Lifestyle Medicine and Heart Failure in Viet Nam: Exercise Safety, Sodium and Fluid Management, and Guideline-Directed Therapy

Lifestyle Medicine and Heart Failure in Viet Nam: Exercise Safety, Sodium and Fluid Management, and Guideline-Directed Therapy

Last reviewed: October 30, 2026

A person recovering from hospitalization for heart failure may return home with several medications and a long list of instructions. They are told to monitor their weight, reduce salt intake, be careful about drinking water and avoid overexertion. They may also wonder whether walking more would help them regain strength.

A few weeks later, their breathing has improved and the swelling in their legs has disappeared. They begin to feel more confident about resuming everyday activities, but some questions remain. How much water can they safely drink? Should they exercise if walking still makes them breathless? And if they feel better, do they still need every prescribed medication?

These questions illustrate why heart failure management cannot rely on general lifestyle advice alone.

Physical activity can improve functional capacity in appropriately selected patients, but exercise during clinical instability may be unsafe. Avoiding excessive sodium is reasonable, yet increasingly restrictive dietary or fluid limits do not necessarily produce better outcomes. Medications that reduce hospitalization and mortality remain important even when symptoms are controlled.

For Lifestyle Medicine, the challenge is to help people adopt healthier behaviors without separating those changes from the clinical decisions on which safe heart failure management depends.

Understanding Heart Failure and Why Clinical Stability Matters

Heart failure is a clinical syndrome in which structural or functional abnormalities of the heart lead to symptoms and signs associated with impaired cardiac function or elevated cardiac filling pressures.

People may experience breathlessness, fatigue, reduced exercise tolerance, ankle swelling or difficulty breathing while lying flat. These symptoms are not specific to heart failure, however. Similar problems can occur with respiratory disease, anemia, kidney disease and other medical conditions.

Diagnosis requires appropriate clinical assessment, supported by investigations such as electrocardiography, natriuretic peptide testing and echocardiography when indicated. Identifying the underlying cause is equally important. Coronary artery disease, hypertension, valvular heart disease, cardiomyopathy and arrhythmias can contribute to heart failure through different mechanisms, and some causes require specific interventions beyond medication and lifestyle support.

The European Society of Cardiology published updated guidelines for the management of heart failure on August 28, 2026. One important change concerns classification according to left ventricular ejection fraction, which describes the proportion of blood ejected from the left ventricle during contraction.

Under the 2026 European framework, heart failure with reduced ejection fraction includes patients with a left ventricular ejection fraction below 50%. Heart failure with preserved ejection fraction involves a value of 50% or higher, together with relevant clinical features and objective evidence of cardiac structural or functional abnormalities. The previously separate category of mildly reduced ejection fraction has been removed.

This differs from Viet Nam's Ministry of Health guidance issued in 2022, which distinguishes reduced ejection fraction of 40% or lower, mildly reduced ejection fraction of 41–49%, and preserved ejection fraction of 50% or higher.

The updated European guidelines also adopt a stage-based framework, ranging from individuals at risk of heart failure to those with advanced disease. This places greater emphasis on prevention, early recognition and timely intervention before severe clinical deterioration occurs.

These frameworks describe different aspects of heart failure and should not be confused. Ejection fraction helps characterize cardiac function and guide treatment, while clinical stage and stability provide additional information about disease progression and immediate care needs.

A person with stable chronic heart failure may have persistent limitations but relatively consistent symptoms and no evidence of acute congestion or circulatory instability. With appropriate assessment and treatment, many such patients can participate safely in physical activity and rehabilitation.

A patient experiencing decompensated heart failure requires a different response. Worsening congestion, pulmonary edema, reduced cardiac output or inadequate tissue perfusion may develop gradually or rapidly. Increasing breathlessness, difficulty lying flat, worsening peripheral edema or a sudden decline in exercise tolerance may indicate deterioration and require prompt medical assessment.

Severe breathlessness at rest, chest pain, fainting, confusion or signs of serious respiratory or circulatory compromise require emergency evaluation.

This distinction is fundamental to Lifestyle Medicine. Exercise, dietary changes and self-management education can support long-term health, but they cannot replace necessary medical assessment or treatment when heart failure becomes unstable.

Exercise Can Improve Function, but the Starting Point Matters

Physical inactivity is common among people living with heart failure. Breathlessness, fatigue, fear of overexertion and previous hospitalizations may lead patients to reduce their daily activities.

