1.	Maintain patient on 2- to 3-g sodium diet. Follow daily weight. Monitor standing blood pressures in the office, as these patients are prone to orthostasis. Determine target/ideal weight, which is not the dry weight.
	In order to prevent worsening azotemia, some patients will need to have some edema. Achieving target weight should mean no orthopnea or paroxysmal nocturnal dyspnea. Consider home health teaching.
2.	Avoid all nonsteroidal anti-inflammatory drugs because they block the effect of ACE inhibitors and diuretics. The only proven safe calcium channel blocker in heart failure is amlodipine (Lotrel).
3.	Use ACE inhibitors in all heart failure patients unless they have an absolute contraindication or intolerance. Use doses proven to improve survival and back off if they are orthostatic. In those patients who cannot take an ACE inhibitor, use an angiotensin receptor blocker like irbesartan (Avapro).
4.	Use loop diuretics (like furosemide [Lasix]) in most NYHA class II through IV patients in dosages adequate to relieve pulmonary congestive symptoms. Double the dosage (instead of giving twice daily) if there is no response or if the serum creatinine level is > 2.0 mg per dL (180 μmol per L).
5.	For patients who respond poorly to large dosages of loop diuretics, consider adding 5 to 10 mg of metolazone (Zaroxolyn) one hour before the dose of furosemide once or twice a week as tolerated.
6.	Consider adding 25 mg spironolactone in most class III or IV patients. Do not start if the serum creatinine level is > 2.5 mg per dL (220 μmol per L).
7.	Use metoprolol (Lopressor), carvedilol (Coreg) or bisoprolol (Zebeta) (beta blockers) in all class II and III heart failure patients unless there is a contraindication. Start with low doses and work up. Do not start if the patient is decompensated.
8.	Use digoxin in most symptomatic heart failure patients.
9.	Encourage a graded exercise program.
10.	Consider a cardiology consultation in patients who fail to improve.