If you’ve recently been diagnosed with heart failure, you’re not alone. More than 6 million Americans have the same condition. And roughly 1 million people are hospitalized each year for heart failure complications, according to the most recent data from the Centers for Disease Control and Prevention. For those age 65 and older, heart failure is the most common cause of hospitalization.

But even though hospital stays for heart failure are common, that doesn’t mean you want to make them a regular part of your life. For one, another hospital stay will increase your healthcare costs. Plus, it can be stressful, which is not ideal when you’re trying to heal. The good news is that not everyone has to make a return trip. And with the right strategies in place, you can lower your risk of readmission.

“The words ‘heart failure’ carry a sense that it’s gloom and doom,” says Tomas Ayala, M.D., a cardiologist with Mercy Medical Center in Baltimore. “That’s not necessarily the case. You have a lot more control over your condition than you realize.”

Dr. Ayala emphasizes things like taking your medications, eating well, and monitoring your symptoms. “They can have a huge impact on whether you stay home or go back to the hospital.”

Here’s how to flex some control over your condition and improve your chances of staying home.

Step 1: Set Yourself Up for Success

At the end of your hospital stay, you might be focused on getting out as quickly as possible. But don’t rush through those discharge instructions. Think of this time as a chance to set yourself up for success at home. Before you leave the hospital, try to:

• Choose an advocate. Heart failure can leave you exhausted and off your game. So now is the time to enlist help from your friends and family members. That might mean having someone drive you to follow-up appointments with your doctor. Or you might ask them to pick up your prescription medications for you, or deliver you home-cooked meals. Rather than coordinating all that care yourself, ask a loved one to act as your advocate and handle the details as much as they can.
   
• Get it in writing. Your care team of doctors, nurses, and therapists will be sharing information about your condition and your treatment plan. Keep a notebook by your hospital bed to take notes — or ask your advocate to jot things down. Also ask your care team for printed information and save everything in a dedicated folder.
   
• Sign up for support. Post-discharge appointments, such as physical and occupational therapy, can feel like a hassle. But there are good reasons to follow through with available resources. Physical therapy sessions can help you build up your endurance, for example. And occupational therapy can help you get around your house once you’re back home. One study linked higher hospital spending on occupational therapy with lower readmission rates for heart failure patients.

(If you have questions after a hospital stay, Wellframe, your digital health management app, can help you get answers fast. Search the Wellframe library for information written by medical professionals, or send your questions straight to your care team. The free app comes with your health plan; log in or download it today.)

Step 2: Get Your Meds in Order

“Your medications often change so much after a hospital stay that it’s easy to get confused,” Dr. Ayala says. “It’s easy to make a mistake and go back to the old regimen — especially if you already have pillboxes and bottles at home.”

Taking the right meds — at the right times — is essential for your safety. And it can also help you better avoid another hospital stay. To stay on top of any medication changes, Dr. Ayala suggests that you:

• Keep a list of all your meds and how to take them. For example, should they be taken with or without food, and at what time of day? Your digital health management tool, Wellframe, can help. This smartphone app comes free with your health plan. It makes organizing and planning your medication regimen easy.
   
• Set an alarm on your phone to remind you to take your next dose. Wellframe also has a built-in reminder tool that you can use. It allows you to set as many alarms as you need.
   
• Get help with refills. Ask your pharmacy to contact you when it’s time for a refill. Many pharmacies will send texts when it’s time to refill or pick up your prescription. Or enroll in an automatic refill program through your insurance plan.
   
• Speak up if you can’t afford your medications. “We go to great lengths to help our patients get their medicine,” says Allen Anderson, M.D., chief of cardiology at the Long School of Medicine at University of Texas Health Science Center at San Antonio. “There are assistance programs where patients can get what they need at a reduced cost. But if they don’t tell us there’s a problem, we can’t help.”

Step 3: Stock Your Kitchen

Before you head home, your care team will talk to you about healthy eating. Pay attention. The big takeaway: Too much salt can make your body retain fluid, which forces your heart to work extra hard.

“Any increase in salt, even a bag of chips, can cause problems,” says Dr. Ayala. “Ordinary foods like ketchup, lunch meats, and frozen dinners are loaded with salt. Too much of it can make the difference between staying out of the hospital and coming back in.”

Of course, it’s hard to stay on track when you’re hungry and your pantry is full of salty snacks. Get ready ahead of time by asking your advocate to stock your kitchen with low-salt or no-salt foods. That means moving fresh vegetables, fruits, and whole grains to the top of the grocery list and clearing the cupboards of many salty items. Try these tips:

• Share your dietary plan. Give it to your advocate and to any friends or family who may offer to bring you a meal. Your loved ones want to keep you healthy — and at home. They will appreciate concrete information about any sodium limits your doctor has shared.
   
• Order groceries online or by phone. Many local markets offer lower-cost delivery services. This can be less taxing than in-person shopping. It also means you can more easily stick to the list and stay away from impulse purchases.
   
• Ask about resources. Talk to your care manager or social worker about any programs that might be available, especially if you’re managing on your own. Some insurance plans provide for meal delivery. Or your community may offer a Meals on Wheels program.

(Need some mealtime inspiration? You can find healthy low-salt recipes that are still packed with plenty of flavor on your Wellframe app.)