Over time, inactivity can contribute to muscle weakness, reduced physical capacity and increasing difficulty performing ordinary tasks. Someone who previously walked regularly may begin avoiding stairs, household activities or short trips outside the home because these activities feel exhausting.

For clinically stable patients, appropriately prescribed exercise can help interrupt this cycle.

The 2026 European Society of Cardiology heart failure guidelines recommend personalized exercise training for stable patients unless specific contraindications are present. The separate 2026 European guidelines on cardiac rehabilitation also support comprehensive rehabilitation for people with chronic heart failure, including those with reduced or preserved ejection fraction.

Evidence from randomized trials and systematic reviews shows that exercise-based rehabilitation can improve exercise capacity and health-related quality of life. Reductions in hospital admissions have also been demonstrated, particularly among patients with reduced ejection fraction.

However, the evidence needs to be interpreted according to the outcomes studied. A consistent reduction in all-cause mortality has not been established across every heart failure population and rehabilitation intervention. For patients with preserved ejection fraction, improvements in exercise capacity and quality of life are better established than effects on mortality.

Improved physical functioning remains valuable in its own right. For someone who struggles to climb stairs, the goal may be to regain enough endurance to move around the house comfortably. Another person may want to walk to a nearby market, return to work or participate in family activities without frequent rest. These are meaningful improvements even when they do not demonstrate a change in cardiac ejection fraction or mortality risk.

Nevertheless, recommending physical activity does not mean that every patient should immediately begin a progressive training program.

Exercise training should start when the person is clinically stable and appropriate medical treatment has been initiated. Decompensated heart failure with hemodynamic instability, untreated life-threatening arrhythmias, unstable ischemic conditions and other serious cardiovascular problems may make exercise unsafe. Acute systemic illness and certain uncontrolled noncardiovascular conditions can also require postponement.

Before recommending structured activity, clinicians should consider symptoms, functional capacity, treatment status, comorbidities and possible contraindications.

For selected patients, formal cardiac rehabilitation provides an opportunity for supervised assessment, individualized exercise prescription, education and monitoring. Programs may combine aerobic exercise, resistance training and other components according to the person's clinical condition and rehabilitation goals.

The type, frequency, duration and intensity of exercise should be individualized, with progression guided by clinical response and tolerance. An older patient with frailty, anemia and significant kidney disease may require a different approach from a younger person with stable symptoms and good functional capacity.

Frailty or coexisting illness should not automatically exclude someone from rehabilitation, but these conditions can influence how a program is designed and supervised.

Breathlessness during activity also requires appropriate interpretation. Some exertional symptoms may occur during rehabilitation, but new or disproportionate breathlessness, dizziness, chest discomfort or a meaningful decline in exercise tolerance should not automatically be attributed to poor fitness.

The purpose of exercise training is to help patients regain function safely, not to encourage increasingly demanding activities regardless of symptoms.

Rehabilitation After Hospitalization Requires Particular Attention

Hospitalization for decompensated heart failure can leave patients physically weaker and less confident about returning to normal activities. Some experience considerable declines in walking ability, muscle strength and independence, particularly after prolonged hospitalization or repeated admissions.

The period surrounding discharge may also involve changes in medication, fluid balance, kidney function and blood pressure. A patient whose breathing has improved may still have residual congestion or limited physiological reserve.

The 2026 European cardiac rehabilitation guidelines support considering rehabilitation after decompensated heart failure as soon as it can be undertaken safely. This does not mean that structured exercise should begin before the patient is sufficiently stabilized.

Appropriate decongestion, hemodynamic stability, initiation of indicated medical treatment and assessment of rehabilitation readiness are important considerations. For selected patients, rehabilitation may begin during hospitalization once these requirements have been met.

In some cases, the initial focus may be on basic mobility, standing, walking short distances and rebuilding confidence in ordinary activities. Other patients may be ready for a more structured aerobic and resistance training program.

Modern cardiac rehabilitation involves more than exercise alone. Patient education, psychological support, risk-factor management, medication-related education and assistance with returning to everyday activities can all contribute to recovery.

This creates an opportunity for Vietnamese healthcare organizations to strengthen the connection between inpatient treatment, rehabilitation and post-discharge follow-up.

A hospital may successfully treat acute congestion, but the patient's longer-term recovery also depends on whether they can regain physical function, understand their treatment and obtain appropriate support after returning home.

