1 , What is heart failure Heart failure is a group of clinical syndromes caused by various heart diseases in which cardiac blood output is reduced and cannot meet the metabolic needs of the body, and is clinically characterized by insufficient blood perfusion to organs and tissues, fluid retention, and stasis of blood in the body and/or pulmonary circulation. It is well known that the heart is a pump that is responsible for transporting blood throughout the body, minute by minute, and is an organ that never stops. Therefore, heart failure occurs once the heart fails to function to provide adequate pumping function. Heart failure is the ultimate common denominator of most cardiovascular diseases, with the main clinical manifestations being dyspnea, weakness, decreased exercise tolerance and fluid retention. The progression of the disease is gradual, requiring repeated hospitalization, with a 3-month readmission rate of 24%-31%. 2, fluid retention and its consequences Simply put, fluid retention is an excess of fluid in the body, mainly salt (sodium and water), which accumulates in the lungs, liver, digestive tract and other tissue spaces, causing a series of symptoms. For example, fluid accumulation in the lungs can cause difficulty in breathing, limited physical activity, and in severe cases, shortness of breath even when sitting at rest, seriously affecting the quality of life. When symptoms become severe enough, hospitalization is required. 90% of heart failure patients are hospitalized because of fluid retention. 3, What is heart failure ultrafiltration therapy Heart failure ultrafiltration therapy is the use of special equipment, through the puncture of a vein, the blood is drawn out, then passed through a special blood filter to remove the salt and water, and finally the blood is returned to the body. During the treatment the patient can visualize the extracorporeal circulation of the blood and see the slow discharge of excess water from the body into the bag. In clinical practice, only a lower blood flow rate, a fine blood circuit and a slow ultrafiltration rate can meet the requirements of ultrafiltration therapy. 4 . What is the efficacy of ultrafiltration treatment for heart failure From the results of clinical studies published at home and abroad, compared with conventional drug treatment, ultrafiltration treatment can rapidly relieve symptoms such as dyspnea, shorten hospitalization time, improve quality of life, and reduce re-hospitalization rate, and the efficacy of a single treatment can be maintained for 3 months. As fluids are slowly removed, shortness of breath symptoms usually improve within a short period of time, or may begin to improve only after a few hours, depending on the amount of fluid retention, type of heart failure, and cardiac function status. The 2013 American College of Cardiology guidelines for the management of heart failure recommend ultrafiltration for patients with heart failure who have fluid retention to address congestive symptoms and fluid retention. The recommendation of international authoritative guidelines signifies that ultrafiltration has become the standard of care for heart failure. Although the risks associated with the use of heart failure-specific ultrafiltration devices are minimal, patients need to be aware of the possible risks associated with them. (1) Bleeding, hematoma, thrombosis and infection at the venipuncture site; (2) Bleeding caused by anticoagulants; (3) Clotting in the blood filter, which is likely to occur in people with hypercoagulable blood; (4) Hypotension, which requires a lower ultrafiltration rate; (5) Allergic reactions. 7. How to cooperate with ultrafiltration treatment The doctor in charge will assess the need for ultrafiltration treatment and the possible benefits and risks of this treatment based on cardiovascular history, medical condition, physical examination and laboratory indicators. This treatment requires puncturing a vein in the thigh or upper extremity in order to administer the treatment. During treatment, the nurse will advise the patient to maintain proper positioning to avoid knots in the venous cannula and blood lines, which may interfere with blood flow; to use anticoagulants for extracorporeal circulation to prevent the formation of blood clots; to regularly measure blood pressure, heart rate and blood tests; to describe changes in symptoms, especially chest tightness, shortness of breath, abdominal fullness, etc., to the health care provider at regular intervals; to cooperate with the nurse to Accurately record the amount of fluids taken orally, urine and other routes of fluid intake and output; and measure body weight as required. All these elements help the doctor to evaluate the effect of treatment and make appropriate treatment adjustments. 8. Choose ultrafiltration or diuretics Diuretics are the basic treatment for heart failure. About 50% of patients can achieve dry weight with diuretic therapy, and the other half of patients have poor or ineffective results. It is worth noting that 30% of patients will develop resistance to long-term medication, and the poor efficacy of diuretics is one of the important reasons for repeated hospitalization. Clinical practice proves that ultrafiltration therapy is the gold standard for the treatment of fluid retention as it can remove excess body fluid in a regular and quantitative manner. 9. Treatment cost In developed countries, ultrafiltration has become a routine treatment for heart failure. The total cost of one treatment in the United States is about 3000-5000 USD, of which the cost of disposable consumables is 1100 USD. The treatment is in its infancy in China, and patients need to consult the staff of their hospitals for the specific treatment cost. 10. What is dry weight? Dry weight is the weight when there is no fluid retention, i.e., when there is no excess sodium or water in the body. In fact, weight gain in heart failure patients is due to the increase of water in the body (water weight), and weight loss means a reduction of fluid retention, so weight change is a simple objective indicator of fluid retention. Heart failure patients achieve dry weight in order to address symptoms such as dyspnea and edema, and for other therapeutic measures to work. The ideal therapeutic goal for heart failure patients is to achieve dry weight and maintain it. Weight: a barometer of fluid retention Weight is the simplest objective indicator of fluid retention. Weight is measured on an empty bladder every morning after waking up, with daily clothing intact and on an empty stomach. If weight increases in a short period of time, it means that fluid retention has rebounded, usually accompanied by increased asthma symptoms and decreased activity tolerance. At this point, it is necessary to consult the doctor, adjust the treatment and, if necessary, re-treat with ultrafiltration. Patients should fully understand the severity of fluid retention and limit sodium intake in an effort to achieve and maintain dry weight. Low-salt diet: fluid retention is first and foremost sodium retention. An increase of 7 grams of sodium chloride in the body will be accompanied by 1000 ml of water accumulation. Therefore, patients should limit their daily salt intake to 2-3 grams, including other salt-rich foods: such as soy sauce, salted duck eggs, and cured meats. Also limit fluid intake and control the amount of fluid entering the body through all means, such as drinking water, soup, drinks, etc. 13, how to arrange daily activities Daily physical activity should follow the principle of “gradual, within reach, symptom limitation, combination of static and dynamic”. Activities should not feel short of breath, fatigue, heart rate not more than 100 times / min, you can do housework, walking, tai chi, etc. Regular activities help to improve the heart function reserve, prevent venous thrombosis. 14, what does the basic treatment of heart failure include After heart failure patients are discharged from the hospital with symptoms relieved, they still need to adhere to long-term drug therapy and implement the “golden triangle” treatment concept. The core drugs include beta blockers, converting enzyme inhibitors and aldosterone antagonists, and the dose of drugs must also be up to standard. 15, How to communicate effectively with the doctor Before the patient sees the doctor, he or she needs to be prepared for the following elements, which are important for the doctor to determine the condition. (1) major symptoms, such as shortness of breath, difficulty sleeping at night, cough, urine output, appetite and diet; (2) maximum physical activity tolerance, how many meters on foot, how many floors, whether he/she can bathe and do household chores; (3) recent weight change chart; (4) type, dosage and administration of medications.