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Non-pharmacological management and patient self-management New

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Non-pharmacological management

Salt intake
  • The quantity of salt in the diet should be adapted to the clinical situation, severity of symptoms and baseline consumption
  • The evidence base to support dietary salt restrictions is limited
Fluid intake
  • Strict limits on fluid intake (2L/day) should only be imposed when there is a clear fluid overload or demonstrated sensitivity to fluid intake
  • The evidence base to support fluid restrictions is limited and severely limiting intake may have adverse consequences
Alcohol consumption
  • Alcohol consumption should be limited for all patients with HF
  • Alcohol consumption should be avoided altogether if it is believed to be responsible or contributing to the syndrome
Smoking cessation
  • All attempts should be done to promote smoking cessation (smoking has been linked to the progression of coronary artery disease)
  • Nicotine replacement therapy and other smoking cessation therapies are acceptable
  • Refer patients for counselling
Physical activity
  • Support patients with NYHA HF types I-III to gradually increase regular physical activity to improve HF symptoms, quality of life of physical activity capacity (physical activity intolerance is recognized as a hallmark of HF)
  • Physical activity in patients with NYHA HF type IV should be supervised by experts
  • Aerobic activity: Start with 10-15 minutes 2-3 times/week, working way up to a goal of 30 minutes 5 times/week
  • Resistance activity: 10-20 repetitions with 5-10-pounds of weight, 2-3 times/week
Weight monitoring
  • Patient should weigh themselves every morning (after voiding and before breakfast), and record their weights
  • Patients should report weigh increases of ≥ 1kg per day or > 5kg per week

Patient self-management

Work in partnership with patients and caregivers to create a care plan.

Care plans should include information on the self-management strategies patients and caregivers should do and the frequency and include important resources for them to reference. Many patients will benefit from having clear instructions as opposed to multiple options based on a given situation. Consider discussing the potential options with the patient and caregiver before determining the instruction provided in their care plan.

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Health Canada has approved the Pfizer vaccine for use in children aged 5 and over and the Moderna vaccine for use in children aged 12 and over. The Pfizer vaccine will be administered at a lower dose (10 mcg of mRNA) in children ages 5-11, compared to the 30 mcg dose for ages 12 and over. The recommended interval between doses of the pediatric Pfizer vaccine is 8 weeks (56 days). In light of the Omicron variant both NACI and the Ontario Immunization Advisory Committee continue to recommend this interval in order to optimize for a strong and robust immune response in children. It is recommended as a precaution that children ages 5-11 do not receive the Pfizer COVID-19 vaccines within 14 days of other vaccinations. (MOH, November 22, 2021, Health Canada, November 19, 2021, Public Health Ontario, December 23, 2021)

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Primary care has a critical role to play in the effort for a successful flu campaign. Aside from physically administering the vaccine, communication by trusted health professionals about the importance of the vaccine is directly linked to its uptake: 69% of survey respondents reported that the opinion of their family doctor, general practitioner or nurse practitioner was an important factor in their decision to get the flu vaccine

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Supporting your patient

Additional Community-based Mental Health Support

211Ontario: Regional community mental health centres, geriatric psychiatry services, and support groups.

ConnexOntario: Mental health system navigation and information. Mental health: 1-800-531-2600 | Addictions: 1-800-565-8603 Directory of publicly funded regional service coordination and case management services.

Hope for Wellness: Mental health counselling and community-based cultural and emotional support for Indigenous people. 1-855-242-3310

Talk4Healing: 24/7 talk, text, and chat to support Indigenous women by Indigenous women. 1-888-200-9997 Regional mental health organizations, clinics, workshops, conferences, and support groups.

Togetherall: Virtual community of anonymous support to help improve mental health and wellbeing. Free access through some organizations, colleges, and universities.

Educational Supports for Patients, Families, and Caregivers

Here to Help: Reading material about depression and anxiety disorders. 

Mindfulness 101: Information about mindfulness and informal ways of practicing mindfulness everyday.

Clinical Support for Providers

ECHO Ontario Mental Health: Virtual training and capacity building platform that links expert interdisciplinary teams with front line care providers.