Side effects 

Patients’ experiences of side-effects from HF medicines differ markedly. For example, some patients feel tired when they first take beta blockers and for some this may gradually improve, or they find they are able to tolerate it. Many of the medicines lower blood pressure.

To avoid symptoms patients may find it helpful to be careful when getting up quickly (lying or sitting to standing) especially if they are starting a new medicine or after a dose increase. Increased urination is a common side-effect of the SGLT2 inhibitors, and some patients find this settles after a few weeks. Advising the patient about good ‘genital hygiene’ is also helpful to reduce the risk of UTI and genital fungal infection (e.g. candida).

Lifestyle advice

Healthy heart advice for HF does not differ from other CVD conditions: diet, exercise, weight management, sensible alcohol intake and smoking cessation should be encouraged. 

Enquiring about fluid intake can be helpful. In general 2-2½ litres is a reasonable intake. Many people think this means ‘how much water do I drink’ and forget that it should include all fluids so adding in the cups or tea or coffee, soups and alcohol is needed too.

Salt intake is also important in managing fluid overload (high salt intake will lead to fluid retention). Advise patients not to add salt to food, to check food labels and learn how to choose lower salt options.