01 — Introduction

Introduction

Your Heart, Your Mind, in Your HandsHeart held in hands

A Self-Management Guide for Living Well with Heart Failure

RE-FRAME your wellbeing: Learning how to strengthen your mental wellbeing and manage heart failure with confidence.

This resource is designed to help patients develop healthy habits and strategies to manage their wellbeing and live better with heart failure.

CCAER Research
Santé Bruyère Health
Brain-Heart Interconnectome
Archipel
Great River / Grand Fleuve

Section icons: exercise, social, journal, sleep, nutrition, meditation

Heart Failure Self-Management

Patient self-management, also known as self-care, is an essential part of heart failure treatment1. It is the ability of a heart failure patient to recognize and understand their signs and symptoms and then implement appropriate self-care strategies to alleviate them or minimize their impact on their engagement in activities of daily life1,2.

Mental Health

Brain with colourful flowers representing mental wellness

Along with physical symptoms of heart failure, like fatigue and shortness of breath, individuals with this condition often experience challenges with their mental health2–4. Compared to the general Canadian population, those with heart failure are at greater risk for anxiety, depression, and stress5.

We acknowledge that not everyone experiences these symptoms severely enough to seek help, nor is everyone comfortable discussing mental health with providers or loved ones. This is why we created this tool.

Our goal is to educate patients on the link between mental well-being and heart failure and provide evidence-based strategies for improving mental health independently.

How is this guide organized?

This tool is divided into five different sections. The sections can be read in any order, and you can choose which area you would like to learn more about.

Depending on where you are in your heart failure journey, some of these recommendations may not be the best fit. We suggest exploring the activities that feel most relevant or meaningful to you.

Illustration of people planning and organizing their time

Who is this guide for?

While this guide was written for people living with heart failure, we recommend sharing it with your loved ones and people that you trust. Reading and discussing this guide together can help them understand how to better support you in your heart failure journey.

Couple sitting on a couch reading books together

What’s in This Guide?

Vegetable basket

Nutrition

Our diet plays a big role in how we feel every day6,7. Paying attention to what we eat can boost our mood, energy levels, heart health, and quality of life. Eating healthier can improve mental well-being and lead to better heart failure outcomes6,7.

This section will show you ways to enjoy a well-balanced diet that supports good health. Click here to learn more.

Brain and heart exercise illustration

Exercise

When you move your body, your heart has to pump more blood to your muscles8. Doing this regularly helps your heart get stronger and better at its job8. People with heart failure who exercise often report feeling more physically able and stronger, and experience improvements in their overall heart failure symptoms9.

Since movement is so beneficial, this section will help you find enjoyable ways to add more movement to your day. Click here to learn more.

Person watering a brain with a flower

Mental Health

Heart failure comes with its own set of challenges and can lead to high levels of stress. As a result, patients living with heart failure are at a higher risk of depression and anxiety5. Since the brain and the heart are connected, experiencing poor mental health can also harm the health of our hearts10.

This section will teach you wellness practices that improve mental health and heart failure. Click here to learn more.

Two people connecting puzzle pieces together

Social Support and Social Inclusion

Social support has a positive impact on both mental and physical health11,12. When we feel supported by others, we tend to be more satisfied with our relationships12. Strong social connections also help people manage heart failure more effectively13.

This section will give you tips on how to improve your social support network and feel more connected to your community. Click here to learn more.

People caring for the earth and nature

Daily Wellness

Our daily choices can support our health goals. Sleeping well and spending time in nature boost the health of people living with heart failure14,15. Those who think positively also show good health outcomes16. Limiting alcohol, avoiding smoking, and engaging in meaningful activities are other choices that improve heart health17,18.

This section will show you ways to make more informed choices that will improve your well-being in the long run. Click here to learn more.

Person reflecting

About this Tool

Brain and heart combined icon representing the FRAME intervention

This tool is part of the Heart Failure × Mental Health FRAME intervention that aims to support patients, caregivers, and providers in improving the awareness, recognition, discussion, and management of mental health among individuals living with heart failure.

FRAME Intervention

Foundation — Build your understanding of the connection between heart health and mental well-being.

Recognition — Identify early signs and risk factors for emotional distress, depression, anxiety and stress.

Awareness — Understand how heart failure can affect mood, relationships, identity, and quality of life.

Management — Learn and apply self-management strategies to care for your brain and heart health.

Engagement — Connect patients and caregivers with community resources and support preventative practices.