The quality of rehabilitation should therefore not be judged simply by the number of exercise sessions completed. A more meaningful question is whether patients can perform everyday activities more safely and confidently without experiencing preventable clinical deterioration.

Sodium Management Is More Nuanced Than Strict Salt Avoidance

Sodium influences fluid balance and is therefore relevant to heart failure, particularly when congestion is present.

For many years, patients were routinely advised to restrict dietary sodium, sometimes with strict targets and limited consideration of nutritional status, appetite or the practical burden of following the diet.

Contemporary evidence has made this approach more nuanced.

The SODIUM-HF randomized trial, published in The Lancet in 2022, evaluated a structured sodium-reduction intervention in 806 ambulatory patients with heart failure.

After 12 months, the intervention group had lower reported dietary sodium intake than the usual-care group. However, the trial did not demonstrate a statistically significant reduction in its primary composite outcome of cardiovascular-related hospitalization, cardiovascular-related emergency department attendance or all-cause death.

These findings do not establish that sodium intake is irrelevant to heart failure. They indicate that the additional sodium reduction achieved in the studied population did not demonstrate the anticipated benefit for the trial's primary clinical outcome.

The absence of a statistically significant difference should also not be interpreted as definitive proof that sodium reduction provides no benefit in any patient group.

A 2024 clinical consensus statement from the Heart Failure Association of the European Society of Cardiology similarly questioned the assumption that aggressive sodium restriction necessarily improves outcomes and encouraged a more individualized approach.

Avoiding excessive sodium remains reasonable, particularly when intake is high or congestion is difficult to control. However, there is insufficient justification for assuming that progressively lower sodium intake will always produce progressively better clinical outcomes.

Very restrictive diets may reduce appetite, food variety and overall nutritional intake. This can be especially important in older patients or those experiencing frailty, poor appetite, unintentional weight loss or muscle wasting.

The appropriate objective is to support a balanced eating pattern while avoiding excessive sodium intake and unnecessary nutritional harm.

What Sodium Advice Means for Vietnamese Meals

Dietary sodium counseling in Viet Nam should reflect how food is prepared and consumed in everyday life.

Salt may be added during cooking, but sodium also comes from fish sauce, soy sauce, seasoning powders, dipping sauces, soup broths and processed or packaged foods. The amount consumed can vary considerably even when two people eat similar dishes.

A bowl of phở or another noodle soup may contain different amounts of sodium depending on the broth, seasonings and portion consumed. Someone who drinks most of the broth may have a different sodium intake from someone who leaves much of it behind.

Similarly, a meal prepared at home may contain a different amount of sodium from a comparable dish purchased at a restaurant or workplace canteen.

These differences make generalized lists of prohibited Vietnamese foods less useful than understanding the patient's actual eating habits.

Healthcare professionals can help patients identify the main sources of sodium in their usual meals and consider practical changes that preserve dietary variety and nutritional adequacy.

For some people, using less dipping sauce or consuming less salty broth may be a realistic starting point. For others, packaged foods, preserved foods or frequently purchased restaurant meals may contribute more to overall sodium intake.

Nutrition education should also distinguish sodium from salt. The two terms are related but are not interchangeable. One gram of sodium is approximately equivalent to 2.5 grams of salt, and misunderstanding this distinction can lead to incorrect interpretation of food labels.

Potassium-containing salt substitutes deserve particular caution. Some reduced-sodium salt products replace part of the sodium chloride with potassium chloride. Although this can lower sodium intake, these products may be unsuitable for patients with impaired kidney function or those receiving medications that increase serum potassium.

Several commonly used heart failure therapies, including medicines targeting the renin–angiotensin system and mineralocorticoid receptor antagonists, can affect potassium balance.

Consequently, switching to a potassium-based salt substitute should not automatically be considered safer. The decision should reflect kidney function, serum potassium, current medication and the patient's overall clinical condition.

Culturally appropriate nutrition support should help people make practical choices within their usual eating patterns rather than impose an unnecessarily restrictive diet that is difficult to maintain.

Fluid Restriction Should Reflect the Patient's Clinical Condition

Advice about drinking water is another area where traditional heart failure management has been reconsidered.

Some patients receive fixed daily fluid limits without a clear understanding of whether those restrictions are related to congestion, low serum sodium or other medical circumstances.

However, the evidence supporting routine fluid restriction in stable chronic heart failure is limited.

