Academy of Nutrition and Dietetics Guidelines Bundle

Heart Failure Nutrition

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Nutrition Assessment HF: Nutrition Assessment ➤ The RDN should assess the following (Table 1) in adults with HF (NYHA Classes I–IV/AHA Stages B, C and D), to formulate the nutrition care plan: Table 1. Nutrition Assessment and Monitoring and Evaluation New York Heart Association (NYHA) functional classification, which describes the severity of symptoms and exercise intolerance as follows: • Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). • Class II: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). • Class III: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. • Class IV: Unable to carry on any physical activity without discomfort. Symptoms of HF at rest. If any physical activity is undertaken, discomfort increases. Biochemical data, medical tests and medication usage: • Lipid profiles • Blood pressure and/or Doppler blood pressure • Echocardiogram (left ventricular ejection fraction 40% or less) • Complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, fasting lipid profile, liver function tests, thyroid-stimulating hormone, brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) • Use of medications, prescription and other over-the-counter medications, herbal supplements and complementary or alternative medications. Nutrition-focused physical findings: • Height, weight, body mass index (BMI) and waist circumference • Edema, congestion and shortness of breath • Cachexia and muscle wasting • Hand grip strength testing

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