Step 4: Know Which Symptoms to Monitor

Before you leave the hospital, your doctor will tell you which symptoms to watch daily and when to reach out if there’s a significant change. “One of the best ways to prevent readmission is to catch problems before they become so serious that the only solution is hospitalization,” says Dr. Ayala. “If you call early enough, we can make an adjustment to your medication that may help you stay home. Those early warning interventions are important.”

Symptoms to track might include:

• Weight gain: This is often one of the earliest signs that heart failure is getting worse. The American Heart Association recommends contacting your doctor if you gain more than 2 or 3 pounds in a 24-hour period or more than 5 pounds in a week.
   
• Swelling: It’s most common in the ankles, lower legs, and feet. Swelling is a sign that fluid is collecting in your body.
   
• Blood pressure: Your doctor may suggest an at-home blood pressure monitor to make tracking your numbers easy.
   
• Heart rate: When your heart isn’t able to pump as well as it used to, it can beat faster. That can cause heart palpitations, which often feel like the heart is racing or throbbing.
   
• Shortness of breath: Any difficulty breathing or doing your regular activities is a red flag to watch out for.
   
• Impaired thinking: Memory loss, confusion, or changes to your mental state can happen because the amount of oxygen and sodium in your blood changes with heart failure. It can sometimes be tricky to monitor these changes on your own. Ask loved ones to let you know if they notice a change.
   
• Other symptoms: Depending on your health and your care team, you may also be asked to track things like appetite, sleep, and certain medications.

(Your Wellframe app makes it easy to keep track of all your symptoms. Even better, the information can be sent to your care team to watch changes in real time. Log in or download the app today.)

Step 5: Keep Your Follow-Up Appointments

At follow-up appointments, your care team will track your progress and check for subtle symptom changes that may be hard to notice on your own. “We can see if there’s swelling or if a patient seems breathless,” says Dr. Anderson. “Those are helpful observations that let us know how you’re doing.”

If in-person appointments feel challenging, ask your care team if videoconferencing is available. If transportation is an issue, ask your care team about local transportation programs that might be able to help. Some cities or counties offer shuttle buses that will drive patients to and from appointments. Ride share apps like Uber and Lyft are now working with hospitals for patient discharge, appointments, and more. You can also ask your advocate to arrange for friends or family members to take turns driving you to appointments.

Step 6: Mind Your Mood

Feeling down? That’s understandable. You’ve been through a lot. But don’t assume that negative emotions will simply lift on their own.

“We can have a patient’s heart failure pretty well tuned up. But they might still feel poorly because of depression,” says Dr. Anderson. He points out that depression is linked to worse outcomes. It can interfere with your motivation to get up and move and your ability to follow through on tasks. At your follow-up visits, you’ll likely be screened for depression. But if you have concerns before you’re screened, talk to your doctor right away.

(If you think you might be depressed, Wellframe can help. The digital health management tool can connect you with your care team and mental health support. Log in or download the Wellframe app today.)

Step 7: Stay Informed

Heart failure is a complicated condition. The more you know, the better you’ll do. A study in the journal Circulation found that heart failure patients who were educated about their condition had better self-care adherence (meaning they took care of themselves at home), and they had better health outcomes.

Even after discharge, you can keep learning about your condition. Some websites to check out:

• Pumping Marvellous. This British website focuses on heart failure. Find easy-to-understand videos, webinars, and more.
   
• Heart Failure Matters. Find healthy living tips, tracking charts, videos for you and anyone assisting you, diet tips, and links to healthy recipes. You can even interact with other heart failure patients on the Facebook page.
   
• Heart Failure Society of America. Their patient tool kit has a wealth of information about heart failure. You can also learn how to connect with financial assistance programs.
   
• Mended Hearts. This is a complete online guide to heart failure, with videos, social media pages, and blogs where you can share your own story.

After being admitted to the hospital with heart failure, you might be feeling a lot of things as you prepare to head home: excitement and relief, but also uncertainty and fear. Remember that you’re not alone. And there are actionable steps you can take to stay at home and stay healthy.

SOURCES:

[1] “Heart Failure.” CDC, September 8, 2020, https://www.cdc.gov/heartdisease/heart_failure.htm. Accessed August 10, 2021.

[2] “Hospitalization for Congestive Heart Failure: United States, 2000–2010.” CDC, October 2012, https://www.cdc.gov/nchs/products/databriefs/db108.htm. Accessed August 10, 2021.

[3] Reddy YNV and Borlaug BA. “Readmissions in Heart Failure: It’s More Than Just the Medicine.” Mayo Clinic Proceedings, vol. 94, no. 10, October 19, 2019, pp: 1919-1921.

[4] Rogers AT, Bai G, Lavin RA, et al. “Higher Hospital Spending on Occupational Therapy Is Associated with Lower Readmission Rates.” Medical Care Research and Review, vol 74, no. 6, 2017.

[5] “Managing Heart Failure Symptoms.” American Heart Association, May 31, 2017, https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure/managing-heart-failure-symptoms. Accessed August 10, 2021.

[6] Koelling TM, Johnson ML, Cody RJ, et al. “Discharge Education Improves Clinical Outcomes in Patients with Chronic Heart Failure.” Circulation, vol 111, no. 2, January 18, 2005, pp: 179-185.