The FRESH-UP randomized trial, published in Nature Medicine in March 2025, compared advice for liberal fluid intake with restriction to 1,500 milliliters per day among 504 ambulatory patients with chronic heart failure.

After three months, the primary outcome, measured using the Kansas City Cardiomyopathy Questionnaire overall summary score, did not show a statistically significant difference between the groups.

Patients assigned to fluid restriction experienced greater thirst-related distress, while the study did not demonstrate a statistically significant difference in the reported safety outcomes.

These findings challenge the assumption that routine fluid restriction necessarily improves health status in stable chronic heart failure.

They do not establish that unlimited fluid intake is safe, that the two approaches are equivalent in every respect or that individualized fluid restrictions are never necessary.

The results apply to the population and circumstances studied. They should not automatically be extended to patients with acute pulmonary congestion, severe fluid retention, significant hyponatremia or other conditions requiring closer fluid management.

The 2024 Heart Failure Association consensus supports a more individualized approach to fluid intake. The 2026 European heart failure guidelines also recognize that managing decompensated heart failure requires appropriate control of fluid balance, primarily through effective treatment of congestion.

For selected patients, including some with hyponatremia, fluid restriction may be appropriate as part of a supervised treatment plan.

The clinical objective is not simply to minimize or maximize water consumption. It is to maintain an appropriate fluid balance while avoiding congestion, dehydration and electrolyte disturbances.

This distinction has practical relevance in Viet Nam.

Hot and humid weather, outdoor work, prolonged travel, fever, vomiting and diarrhea can influence fluid requirements. Someone exposed to substantial heat and sweating may face different challenges from a person remaining indoors in a temperature-controlled environment.

At the same time, a patient with significant congestion or impaired kidney function may have limited capacity to tolerate additional fluid.

Diuretic treatment introduces further considerations. Changes in fluid intake, medication, kidney function and electrolyte balance can interact, particularly during illness or periods of unstable heart failure.

Patients also need to understand what is included in a prescribed fluid allowance. Depending on the individualized plan, this may involve total fluid consumed from beverages and liquid foods such as soup, rather than drinking water alone.

This is particularly relevant to Vietnamese meals, where soups and broth-based dishes are commonly consumed.

Thirst alone may not always provide a reliable assessment of fluid balance. Severe thirst can occur during aggressive diuresis or fluid restriction, while congestion may develop even when a person does not believe they are drinking excessive amounts.

Patients therefore need individualized instructions about fluid intake, monitoring and when to contact their treating team.

Someone who has been prescribed a specific fluid restriction should not independently discontinue it or increase fluid intake substantially on the basis of general online advice.

The appropriate recommendation depends on the person's current clinical condition, not simply on a universal daily volume.

Guideline-Directed Medical Treatment Remains Central

Lifestyle interventions can support cardiovascular health and daily functioning, but they do not replace medical treatments that have demonstrated benefits for reducing serious heart failure outcomes.

The 2026 European Society of Cardiology guidelines introduce the term foundational medical therapy to describe treatments with strong recommendations for reducing heart failure hospitalization or death in relevant patient populations.

For heart failure with reduced ejection fraction, foundational treatment generally includes appropriate medicines targeting the renin–angiotensin system, evidence-based beta-blockers, mineralocorticoid receptor antagonists and sodium–glucose cotransporter-2 inhibitors.

These treatments act through different physiological mechanisms and have demonstrated benefits in clinical trials. Their selection, dosing and suitability depend on the patient's condition, and the amount of supporting evidence is not identical across all ejection fraction ranges.

The updated European guidelines also recommend sodium–glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists across symptomatic heart failure phenotypes, including preserved ejection fraction, while recognizing differences in the strength and nature of the demonstrated benefits.

For patients with preserved ejection fraction, evidence supporting some of these treatments is more strongly driven by reductions in heart failure hospitalization than by a consistent reduction in mortality considered separately.

This distinction matters when explaining treatment benefits and discussing expectations with patients.

Other medications, including loop diuretics, remain important for relieving congestion and associated symptoms. However, not every medicine serves the same purpose.

A diuretic may produce noticeable improvement in breathlessness and swelling, while another medication may be prescribed primarily because of evidence that it reduces the risk of future hospitalization or death.

Improvement in symptoms after diuretic treatment does not establish that disease-modifying medication is no longer required. Similarly, improvement in ejection fraction does not automatically justify withdrawing foundational treatment.

