The pharmacy team can play an important role in supporting patients with heart failure. General advice should be given regarding cardiovascular health including:

• Smoking cessation 
• Healthy eating
• Exercise – regular physical activity will improve both general health and the symptoms in heart failure. Patients should be offered access to tailored cardiac rehabilitation programmes
• Moderation of alcohol intake.

Strict fluid restriction is not required unless severe fluid overload is present. In patients where congestion is a problem, fluid intake should be kept to a level of two to 2.5 litres per day. Strict salt restriction is not required but moderating salt intake is important. Patients should be advised not to add extra salt to food and to choose lower salt options where possible. Salt substitutes should be avoided as these contain potassium, which may lead to an increased risk of hyperkalaemia.

Ensure patients are aware of the signs and symptoms of heart failure and advise them to make an early self-referral to their GP or heart failure team if they develop worsening symptoms of dyspnoea, oedema, sudden weight gain or nocturnal symptoms of breathlessness
or cough.

Recognise where doses of medication have not been optimised and refer back to the GP or heart failure team for consideration of dose titration.

This high-risk group should be offered the influenza vaccine annually and the pneumococcal vaccine as a one-off.

Advice should be given to avoid prescribed or over-the-counter NSAIDs, effervescent formulations (due to high salt load) and cough/cold remedies containing a sympathomimetic, as well as advising patients to check any herbal remedies before taking them.

Further information

• Pumping Marvellous
• British Heart Foundation
• Heart Failure Matters