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Self-Management Guide — Full PDF

Download the complete guide as a PDF to read offline or share with your care team.

Download PDF →

References

  1. Lancey A, Slater CE. Heart failure self-management: a scoping review of interventions implemented by allied health professionals. Disabil. Rehabil. 2024;46(21):4848–4859. https://doi.org/10.1080/09638288.2023.2283105.
  2. Jiang Y, Wang W. Health Promotion and Self-Management Among Patients with Chronic Heart Failure. In: Haugan G, Eriksson M, editors. Health Promotion in Health Care – Vital Theories and Research. Cham: Springer International Publishing; 2021. p 269–285.
  3. Ontario Health. Heart Failure: Care in the Community for Adults Quality Standards [Internet]. Toronto (ON): Ontario Health; 2022 [cited 2025 Jun 17] p. 47. Available from: https://www.hqontario.ca/evidence-to-improve-care/quality-standards/view-all-quality-standards/heart-failure.
  4. Zhao Z, Liu P, Jin J, Wang W. Effects of non-drug interventions on anxiety and depression in patients with heart failure: A systematic review based on Bayesian network meta-analysis. J Psychiatr Res. 2023;161:348–357. https://doi.org/10.1016/j.jpsychires.2023.02.039.
  5. Rashid S, Qureshi AG, Noor TA, Yaseen K, Sheikh MAA, Malik M, et al. Anxiety and Depression in Heart Failure: An Updated Review. Curr. Probl. Cardiol. 2023;48(11):101987. https://doi.org/10.1016/j.cpcardiol.2023.101987.
  6. Yu X, Chen Q, Xu Lou I. Dietary Strategies and Nutritional Supplements in the Management of Heart Failure: A Systematic Review. Front Nutr. 2024;11:1428010. https://doi.org/10.3389/fnut.2024.1428010.
  7. Joseph Firth, James E Gangwisch, Emeran A Mayer. Food and mood: How Do Diet and Nutrition Affect Mental Wellbeing? BMJ. 2020;369:m2440. https://doi.org/10.1136/bmj.m2440.
  8. Morris JH, Chen L. Exercise Training and Heart Failure: A Review of the Literature. Card Fail Rev. 2019;5(1):57–61. https://doi.org/10.15420/cfr.2018.31.1.
  9. Ladwig KH, Baghai TC, Doyle F, Hamer M, Herrmann-Lingen C, Kunschitz E, et al. Mental health-related risk factors and interventions in patients with heart failure: a position paper endorsed by the European Association of Preventive Cardiology (EAPC). Eur. J. Prev. Cardiol. 2022;29(7):1124–1141. https://doi.org/10.1093/eurjpc/zwac006.
  10. Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, et al. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021;143(10). Available from: https://doi.org/10.1161/CIR.0000000000000947.
  11. Acoba EF. Social support and mental health: the mediating role of perceived stress. Front Psychol. 2024;15:1330720. https://doi.org/10.3389/fpsyg.2024.1330720.
  12. Drageset J. Social Support. In: Haugan G, Eriksson M, editors. Health Promotion in Health Care – Vital Theories and Research. Cham: Springer International Publishing; 2021. p. 137–144.
  13. Platz K, Cavanagh CE, Metzger M, Park LG, Howie-Esquivel J. Effects of Social Isolation and Loneliness on Heart Failure Self-care: A Cross-sectional Analysis. J Cardiovasc Nurs. 2025;40(3):218–27. https://doi.org/10.1097/JCN.0000000000001123.
  14. Zheng T. Sleep disturbance in heart failure: A concept analysis. Nursing Forum. 2021;56(3):710–716. https://doi.org/10.1111/nuf.12566.
  15. Mao G, Cao Y, Wang B, Wang S, Chen Z, Wang J, et al. The Salutary Influence of Forest Bathing on Elderly Patients with Chronic Heart Failure. IJERPH. 2017;14(4):368. https://doi.org/10.3390/ijerph14040368.
  16. Sin NL. The Protective Role of Positive Well-Being in Cardiovascular Disease: Review of Current Evidence, Mechanisms, and Clinical Implications. Curr Cardiol Rep. 2016;18(11):106. https://doi.org/10.1007/s11886-016-0792-z.
  17. Ezekowitz JA, O’Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33(11):1342–433. https://doi.org/10.1016/j.cjca.2017.08.022.
  18. Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, et al. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021;143(10). Available from: https://doi.org/10.1161/CIR.0000000000000947.
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