The 2026 European guidelines recommend continuing effective foundational treatment when tolerated, including in patients whose symptoms or ejection fraction have improved.

They acknowledge that carefully supervised treatment withdrawal may be considered in exceptional, highly selected circumstances when a clearly reversible cause has been successfully treated and cardiac function, structure and relevant biomarkers have normalized.

These decisions require specialist assessment, close monitoring and careful consideration of relapse risk. They should never be interpreted as general advice for patients to stop medication once they feel better.

Lifestyle Medicine should therefore support the safe use and continuity of indicated treatment rather than present medication reduction as a measure of success.

Medication Safety Requires Clinical Monitoring

Heart failure treatment often involves several medications that affect blood pressure, kidney function, electrolyte balance and fluid status. These effects require clinical monitoring, particularly when treatment is initiated or doses are adjusted.

Medicines targeting the renin–angiotensin system and mineralocorticoid receptor antagonists may increase serum potassium. Diuretics can contribute to changes in sodium, potassium, kidney function or blood pressure.

Sodium–glucose cotransporter-2 inhibitors have important benefits for appropriately selected patients with heart failure, including many people without diabetes. However, they still require clinical assessment, including attention to fluid status, kidney function and potential adverse effects in particular circumstances.

A patient experiencing dizziness, marked weakness, hypotension or abnormal laboratory results may need medication review. Nevertheless, minor or anticipated changes in laboratory measurements do not always justify stopping beneficial treatment.

The 2026 European guidelines emphasize avoiding inappropriate discontinuation of foundational therapy because of misinterpretation of kidney function changes.

Medication decisions should consider the overall clinical picture, including symptoms, blood pressure, congestion, laboratory findings and the risks associated with treatment interruption.

Patients should not independently stop beta-blockers, change diuretic doses or discontinue other heart failure medications simply because their weight or symptoms have changed.

Some people may have individualized clinician-directed plans for responding to specific changes, but these instructions need to be established in advance and understood clearly.

Medication reconciliation is also important. Nonsteroidal anti-inflammatory drugs and certain other prescribed or nonprescription products can worsen heart failure, fluid retention or kidney function in susceptible individuals.

Someone taking medication for pain or another condition may not recognize its potential effect on heart failure management. Regular review of prescribed medicines, nonprescription products and supplements can help identify avoidable risks and reduce confusion.

The aim is to maintain treatments with demonstrated benefit while addressing adverse effects and unnecessary medication burden through appropriate clinical decisions.

Self-Monitoring Should Lead to Useful Action

People living with chronic heart failure are often encouraged to monitor their weight, symptoms and other relevant indicators.

For some patients, regular weight monitoring can help identify fluid accumulation before more severe symptoms develop. However, body weight is influenced by more than fluid balance. Changes in food intake, bowel habits, muscle mass and other factors can affect measurements.

A single change in weight should not automatically trigger medication adjustment without an agreed clinical plan.

The value of monitoring lies in recognizing meaningful patterns. Increasing breathlessness, worsening swelling, difficulty lying flat, reduced exercise tolerance and changes in weight may warrant clinical review, particularly when several changes occur together.

Patients need to understand which findings require routine communication with their healthcare team and which may indicate an urgent problem. The appropriate thresholds and response plans should be individualized by the treating team.

Self-management is not simply asking people to record numbers. It involves helping them understand why monitoring matters, what changes may indicate and how to respond safely.

For some patients, a simple written record may be sufficient. Others may benefit from digital monitoring tools or structured follow-up calls. The best approach depends on clinical needs, health literacy, resources, preferences and the person's ability to use the information.

Monitoring should reduce uncertainty and support timely care rather than make patients responsible for interpreting complex clinical changes without professional assistance.

Treatment Continuity After Hospital Discharge

The period following hospitalization for heart failure can be particularly challenging.

Patients may leave the hospital with changes in medication, unresolved functional limitations, new monitoring instructions and concerns about recurrence. Clinical recovery may continue after discharge, while kidney function, blood pressure, congestion and medication tolerance still require reassessment.

The 2026 European guidelines emphasize treatment optimization and appropriate follow-up after decompensated heart failure.

The purpose is not simply to arrange another appointment. Follow-up needs to identify residual congestion, review medication safety, manage comorbidities and respond to problems that could lead to avoidable readmission.

Practical obstacles can affect whether this happens.

