Living With Heart Failure

The staff at the UPMC in Central Pa. Heart Failure Clinic will work with you and your family to develop a plan to help you live with heart failure.

How can UPMC in Central Pa. help me manage my heart failure care?

If you participate in our Heart Failure Center, you will be supervised and treated wherever you are -- whether you are in the hospital, at a skilled nursing facility, or at home.

We have three dedicated Heart Failure inpatient units (7th floor at UPMC Harrisburg, WS3 at UPMC West Shore and CG4 at UPMC in Central Pa. Community Osteopathic Hospital). Plus three other nursing units with telemetry at UPMC Harrisburg for inpatient heart failure care.

If you are admitted to the hospital, a nurse navigator from the Heart Failure Center will follow your progress, help determine why you were hospitalized, and assist the health care team to develop a plan for your return home. The nurse navigators work with the health care team to identify any personal barriers that may prevent you from following your plan of care for your heart failure, such as inability to afford your medications, lack of transportation, no close family, visual problems, etc.

All heart failure patients need outpatient and follow-up care. You should see your primary care physician (PCP), cardiologist, or nurse practitioner in the Heart Failure Center within 5-7 days of being discharged from the hospital. At UPMC in central Pa., the case managers can assist you to make this appointment. In addition, our nurse navigators will call any agency (home care, skilled nursing facility, rehab, etc.) that is responsible for your care upon discharge to coordinate your heart failure care.

What can I do to manage my heart failure care?

With proper treatment, many heart failure patients can live healthy lives for years. However, you can play an important role in keeping yourself healthy:

Recognize heart failure symptoms

After you are discharged from the hospital, it is important to recognize your individual symptoms of heart failure and know how to deal with them. The Heart Failure Program uses the STOPLIGHT (PDF). The stoplight has green, yellow, and red days.

• Green day: day: This is your baseline and your GOAL. A green day describes a day when you feel your best. You need to pick an activity you can always do on your best day and identify your symptoms on this day, if any. As your heart failure progresses, green day activities will change.
  • Examples: 1. Mr Richards states that he can do all his own personal care and yard work on a good day without any symptoms. 2. Mrs. Edwards wears oxygen at home. On her best day (while taking all her meds and following diet) she can do light house work for about 20-30 minutes before she feels any shortness of breath.
  • Checklist of good/GREEN day:
    • Able to do normal activities
    • No shortness of breath or usual amount of shortness of breath
    • No weight gain, or a gain of less than 2 pounds
    • No swelling, or usual amount of swelling
    • No chest pain

• Yellow day: WARNING ZONE (unique to each patient)
  • You begin to feel that normal activities are harder to complete due to heart failure symptoms.
  • Weight gain of 2-3 pounds overnight or gain/loss of 5 pounds in a week – you should call physician's office immediately
  • Other yellow day signs:
    • More short of breath than usual
    • More than usual swelling of ankles, feet, legs, and/or stomach
    • Dry, hacky cough
    • Dizziness
    • Uneasy feeling that something isn't right
    • Hard time breathing when lying down or needing more pillows to feel comfortable
    • If other yellow day signs persist for two days, call physician's office immediately

• Red day: EMERGENCY ZONE go to emergency room or call 911 immediately
  • Unable to do any normal activities at all due to symptoms
  • Shortness of breath unrelieved by rest
  • Chest pain unrelieved by rest or nitroglycerine
  • Feeling confused and/or unable to think clearly
  • Fainting
  • Breathless or unable to talk
  • Continuous rapid, racing heart rate

Keep a Weight Record

Heart failure can cause your body to hold water weight, so it's important to keep track of how much you weigh. Weigh yourself and record your weight each morning before you eat breakfast. Before you weigh yourself, empty your bladder and try to wear the same amount of clothing each time you weigh in. You should notify your doctor if:

• You gain more than two pounds in 24 hours or five pounds in a week.
• You begin to have trouble breathing.
• You have swelling in your arms, legs, or feet.
• Your jewelry or clothing is fitting tighter.

Track Your Fluid Intake

Too much fluid in your body can make it harder for your already-weakened heart to pump. If fluids have built up in your lungs and other parts of your body, such as your legs and stomach, your physician will order medicine (a diuretic) to help get rid of extra fluids. He or she also may suggest that you limit your liquid intake so that your body can get rid of the extra water and sodium.

