Manual of Clinical Nutrition Management III- 42 Copyright © 2013 Compass Group, Inc.
HEART FAILURE
Discussion
Heart failure, which is a syndrome characterized by left ventricular dilation or hypertrophy, is caused by
cardiac dysfunction that results from myocardial muscle dysfunction or loss (1). Heart failure leads to
neurohormonal and circulatory abnormalities that cause fluid retention, shortness of breath, and fatigue (1).
The leading causes of heart failure include hypertension, coronary heart disease, and diabetes mellitus (1).
Other causes include cardiomyopathy, valvular heart disease, arrhythmias, congenital heart disease, thyroid
disease, obesity, alcohol abuse, human immunodeficiency virus, acquired immune deficiency syndrome, and
illicit drug use (1,2). Heart failure is common in older adults; the prevalence increases from 2% to 3% at age 65
to more than 80% in persons older than 80 years (2). Heart failure is the most common reason for
hospitalization, morbidity, and mortality in the elderly (1,2). Referral to a registered dietitian for medical
nutrition therapy is recommended for individuals who have heart failure (Grade II)* (3). A minimum of four visits
with a registered dietitian can lead to an improved dietary pattern and quality of life and decreased edema
and fatigue (Grade II) (3). Medical nutrition therapy in conjunction with optimal pharmacological management
may also reduce hospitalizations (Grade II) (3).
Indications
Heart failure precipitates the onset of sodium retention and edema due to the inability of the body to excrete
sodium at a rate in equilibrium with dietary sodium intake (1). The primary objectives in managing the signs
and symptoms of heart failure include the achievement of fluid homeostasis by using medications such as
loop diuretics and the implementation of dietary interventions to reduce fluid retention and increase the
excretion of sodium and water (1).
Signs and symptoms of heart failure include (1):
difficulty breathing, especially when lying flat in bed or with exertion
waking up breathless at night
frequent, dry, hacking cough
poor tolerance to exercise, or dyspnea on exertion
sudden weight gain caused by edema or ascites
frequent urination
swelling in the lower extremities (especially the ankles)
fatigue, dizziness, weakness, or fainting
early satiety, nausea, and abdominal swelling or bloating
The medical diagnosis is verified by echocardiography or the assessment of left ventricular function by
measuring the ejection fraction. A laboratory test for B-type natriuretic peptide can indicate a diagnosis of
heart failure in the clinical setting (2). Heart failure is classified into one of four stages (with stage IV being the
most severe) based on its severity and physiological impact (1).
Medical management of heart failure involves a combination of drugs including diuretics, angiotensin-
converting enzyme inhibitors, and beta blockers; dietary modifications; exercise recommendations; and
symptom and risk factor management (eg, blood pressure control and lipid management) (1-4). Behavioral
compliance to the treatment regimen, especially physical exercise, is correlated with successful outcomes. A
multidisciplinary approach to treatment, including medical nutrition therapy, decreases hospital utilization
and medical costs and improves the quality of life of elderly persons who have heart failure (1-3).
Adverse health outcomes associated with heart failure are (5):
reduced tolerance to exercise or activity
stroke
peripheral vascular disease
renal failure
Nutrition Assessment and Diagnosis
Referral to a registered dietitian for medical nutrition therapy is recommended for individuals who have
heart failure (Grade II) (3). The initial assessment should include a comprehensive evaluation of nutritional