The following lifestyle advice should be given to all patients with chronic heart failure:

• Stop smoking – pharmacy teams can refer patients to smoking cessation clinics
• Those with alcohol-related heart failure should abstain from drinking
• Have the annual influenza vaccination
• Have the once-only vaccination against pneumococcal disease
• Participate in a supervised group exercise-based rehabilitation programme
• Restrict salt intake to no more than 6g per day (2.5g sodium)
• Regularly monitor weight. Patients should also understand the common signs and symptoms of worsening heart failure, such as increased shortness of breath with a decrease in exercise tolerance and weight gain of more than 2kg in two days.

Reflection exercise

Contact your GP surgery, your community cardiac services or your local hospital and identify your local heart failure clinics. How do they operate and what policies are in place for heart failure drug therapy review and optimisation? What local information does your hospital and heart failure service provide to patients?