If you are at home, you should limit your fluid intake to six cups per day. If you are in the hospital, your nurses and patient care assistants (PCAs) will write down your intake (how much fluid you consume) and output (how much you urinate). You can help by:

• Telling the staff when you drink liquid and eat food that is mostly liquid (jello, soup, ice cream, etc.) and keeping track of how much you eat or drink.
• Checking with your nurse before drinking any liquids given to you by your family. You may be put on fluid restriction and only allowed six glasses of fluid a day.
• Not urinating in the toilet -- all of your urine must be measured. Men must use a urinal and women must use a "hat" (a container that is placed in the toilet to collect urine).

Follow a Low-Salt Diet

Too much salt (or sodium) causes fluid to build up in your body. You must follow a low-salt diet. If you are in the hospital, you should only eat the food that is on your tray and check with your nurse or PCA before eating anything else. If you are at home, you should not add extra salt to your food and avoid salty foods.

Take Care of Yourself

When you are living with heart failure, it is important to take good care of yourself in other ways, including:

• Taking the medications that your doctor prescribes for you – and not stopping any medications without first talking to your doctor.
• Going to your doctor appointments.
• Paying attention to how you feel and reporting increased symptoms.
• Exercising as directed by your health care provider.
• Limiting alcohol and caffeine, and avoiding tobacco.
• Planning rest periods between your activities throughout the day.
• Avoiding activities that make your heart work harder, such as working with your arms above your head or sitting with your legs down for a long time.
• Avoiding extreme temperatures and humidity. When it's below 30 or above 80?, stay inside.
• Notifying your doctor right away when you are sick. Even a cold can make your heart failure worse.

Make Decisions About Your Care

Each year at your annual physician appointment, you should discuss your heart failure with your doctor and determine if it is progressing. Here are some questions you should ask:

• Discuss what you can do on your GREEN days or baseline. Are you able to do less even though you are following the ordered treatment plan?
• Is it time to make decisions about how you want to manage your heart failure? For instance, do you want to discuss being referred to another facility to be evaluated for a transplant?
• Would you like to know more about resources to manage heart failure in your home with the support of palliative care or hospice?

As heart failure progresses, it is very important to share your wishes with your family.

• Start the Conversation is an excellent program to help you begin this discussion with your loved ones and friends.
• Pennsylvania has a legal document called a POLST (Pennsylvania Orders for Life Sustaining Treatment) which can help guide the discussion.
• If you do not want to be in the hospital, we can connect you with supportive services that can help you to be comfortable in your home.

What other heart failure resources does UPMC in Central Pa. offer?

The heart failure specialists at UPMC Heart and Vascular Institute will provide you with the information, education, and resources you need to live successfully with heart failure, including:

• Low-Sodium and Stop and Go Food Pantry. The Heart Failure Program offers a low-sodium food pantry. The pantry supplies low-sodium food choices to our patients in financial need. A side benefit of the pantry is to use the food items for teaching about low-sodium food choices. In addition to the pantry, the Heart Failure Program also has a STOP-n-GO pantry. In the STOP cupboard are foods with high sodium (<140mg/serving) foods and in the GO cupboard are low sodium choices. Visuals and hands-on learning work best.
• Living with Heart Failure Booklet (PDF). You will receive this booklet on your first visit. We hope that you will bring it with you to all of your medical appointments, tests, and hospitalizations. In the booklet there are sections that your doctors and nurses will help you fill out. If there is something you would like to learn more about, please let us know.
• Heart Calendar (PDF). Each patient of the Heart Failure Program receives a heart calendar. The calendar is a tool that you can use to manage your symptoms.

Providers

• Brian Michael Corbally, DO

Need more information?

Phone: 717-231-8445

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Locations

UPMC Advanced Heart Failure Center
Located at Medical Office Building 2
2005 Technology Parkway
Suite 300
Mechanicsburg, PA 17050
Phone: 717-231-8445

UPMC Advanced Heart Failure Center
Located at UPMC Harrisburg
111 South Front Street
2nd floor
Harrisburg, PA 17101
Phone: 717-231-8445
Fax: 717-231-8459

UPMC Advanced Heart Failure Center
Located at UPMC Outpatient Services
Formerly known as Bloom Outpatient Center
4310 Londonderry Road
2nd floor
Harrisburg, PA 17109
Phone: 717-920-4201
Fax: 717-920-4269

UPMC Heart and Vascular Institute
360 Alexander Spring Road
Carlisle, PA 17013
Adult Cardiology: 717-243-6557
Pediatric Cardiology: 717-761-0200
Fax: 717-243-0102