Less than 10% of heart failure patients comply with advice on salt and fluid restrictions, daily weighing, and physical activity, according to a study presented at the Heart Failure 2019 Conference.

Failure to adhere to lifestyle recommendations or regularly take medications contributes to worsening heart failure symptoms and a raised risk of hospitalisation. Breathlessness, swollen ankles and legs, and tiredness occur because the heart can no longer pump effectively. Fluid backs up in the lungs and is retained in parts of the body, and the muscles receive insufficient blood and oxygen.

Daily weighing flags up worsening fluid retention, while salt and fluid restrictions help keep fluid retention under control. Physical activity improves energy levels and quality of life. This study examined adherence to these four recommendations in 475 patients with chronic heart failure using the Revised Heart Failure Compliance Scale.

Following the recommendations was defined as “every day” or “three times a week” for weighing and "most of the time" or "all the time" for salt, fluid, and exercise. Just 7% of patients followed all four non-drug recommendations. Compliance with medication and regular check-ups was higher, at 58%.

Nearly 48% did no physical activity, and 19% very rarely exercised. Some 25% and 17% never or very rarely adhered to fluid restrictions, respectively. While 13% never and 22% very rarely restricted salt intake. More than half of the patients (54%) weighed themselves less than once a week, and 17% did it once a week.

“It is worrying that fewer than one in ten patients observed all of the lifestyle advice,” said Professor Jankowska-Polańska. “We also found that women were less compliant than men, and patients over 65 had poorer scores than younger patients.”

Independent predictors of non-compliance

Multivariate analysis showed that loneliness, a higher number of comorbidities, and more physically limiting heart failure were independent predictors of non-compliance to the four recommendations.

Study author Natalia Świątoniowska said: “Patients with comorbid conditions may find it difficult to understand and follow all of the medical advice. For example, those with heart failure and kidney disease have more than ten pills to take and some guidance may appear to be conflicting.”

Doctors and nurses need to encourage better self-care in their patients with heart failure, said Professor Jankowska-Polańska. “Patients need clear written instructions on how to exercise for example, while text messages or phone calls can be used as reminders. It’s important to check that patients understand the advice, tailor the recommendations, and assess adherence at every visit.

“It can be difficult for patients with heart failure to stick to lifestyle advice. Family members, in particular, have a big influence and it’s a good idea to involve them with meal preparation, physical activity, and reminders to check weight.”