Some patients may have difficulty returning for appointments because of transportation costs, employment commitments or family responsibilities. Others may receive prescriptions from different healthcare providers and become uncertain about which treatment plan is current.

Someone may understand why a medication is necessary but still have difficulty obtaining it consistently.

These problems should not automatically be interpreted as poor treatment adherence. They may reflect financial, organizational or communication barriers that need practical solutions.

Coordination among hospital specialists, outpatient services, primary care practitioners, pharmacists, rehabilitation professionals and other appropriate providers may help maintain continuity.

Communication becomes particularly important when a patient moves between hospitals, returns to a provincial healthcare facility or begins follow-up closer to home.

Healthcare professionals need to know whether important laboratory results have been reviewed, medication changes have been communicated and the patient understands when further assessment is necessary.

A discharge summary alone does not guarantee that treatment can continue safely.

The value of coordinated care lies in making sure that important findings lead to appropriate actions and that patients can obtain the care they need over time.

Evidence and Practical Opportunities in Viet Nam

Viet Nam has an established national professional resource for heart failure diagnosis and treatment.

On July 5, 2022, the Ministry of Health issued Decision No. 1857/QĐ-BYT, introducing the Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure.

The document addresses diagnosis, classification, chronic heart failure treatment, acute heart failure management and relevant clinical investigations.

The Vietnam National Heart Association subsequently published a professional update in 2024 to supplement its 2022 recommendations, incorporating newer evidence and acknowledging challenges in implementing contemporary treatment.

These challenges include clinical factors such as low blood pressure, kidney dysfunction, frailty and comorbidities, as well as financial and practical limitations.

The 2026 European guidelines provide a more recent international evidence framework. However, they do not automatically replace Vietnamese professional guidance or establish the regulatory approval, reimbursement or local availability of particular medications, devices and procedures.

For healthcare professionals in Viet Nam, the appropriate approach is to consider international evidence alongside national recommendations, current regulatory requirements and the individual patient's circumstances.

Research conducted in Viet Nam also provides useful insights into practical models of heart failure care.

A prospective cohort study published in the Journal of Medical Internet Research on March 19, 2025, evaluated a simplified telemedicine model among 426 patients with heart failure and reduced ejection fraction at the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi.

Of these participants, 121 received remote monitoring and management, while 305 received usual care.

During 12 months of follow-up, the telemedicine group had a lower adjusted risk of the study's composite outcome of unplanned heart failure hospitalization or all-cause death.

The difference was primarily driven by fewer heart failure hospitalizations. The study did not demonstrate a statistically significant reduction in all-cause mortality when that outcome was considered separately.

The results therefore should not be interpreted as proof that telemedicine reduces mortality.

The study was observational, so differences between the groups and other unmeasured factors may have influenced outcomes. It was also conducted at a single specialist center among selected patients with reduced ejection fraction and previous hospitalization.

Its findings cannot be generalized automatically to every heart failure population or healthcare facility in Viet Nam.

Nevertheless, the research provides useful support for further evaluation of practical models that connect home monitoring, professional communication and timely clinical responses.

The 2026 European cardiac rehabilitation guidelines also recognize the potential role of home-based, remote and hybrid rehabilitation models for appropriately selected patients.

These approaches may help overcome barriers to access, but they still require suitable patient selection, clinical oversight and the ability to respond when deterioration is suspected.

For healthcare organizations in Viet Nam, one useful starting point may be strengthening existing treatment pathways rather than establishing a separate Lifestyle Medicine service.

A clinically stable patient with reduced exercise capacity may benefit from appropriate referral to cardiac rehabilitation. Someone with excessive dietary sodium intake may need practical nutrition support based on familiar meals. A patient with recurrent congestion may require better monitoring, medication review and follow-up arrangements.

These interventions are connected, but they are not interchangeable.

A patient experiencing worsening congestion needs appropriate medical assessment, not a generic exercise program. Someone with poor appetite, unintentional weight loss or muscle wasting should not automatically receive restrictive dietary advice.

Physicians, nurses, pharmacists, clinical nutrition professionals and rehabilitation practitioners can contribute according to their qualifications, competence and legally authorized responsibilities.

The most appropriate service model will depend on the healthcare facility's capacity, referral arrangements and the needs of the people it serves.

The central question is whether patients can obtain coordinated, safe and effective care over time.

Measuring Outcomes That Matter to Patients

Healthcare organizations may measure how many patients receive nutrition counseling, attend rehabilitation sessions or complete self-management education.

