How often will I see my doctor if I have heart failure?
How often you see your doctor mostly depends on how far your heart failure has progressed and how severe your symptoms are. If you have class I or II heart failure, you may see your doctor only 2 or 3 times a year to assess the status of your heart, evaluate your overall health, and review important issues about your diet and lifestyle. You might speak with a nurse or physician assistant in your doctor's office more often to answer basic questions between visits.
If you have more advanced heart failure and therefore more severe symptoms, you will probably see your doctor more often, even as frequently as once per month. Your doctor may also ask you to contact nursing staff regularly so that changes in your condition can be monitored. If your heart failure is severe enough, your doctor may have a nurse evaluate you regularly at your home. However, usually even advanced heart failure can be managed well with minor adjustments in your medicines every few months.
During these follow-up visits, you may have tests done to monitor your condition to make sure that you are on the medicine schedule that is best for you and to evaluate you for early signs of complications.
If your heart failure is particularly difficult or drug-resistant, you may wish to seek treatment from a heart failure specialist, which is a cardiologist who specializes in heart failure treatment. These doctors may know more about the latest treatments or may have access to research studies that are testing new drug regimens.
Monitoring the progression of your heart failure
It is important to closely monitor how your disease is progressing to determine whether your treatment is working or whether it should be adjusted. In most cases your doctor will monitor the progress of your disease clinically, that is, based on your symptoms and physical signs rather than through tests. At each visit, your doctor will ask you whether your symptoms have become worse. Common signs of worsening heart failure include weight gain, increased ankle swelling, increased shortness of breath during the day, and difficulty breathing while lying flat.
It is also important to note any change in your exercise capacity. For example, if you used to become short of breath after 2 blocks and now it only takes 1 block, your symptoms have gotten worse and you should tell your doctor.
At each visit, your doctor will also perform a physical exam to look for signs that your heart failure is getting worse. Increased "crackles" in your lungs, swelling in your ankles, or weight gain all can indicate a worsening of the disease which may mean that your treatment should be changed.
Your doctor may order a new test called a brain natriuretic peptide (BNP) test, or the b-type natriuretic peptide test. This blood test can help your doctor follow your progress and adjust your treatment when needed. BNP is a hormone that your heart releases when its workload increases. The BNP level rises when heart failure is present or gets worse; it drops when heart failure is successfully treated.
In some cases, especially if your doctor thinks that your disease has progressed, he or she may order a follow-up echocardiogram to estimate your ejection fraction and screen for worsening valvular diseases. For example, in people whose heart failure is caused by coronary artery disease (CAD), progression of CAD that leads to severe ischemia or heart attack may have decreased the heart's pumping action.
Your doctor may order an electrocardiogram periodically to monitor any changes in your heart's rhythm or electrical activity. You may need other tests to further evaluate you for progression of CAD.
| Author: | Robin Parks, MS | Last Updated: September 1, 2006 |
| Medical Review: | Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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