased cardiac output, as evidenced by chest discomfort, cool extremities, or diminished pulses.
• Risk for electrolyte imbalance related to diuretic use and renin angiotensin system blockade.
• Deficient knowledge regarding disease process, diet, medications, and symptom monitoring.
• Anxiety related to breathlessness, hospitalization, or fear of death. 

These diagnoses guide targeted interventions and evaluation of outcomes. 

Interventions 

Nursing interventions should be individualized but commonly include the following categories. 

Improve oxygenation and reduce work of breathing 

• Position the patient in high Fowler position or with the head of the bed elevated to ease breathing.
• Administer supplemental oxygen as prescribed and monitor oxygen saturation.
• Encourage the use of breathing techniques such as pursed lip breathing when helpful.
• Monitor for signs of respiratory distress, such as increased work of breathing or declining mental status, and notify the provider promptly. 

Reduce fluid overload 

• Administer diuretics as ordered, monitoring timing relative to sleep in stable patients to minimize nocturia.
• Strictly monitor intake and output, including response to diuretic therapy.
• Weigh daily and report significant changes, for example, a gain of more than two to three pounds in 24 hours or five pounds a week, based on local protocols.
• Implement sodium and fluid restrictions as ordered and support adherence through dietary consultation and education. 

Support cardiac output and hemodynamic stability 

• Monitor vital signs frequently, especially after initiation or titration of ACE inhibitors, ARBs, ARNIs, beta blockers, and vasodilators.
• Assess for dizziness, lightheadedness, or syncope that may indicate hypotension or arrhythmias.
• In higher acuity settings, assist with monitoring central venous pressure, pulmonary artery pressures, or cardiac output when in place.
• Administer inotropes, vasodilators, or vasopressors as ordered, with close monitoring for desired and adverse effects. 

Promote activity tolerance and energy conservation 

• Collaborate with physical and occupational therapy to create a graded activity plan.
• Encourage rest periods between activities and cluster care to avoid overwhelming the patient.
• Teach energy conservation strategies, such as sitting for tasks when possible and pacing oneself.
• Monitor physiologic responses to activity, including heart rate, blood pressure, oxygen saturation, and dyspnea rating. 

Prevent complications 

• Implement fall precautions when orthostatic hypotension or weakness is present.
• Monitor for skin breakdown due to edema and limited mobility, using pressure injury prevention measures.
• Encourage coughing and deep breathing and early mobilization to reduce risk of pneumonia.
• Monitor for arrhythmias and report changes in rhythm or rate. 

Support self-management and education 

• Use teach-back techniques to confirm understanding of daily weights, medication regimen, diet, and symptom zones.
• Provide written action plans that outline what to do in green (stable), yellow (worsening), and red (emergency) symptom zones.
• Involve caregivers in teaching, particularly for patients with low literacy, cognitive impairment, or complex regimens.
• Coordinate referrals to heart failure clinics, dietitians, social work, and cardiac rehabilitation. 

Expected outcomes 

Expected outcomes should be measurable, realistic, and time bound. 

Examples: 

• Within 48 hours, patient will demonstrate improved respiratory status as evidenced by decreased dyspnea, clear or improved breath sounds, and oxygen saturation within target range.
• By discharge, patient will have stable weight or appropriate weight reduction consistent with reduction in edema and fluid overload.
• Patient will verbalize understanding of heart failure, including at least three key self-care behaviors such as daily weight monitoring, medication adherence, and sodium restriction.
• Within the period of hospitalization, patient will experience no episodes of uncontrolled arrhythmias, syncope, or hemodynamic instability requiring emergency intervention.
• In follow-up, patient will have no preventable readmissions for heart failure exacerbation within a defined period, such as 30 days, when support and resources are adequate. 

Because heart failure is chronic and progressive, long-term goals often aim to slow decline, maintain function, and maximize comfort rather than achieve cure. 

Individual or caregiver education 

Education is central to successful heart failure management and should begin on admission and continue through all encounters. 

Key topics: 

• Understanding heart failure
  • Explain that heart failure is a chronic condition in which the heart is weaker or stiffer than normal, leading to fluid buildup and reduced ability to cope with stress.
  • Emphasize that effective treatment and self-care can help patients live longer and feel better.
• Daily weights and symptom monitoring
  • Demonstrate how to weigh daily and record the results.
  • Provide thresholds for calling the provider, for example, weight gain of more than a specified amount, new or worsening shortness of breath, or swelling.
• Medications
  • Review each medication’s name, purpose, dose, timing, and common side effects.
  • Stress for the patient not to stop medications suddenly without consulting the provider.
  • Encourage use of pill organizers, medication lists, and reminder systems.
• Diet and fluid management
  • Teach how to follow a low-sodium diet, including reading labels, avoiding high-sodium processed foods, and not adding salt at the table.
  • If fluid restriction is ordered, explain the limits and strategies to manage thirst, such as ice chips, sugar-free gum, or mouth moisturizers.
  • Involve dietitians when available to provide individualized meal planning.
• Activity and rest
  • Encourage appropriate physical activity and participation in cardiac rehabilitation if recommended.
  • Discuss pacing, rest periods, and when to stop activity and seek help, such as chest pain or severe dyspnea.
• When to seek urgent or emergency care
  • Teach warning signs such as:
    • Sudden weight gain
    • Marked increase in shortness of breath, especially at rest
    • New onset of confusion or chest pain
    • Fainting or near fainting
  • Provide clear instructions on who to call or where to go.
• Psychosocial and caregiver support
  • Encourage expression of fears and concerns.
  • Provide information on support groups and counseling resources.
  • Educate caregivers on how to assist with medications, diet, appointments, and symptom monitoring while also caring for their own health. 

Written materials, language-appropriate handouts, and visual aids reinforce teaching. Education should be adapted for cultural preferences and health literacy levels.

Resources 

Patients, families, and nurses may find the following types of resources helpful: 

• National heart associations and heart failure societies provide patient-friendly materials on heart failure, diet, and activity.
• Local heart failure clinics that offer multidisciplinary follow-up with nurses, pharmacists, dietitians, and physicians.
• Cardiac rehabilitation programs for supervised exercise and education.
• Community-based programs for chronic disease self-management.
• Telemonitoring or nurse call programs for daily weights, symptoms, and medication support where available.
• Social work services to assist with insurance, medication access, transportation, and caregiver support. 

Availability varies by region, so nurses should be familiar with local options. 

References 

• Centers for Medicare and Medicaid Services. (n.d.). ICD-10-CM official guidelines for coding and reporting. U.S. Department of Health and Human Services.
• Heidenreich, P. A., Bozkurt, B., Aguilar, D., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2021.12.012 
• McDonagh, T. A., Metra, M., Adamo, M., et al. (2021). 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599–3726. https://doi.org/10.1093/eurheartj/ehab368
• World Health Organization. (n.d.). International statistical classification of diseases and related health problems, 10th revision (ICD-10). WHO Press.
• Yancy, C. W., Jessup, M., Bozkurt, B., et al. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 70(6), 776–803. https://doi.org/10.1016/j.jacc.2017.04.025