Heart Failure

HF: Scope of Guideline (2008)

Guideline Scope Characteristics

Disease/Condition(s)

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management of patients with heart failure. Recommendations have been formulated for heart failure within the context of the ADA Nutrition Care Process.

The major focus of this guideline is on nutritional assessment and treatment, and specific dietary interventions for patients with heart failure.

This guideline is intended for use by dietetics practitioners involved in care for patients undergoing treatment for heart failure. It is hoped that the information in this guideline will be used to provide individualized nutrition care with practical nutrition recommendations that are based on the current state of nutrition science for patients with heart failure.

Below, you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Category

Assessment of Therapeutic Effectiveness, Counseling, Diagnosis, Evaluation, Management, Prevention, Treatment

Clinical Specialty

Nutrition

Intended Users

Registered Dietitians

Guideline Objective(s)

Overall Objective:

To provide MNT guidelines aimed at managing symptoms of heart failure (edema, shortness of breath, fatigue), and maintaining optimal nutrition status.

Specific Objectives:

  • To define evidence-based recommendations for registered dietitians (RDs) that are carried out in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical, nutritional and behavioral elements
  • To reduce variations in practice among RDs
  • To promote self-management strategies that empower the patient to take responsibility for day-to-day management
  • To enhance the quality of life for the patient, utilizing customized strategies based on the individual’s preferences, lifestyle and goals
  • To develop guidelines for interventions that have measureable clinical outcomes
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults who are diagnosed with heart failure (LVEF 45% or less).

Interventions and Practices Considered

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.

I. Referral to a Registered Dietitian
II. Medical Nutrition Therapy

 A. Nutrition Assessment

Below you will find the nutrition assessment terms related to heart failure care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition

• Medical history and relevant laboratory values
• Nutrition-focused assessment including:

• Height, weight and BMI
• Comprehensive diet history, including current dietary intake and willingness to undertake behavior change
• Physical activity pattern
• Psychosocial and economic issues impacting nutrition therapy
• Consideration of co-morbid conditions and need for additional modifications in nutrition care plan.

B. Nutrition Diagnosis

Below you will find the nutrition diagnoses related to heart failure care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition

• Inadequate oral food or beverage intake (NI-2.1)
• Excessive fluid intake (NI-3.2)
• Inadequate fluid intake (NI-3.1)
• Decreased nutrient (sodium) need (NI-5.4)
• Altered nutrition related lab values — BUN/CR (NC-2.2)
• Increased energy intake (NI-1.2)
• Inadequate energy intake (NI-1.4)
• Excessive energy intake (NI-1.5)
• Evident protein energy malnutrition (NI-5.2)
• Inadequate protein intake (NI-5.7.1)
• Excessive protein intake (NI-5.7.2)
• Inadequate bioactive substance intake (NI-4.1)
• Excessive bioactive substance intake (NI-4.2)
• Inadequate vitamin intake (NI-5.9.1)
• Excessive vitamin intake (NI-5.9.2)
• Inadequate mineral intake (NI 5.10.1)
• Excessive mineral intake (NI 5.10.2)
• Altered GI function (NC-1.4)
• Underweight (NC-3.1)
• Involuntary weight loss (NC-3.2)
• Involuntary weight gain (NC-3.4)
• Food and Nutrition-Related Knowledge Deficit (NB-1.1)
• Harmful beliefs/attitudes about food- or nutrition-related topics (NB-1.2)
• Not ready for diet / lifestyle change (NB-1.3)
• Self-monitoring deficit (NB-1.4)
• Limited adherence to nutrition related recommendations (NB-1.6)
• Undesirable food choices (NB-1.7)
• Limited access to foods (NB-3.2)

C. Nutrition Intervention (Planning and Implementation)
Individualized prescription based on:

1. Dietary interventions
2. Physical activity interventions
3. Behavioral interventions
4. Pharmacotherapy.

Below you will find the nutrition interventions related to heart failure care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition

• Modify distribution, type, or amount of food and nutrients within meals or at specified time Meals and Snacks (ND-1.2)

• Medical Food Supplements (ND-3.1)

• Vitamin and Mineral Supplements (ND-3.2)
• Bioactive Substance Supplement (ND-3.3)
• Feeding Environment (ND-5)
• Nutrition Related Medication Management (ND-6)
• Initial/Belief Nutrition Education (E-1)
• Comprehensive Nutrition Education (E-2)
• Cognitive-Behavioral Theory (C-1)
• Health Belief Model (C-1)
• Strategies (C-2)

Coordination of Nutrition Care
Coordination of Other Care During Nutrition Care:

• Team meetings (RC-1.1)
• Referral to RD with different expertise (RC-1.2)
• Collaboration/referral to other providers (RC-1.3)
• Referral to community agencies/programs (RC-1.4)

D.  Monitoring and Evaluation

Below you will find the nutrition monitoring and evaluation terms related to heart failure care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition 

• Beliefs and Attitudes (BE 1.1)
• Food and Nutrition Knowledge (BE-1.2)
• Ability to Plan Meals/Snacks (BE-2.1)
• Ability to Select Healthful Food/Meals (BE-2.2)
• Adherence (BE-2.4)
• Goal Setting (BE-2.5)
• Nutrition-related ADLs and IADLs (BE-4.2)

Food and Nutrient Intake Outcomes

• Energy Intake (F-1.1)
• Fluid/Beverage intake (F-2.1)
• Protein Intake (F-5.2)
• Vitamin intake (F-6.1)
• Mineral / element intake (6.2)

Nutrition-Related Physical Sign / Symptom Outcomes

• Weight / weight change (S-1.4)
• Electrolyte and renal profile (S-2.2)
• BUN (S-2.1)
• Creatinine (S-2.3)
• Nutrition quality of life (PC-1.1)

Nomenclature

Please note that the terms “patient” and ‘client” are used interchangeably throughout this guideline to describe an individual receiving care

The monitoring of progress, measuring of outcomes, and evaluating of outcomes against criteria to determine changes in specific indicators of nutrition care outcomes.