After hospital discharge · Model follow-up
Heart failure: a one-week post-discharge follow-up
- Setting
- Primary care clinic
- Patient
- Mrs. Thompson, 72, was discharged seven days ago after treatment for heart failure.
- Read
- 4 min read
Before you walk in
The chart for today’s visit
Seven-day post-discharge review. This is what the doctor knows before the conversation starts.
Last visit
Admitted for acute decompensated heart failure with leg edema and orthopnea. Improved with IV diuresis and was discharged seven days ago.
Current medicines
- Furosemide 40 mg every morning
- Carvedilol 6.25 mg twice daily
- Lisinopril 10 mg daily
- Potassium chloride 20 mEq daily
Previous plan
- Daily morning weight
- Low-sodium diet
- Fluid limit 1.5 L/day
- Call for weight gain over 2 lb overnight or 5 lb in one week
- Repeat basic metabolic panel
New results and observations
- Discharge weight 68.0 kg
- Today reported home weight 69.8 kg
- Yesterday creatinine 1.6 mg/dL, discharge creatinine 1.4
- Potassium 4.8 mmol/L
Today’s tasks
- Medication reconciliation
- Assess congestion and renal warning symptoms
- Review weight diet and fluid self-management
- Create an explicit escalation and follow-up plan
Try it first
Say the doctor’s reply
Read the patient’s words, say your reply aloud, then reveal the model.
“The carvedilol twice a day, the lisinopril, and the potassium, I've taken all of those. My daughter usually sets them up for me. But the water pill, I skipped it yesterday. We had a long car trip, and I didn't want to keep needing the bathroom.”
Respond to the skipped diuretic dose without blame, and turn it into a plan for travel days.
Reveal the model reply
That's a really common problem, and I'm glad you told me. The water pill, furosemide, is what keeps the fluid off, so even one missed dose can matter. On a travel day, it's usually better to adjust the timing than to skip it. We'll write down exactly what to do on those days.
Model follow-up
Full transcript
- Doctor
Mrs. Thompson, I'm Dr. Lee. Welcome back. You left the hospital seven days ago after treatment for heart failure. What's the most important thing you want to go over today?
- Patient
My weight. It's gone up since I came home, and I'm scared it means I have to go back into the hospital.
- Doctor
That's exactly the right thing to be watching, and we'll decide together today. What did you weigh when you left the hospital, and what do you weigh now?
- Patient
It was 150 pounds when I left. This morning it was almost 154.
- Doctor
So that's up by about four pounds in a week. How is your breathing compared with when you were in the hospital?
- Patient
Better than in the hospital. But last night I needed three pillows instead of my usual two.
- Doctor
Thank you, that's an important detail. Have you noticed any swelling in your feet or ankles?
- Patient
My shoes feel tighter today. The swelling went down after the hospital, but it seems to be coming back a little.
- Doctor
Are you short of breath when you're sitting still, like right now? Any chest pain, fainting, or confusion?
- Patient
No, not sitting still. No chest pain, I haven't fainted, and my head is clear.
- Doctor
Good. Any dizziness when you stand up?
- Patient
Sometimes I feel a bit lightheaded when I stand up, but I haven't passed out.
- Doctor
Okay. Could we go through your medicines one by one? Tell me how each one has gone since you got home, including any doses that were hard to take.
- Patient
The carvedilol twice a day, the lisinopril, and the potassium, I've taken all of those. My daughter usually sets them up for me. But the water pill, I skipped it yesterday. We had a long car trip, and I didn't want to keep needing the bathroom.
- Doctor
That's a really common problem, and I'm glad you told me. The water pill, furosemide, is what keeps the fluid off, so even one missed dose can matter. On a travel day, it's usually better to adjust the timing than to skip it. We'll write down exactly what to do on those days.
- Patient
I didn't know that. I thought it was either take it or skip it.
- Doctor
Now that you know, it'll be easier. How has it gone with the low-salt food and the one-and-a-half-liter fluid limit?
- Patient
I've tried, but honestly, the discharge instructions were a lot to take in. My daughter usually organizes all of that.
- Doctor
That's completely understandable. There was a lot to take in, so I'll make it simpler in a moment. First, your blood tests from yesterday. Your kidney number, creatinine, is 1.6. When you left the hospital, it was 1.4, so it's a little higher. Your potassium is 4.8, which is in a safe range but toward the upper end.
- Patient
Is that bad? Are my kidneys getting worse?
- Doctor
It's a small change, and it can happen for two opposite reasons: too much fluid putting strain on the heart, or too little fluid in the body. Your weight, your breathing, and the swelling suggest fluid may be building up again, but I don't want to guess. So today I'd like to examine you, listen to your lungs, look at your neck and legs, and check your blood pressure lying down and standing up. Then I'll decide on the furosemide dose, whether you still need the potassium pill, and when to repeat the blood tests.
- Patient
So I don't have to go back into the hospital?
- Doctor
Not from what you've told me so far. You aren't short of breath at rest, and you haven't had chest pain or fainting. But this is an early warning sign, and we're acting on it today. If the exam shows anything more serious, I'll tell you right away.
- Patient
Okay. That's a relief.
- Doctor
You wanted something simple, so let's make a short written plan with clear numbers. Weigh yourself every morning at the same time. Call us the same day if your weight goes up by more than two pounds overnight, or five pounds in a week. Should we include your daughter when we go over it?
- Patient
Yes, please. She's the one who handles my pills, so she should hear it too.
- Doctor
Good. We'll give you both a copy. Call 911 or go to the emergency room if you're short of breath at rest, can't lie flat, have chest pain, faint, or become confused. Could you tell me in your own words when you'd call us, and when you'd call 911?
- Patient
If my weight goes up more than two pounds overnight or five pounds in a week, or my ankles or breathing get worse, I call you that day. If I'm short of breath sitting still, have chest pain, faint, or get confused, I call 911.
- Doctor
That's exactly right. After the exam, we'll set your furosemide dose, book the repeat blood test, and see you again very soon. Let's get you onto the exam table.
Flow at a glance
The route through the visit
- Open with the patient’s biggest worry
- Compare weight and symptoms with the discharge baseline
- Screen for red flags at rest and on standing
- Reconcile each medicine, including missed doses
- Explain the blood results without guessing their cause
- Examine before changing the diuretic
- Written thresholds, 911 criteria, and teach-back
Reusable language
Phrases to take into your next follow-up
- “Tell me how each one has gone since you got home, including any doses that were hard to take.”
- Medication reconciliation that invites honest reporting of missed doses.
- “On a travel day, it’s usually better to adjust the timing than to skip it.”
- Turns a missed dose into a practical, blame-free plan.
- “It can happen for two opposite reasons, and I don’t want to guess.”
- Explains clinical uncertainty and why an exam comes next.
- “This is an early warning sign, and we’re acting on it today.”
- Takes the finding seriously without causing panic.
- “Could you tell me in your own words when you’d call us, and when you’d call 911?”
- Teach-back that separates same-day calls from emergencies.
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English follow-up case as its source. The chart above is read directly from that case, and the page is checked against the same case and transcript fingerprints.
Editorial update: