Discharge planning for a patient with systolic heart failure and an ejection fraction of 33% should include information about the benefits and side effects of which medication class?

• A. Need to begin an aerobic exercise program
• B. Use of salt substitutes to replace table salt when cooking and at the table
• C. Benefits and side effects of ACE inhibitors
• D. Importance of making an annual appointment with the primary care provider

Answer: (C)

Discharge planning for systolic heart failure should emphasize education about medications that improve survival, especially ACE inhibitors. In someone with an ejection fraction around 33%, ACE inhibitors are a cornerstone therapy because they lower afterload, reduce cardiac remodeling, and decrease mortality and hospitalizations. Therefore, patients need clear information on what benefits to expect and what side effects to watch for.

Explain that these drugs can help symptoms and long-term outcomes, often allowing better exercise tolerance and fewer decompensations, but they can cause a few notable adverse effects. Common concerns include a tendency for blood pressure to drop, leading to dizziness or lightheadedness, and the potential for hyperkalemia or changes in kidney function, so regular monitoring of blood pressure, kidney function (creatinine), and potassium is important after starting or adjusting the dose. A persistent cough is another side effect some people experience due to bradykinin buildup, and angioedema, though rare, is a serious reaction that would require stopping the medication and seeking urgent care.

Provide practical guidance: avoid potassium-rich salt substitutes while on an ACE inhibitor, understand the need for periodic lab tests, know when to contact a clinician about symptoms like swelling of the face or tongue, difficulty breathing, unusual fatigue, or significant dizziness, and plan for gradual dose titration as advised by the clinician. While other components of care, such as initiating an aerobic exercise program or keeping regular PCP follow-up, are important, the crucial discharge topic that directly relates to prognosis and safety is understanding the benefits and side effects of ACE inhibitors.