HF: Scope of Guideline (2017)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

Guideline Scope Characteristics

Below, you will find a list of characteristics that describe the scope of this guideline.

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management of adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D). Recommendations have been formulated within the context of the nutrition care process. The focus of this guideline is on dietary and physical activity interventions for heart failure.

This guideline is primarily intended for use by registered dietitian nutritionists (RDNs) involved in the management and treatment of adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D). Clinical judgment should be used when evaluating patients with co-morbid conditions. It may also be a valuable resource for other health care professionals involved in the care and treatment of heart failure. In addition, other stakeholders (e.g., public health and nutrition program and policy planners, and hospital and community outreach workers) may find the information in this guideline helpful to assess effective practice in the nutrition management of heart failure in adults or for consumer education purposes.

The scope of this guideline is not intended for the following:

Interventions typically within the scope of practice of a certified exercise physiologist or other professional, for which, adequate training in physical activity interventions and other therapies is necessary.

Prevention of heart failure

Children and teens.

The information in this guideline should be used to provide individualized nutrition care with practical nutrition recommendations that are based on the most current evidence to treat heart failure.

Guideline Category

Management, Treatment

Clinical Specialty

Cardiology, Emergency Medicine, Nephrology, Nursing, Nutrition, Pharmacology, Physical Medicine and Rehabilitation

Intended Users

Registered Dietitians, Advanced Practice Nurses, Allied Health Personnel, Health Care Providers, Nurses, Pharmacists, Physical Therapists, Physician Assistants, Physicians

Guideline Objective(s)

Overall Objective

To provide Medical Nutrition Therapy (MNT) guidelines for adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D).

Specific Objectives

To define evidence-based recommendations for RDNs that are carried out in collaboration with other healthcare providers

To guide practice decisions that integrate medical and lifestyle interventions (nutrition, physical activity and behavioral elements)

To reduce variations in practice among RDNs

To promote self-management strategies that empower the patient to take responsibility for day-to-day management and to provide the RDN with data to make recommendations to adjust MNT or recommend other therapies to achieve clinical outcomes

To enhance the quality of life for the patient, utilizing customized strategies based on the individual’s preferences, lifestyle and goals

To develop content for intervention that can be tested for impact on clinical outcomes

To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Advanced Aged (80 years and over), Male, Female

Target Population Description

Adults with heart failure (NYHA Classes I - IV/AHA Stages B, C and D).

Comparison of ACCF/AHA Stages of Heart Failure (HF) and New York Heart Association (NYHA) Functional Classifications

ACCF/AHA Stage NYHA Functional Classification

Stage A At high risk for HF but without structural heart
disease or symptoms of HF None

Stage B Structural heart disease but without signs or
symptoms of HF Class I No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.

Stage C Structural heart disease with prior or current
symptoms of HF Class I No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.

Class II Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results
in symptoms of HF.

Class III Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity
causes symptoms of HF.

Class IV Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.

Stage D Refractory HF requiring specialized interventions Class IV Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.

Interventions and Practices Considered

The Heart Failure Evidence-Based Guideline is based on the Academy of Nutrition and Dietetics' Nutrition Care Process and Model, which involves the following steps. Terms relevant to the treatment of adults with heart failure come from the International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process. Fourth Edition.

Nutrition Assessment

Nutrition Diagnosis

Nutrition Intervention

Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process.

I. Referral to a Registered Dietitian Nutritionist
II. Medical Nutrition Therapy.

Proceed to Statement of Intent

Return to HF Home Page

ACCF/AHA Stage		NYHA Functional Classification
Stage A	At high risk for HF but without structural heart disease or symptoms of HF	None
Stage B	Structural heart disease but without signs or symptoms of HF	Class I	No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.
Stage C	Structural heart disease with prior or current symptoms of HF	Class I	No limitation of physical activity. Ordinary physical activity does not cause symptoms of HF.
		Class II	Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in symptoms of HF.
		Class III	Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms of HF.
		Class IV	Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.
Stage D	Refractory HF requiring specialized interventions	Class IV	Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest.