Heart failure at home: the daily weight and the warning signs

The NHS definition is that heart failure is when the heart cannot pump blood properly, and that it does not mean the heart has stopped working or is about to stop working. It can come on suddenly, after a heart attack or an infection, or build up over years alongside high blood pressure or coronary heart disease. There is no cure at present, but there is a great deal of treatment, and the British Heart Foundation describes it as a condition where the heart needs support to work better.

What that means at home is more ordinary than it sounds. The tablets get taken, the weight gets written down, the legs get looked at, and somebody rings the nurse when the pattern changes. The health conditions guide covers the same rhythm for other long-term conditions, and if breathing is the harder half of the picture, COPD and oxygen at home covers the lungs rather than the heart.

1. 1

   Leave the scales in one place, on a hard floor

   Once

   Scales moved between rooms, or standing on a bathmat, give different readings. The point is comparing today with yesterday rather than knowing the true number.
2. 2

   Weigh first thing, after the toilet, before breakfast

   Every morning

   The British Heart Foundation advises weighing at the same time each morning, after the toilet, in similar clothes. That removes most of what would make the number bounce around.
3. 3

   Write it down the same morning

   Every morning

   A paper chart on the fridge or a note on a phone. The BHF asks people to track the weight by writing it down, because one morning tells you little and a fortnight tells you a great deal.
4. 4

   Compare with the last few days, not with last year

   Every morning

   A jump or a steady climb is what matters. A gain of two to four pounds, roughly one to two kilos, over a day or two with no obvious explanation is what services ask to hear about.
5. 5

   Take the chart to every appointment

   Clinic and GP

   The nurse reads a fortnight of weights faster than anybody can describe them, and the chart often answers the question the appointment was booked for.

The number that should trigger a phone call varies with the person's size and usual weight. The BHF says even an increase of one to two pounds can be significant, and an NHS trust heart failure service asks patients to ring on a gain of three to four pounds, or one to two kilos, within two days with no explanation. Ask the nurse which number applies to your relative and write it at the top of the chart, so nobody has to judge it at seven in the morning. Standing on scales is hard if balance is poor, so say so if it is not possible, because the team can watch for fluid in other ways.

The middle band is where a family makes the most difference. Fluid building for two days is usually managed at home with a change to the water tablets and a follow-up call. The same fluid two weeks later is much harder to treat, and is often why somebody ends up on a ward. The BHF puts it plainly: catching a build-up of excess fluid early can prevent hospital admission.

Ask the team for a written plan if there is not one already, with your relative's usual weight, the gain that means ringing, the number in working hours, and what to do at the weekend. Pin it where the scales are. If your relative has recently come out of hospital, hourly care after a hospital stay covers the first fortnight at home, when readmissions happen.

Most of the salt comes from bread, soup, cheese and ready meals rather than the cellar on the table. Cooking without added salt needs something in its place, whether pepper, lemon or herbs, or the food stops being eaten. Losing weight because meals have become dull does not help, and nutrition and hydration for the elderly covers keeping meals worth eating.

Nights often wear a family out first, because breathlessness lying flat and the toilet trips that come with a water tablet both land after midnight. If somebody is getting up several times a night, overnight care explains what a carer does between bedtime and morning, and waking night or sleeping night? sets out the difference between a carer who sleeps and one who stays awake.

If you want somebody calling in daily to keep an eye on the weight and the legs, you can search for carers near you and compare their rates. Every carer has had their identity and right to work checked, holds an enhanced DBS on the Update Service, and has been interviewed online, and carers are insured while they work. We do not check qualifications, training or references, so what a carer says about their experience with heart conditions is their own account on their profile, for you to ask about. PrimeCarers is an introductory service rather than an agency or a care provider: carers are self-employed, and you agree the visits and the rate with them directly.

Where heart failure sits alongside oxygen, a catheter or a hoist, the arrangement moves into complex care, built around a clinical plan with the community nursing team involved.