These measures are useful for describing service delivery, but they do not necessarily establish that care has improved.

More meaningful evaluation considers functional outcomes, clinical events, treatment safety and the patient's experience.

For cardiac rehabilitation, relevant outcomes may include exercise capacity, daily functioning and health-related quality of life. For chronic heart failure management, hospitalizations, recurrent decompensation, medication optimization and mortality may be important, depending on the purpose and design of the evaluation.

For self-management support, organizations can assess whether patients understand their treatment plans, recognize warning signs and receive appropriate follow-up after reporting concerning changes.

Patient-reported outcomes provide information that clinical measurements alone may miss.

Someone may describe meaningful improvement because they can sleep without breathlessness, walk a short distance without frequent rest or resume ordinary household activities. These changes matter even when ejection fraction has not improved.

Conversely, improved ejection fraction should not automatically be interpreted as complete recovery if the patient continues to experience symptoms, functional limitations or other clinical risks.

Measures also need to be interpreted according to the strength of the evidence.

An observational reduction in hospitalization does not establish that an intervention reduces mortality. Improved knowledge after an education session does not prove that long-term treatment adherence or clinical outcomes have improved.

A responsible evaluation should distinguish what was delivered, what changed and whether the change can reasonably be attributed to the intervention.

This approach supports Lifestyle Medicine as an evidence-based component of healthcare rather than a collection of general wellness activities.

Professional Responsibilities and Legal Boundaries in Viet Nam

Lifestyle Medicine can contribute to heart failure care through evidence-based education, appropriate nutrition, physical activity support, behavior change and attention to the social circumstances affecting long-term health.

However, diagnosing heart failure, interpreting echocardiography and laboratory investigations, determining clinical stability, prescribing medication and managing decompensated heart failure are regulated clinical activities.

In Viet Nam, the Law on Medical Examination and Treatment provides the relevant legal framework. Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026, reflects the consolidated legal provisions.

Healthcare professionals must act within their qualifications, competence and legally authorized scope of practice.

Education or certification in Lifestyle Medicine does not independently authorize an individual to diagnose heart failure, prescribe medication, adjust diuretics or provide specialized clinical rehabilitation beyond their permitted professional responsibilities.

The Ministry of Health's Decision No. 1857/QĐ-BYT remains an important national professional reference for heart failure diagnosis and treatment.

International recommendations, including the 2026 European Society of Cardiology guidelines, can inform professional education, evidence review and clinical quality improvement. However, they do not automatically constitute Vietnamese regulatory requirements.

The use of particular medicines, devices, procedures and clinical services must comply with applicable Vietnamese regulations, approved indications and institutional requirements.

Heart failure monitoring also involves personal health information.

Weight records, symptoms, medication histories, laboratory results and remote monitoring data must be handled in accordance with applicable confidentiality and personal data protection obligations.

Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, are relevant to the collection, processing and sharing of identifiable health information.

Healthcare organizations using digital follow-up or remote monitoring should establish appropriate safeguards, lawful processing arrangements and clear responsibilities for managing patient information.

Patients should receive understandable information about how their data are collected, used and shared, in accordance with applicable legal requirements.

For the Vietnam Lifestyle Medicine Alliance, the appropriate contribution is to promote professional education, scientific knowledge sharing and responsible implementation of evidence-based care.

Educational activities and published articles should not be presented as individualized medical advice, official clinical treatment protocols or authorization to undertake regulated healthcare activities.

Better Heart Failure Care Is Not About More Restriction or Less Medication

Heart failure challenges several familiar assumptions about healthy living.

More exercise is not always better when the condition is unstable. Drinking less water does not necessarily improve outcomes in stable chronic heart failure. Extremely restrictive sodium diets may create burdens without delivering the anticipated clinical benefits.

Feeling better after treatment also does not mean that medications with proven prognostic benefits have become unnecessary.

The evidence available in 2026 supports a more individualized approach.

Clinically stable patients can often benefit from appropriate exercise and rehabilitation. Dietary and fluid recommendations should reflect congestion, nutritional status, kidney function, medication use and daily circumstances.

Guideline-directed medical treatment remains central to reducing serious outcomes, while structured education and coordinated follow-up can help people understand and maintain their care.

For Viet Nam, an important opportunity is to translate this evidence into practical healthcare services that connect hospital treatment, rehabilitation, outpatient management and support for daily living.

The contribution of Lifestyle Medicine is not to provide a competing set of instructions about food, water or physical activity. It is to help healthcare professionals and patients make safer, more informed and more sustainable decisions within a coherent medical treatment plan.

Success should not be judged by how much salt or water a person has restricted, how many steps they walk or how many medications they no longer take.

It should be reflected in better functional capacity, fewer avoidable complications, appropriate treatment continuity and improvements in the outcomes that matter most to the person living with heart failure.

Evidence-based Lifestyle Medicine has a responsible role in heart failure care when it strengthens, rather than replaces, effective medical treatment.

Selected References

1. Køber L, Adamo M, Ruwald AC, et al. 2026 ESC Guidelines for the Management of Heart Failure. European Heart Journal. 2026;47(38):5346–5457. Published online August 28, 2026. doi:10.1093/eurheartj/ehag100.

2. Bäck M, Wilhelm M, Marcin T, et al. 2026 ESC Guidelines on Cardiac Rehabilitation. European Heart Journal. 2026;47(39):5631–5729. Published online August 28, 2026. doi:10.1093/eurheartj/ehag099. Corrected October 23, 2026. doi:10.1093/eurheartj/ehag887.

3. Mullens W, Damman K, Dhont S, et al. Dietary Sodium and Fluid Intake in Heart Failure: A Clinical Consensus Statement of the Heart Failure Association of the ESC. European Journal of Heart Failure. 2024;26(4):730–741. doi:10.1002/ejhf.3244.

4. Herrmann JJ, Brunner-La Rocca HP, Baltussen LEHJM, et al. Liberal Fluid Intake Versus Fluid Restriction in Chronic Heart Failure: A Randomized Clinical Trial. Nature Medicine. 2025;31:2062–2068. doi:10.1038/s41591-025-03628-4.

5. Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of Dietary Sodium to Less Than 100 mmol in Heart Failure (SODIUM-HF): An International, Open-Label, Randomised, Controlled Trial. The Lancet. 2022;399(10333):1391–1400. doi:10.1016/S0140-6736(22)00369-5.

6. Ministry of Health of Viet Nam. Decision No. 1857/QĐ-BYT, dated July 5, 2022. Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure.

7. Vietnam National Heart Association. 2024 Update on the Diagnosis and Treatment of Heart Failure: Supplement to the 2022 Recommendations.

8. Nguyen HTT, Tran HB, Tran PM, et al. Effect of a Telemedicine Model on Patients With Heart Failure With Reduced Ejection Fraction in a Resource-Limited Setting in Vietnam: Cohort Study. Journal of Medical Internet Research. 2025;27. doi:10.2196/67228.

9. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. Published online October 28, 2025. doi:10.1177/15598276251379821.

10. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026. Law on Medical Examination and Treatment.

11. National Assembly of Viet Nam. Law No. 91/2025/QH15, dated June 26, 2025. Law on Personal Data Protection. Effective January 1, 2026.

12. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025. Detailing Certain Articles and Measures for the Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

Editorial, Clinical and Legal Disclaimer

This article is published by Vietnam Lifestyle Medicine Alliance (VLMA) for general information and professional education. VLMA is a professional education and knowledge-sharing platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. The article provides an evidence-informed discussion of Lifestyle Medicine in heart failure care and does not constitute an official clinical practice guideline, individualized medical advice, a diagnosis, an exercise prescription, a dietary or fluid management prescription, a medication recommendation or a treatment protocol.

The information must not be used to diagnose heart failure, determine clinical stability, prescribe rehabilitation, establish an individual's sodium or fluid limits, initiate or discontinue medication, adjust diuretics or manage decompensated heart failure without appropriate professional assessment.

Exercise, nutrition and other lifestyle interventions may support heart failure management but must not replace clinically indicated medication, medical monitoring, rehabilitation or specialist treatment.

People experiencing severe or rapidly worsening breathlessness, chest pain, fainting, confusion or other concerning symptoms should seek urgent medical evaluation. Acute clinical deterioration or decompensated heart failure may require emergency treatment.

International recommendations discussed in this article, including the 2026 European Society of Cardiology guidelines, do not automatically constitute Vietnamese clinical standards or confirm the regulatory approval, availability, reimbursement or suitability of particular medicines, devices or interventions in Viet Nam.

Clinical decisions must be individualized and undertaken by appropriately qualified healthcare professionals acting within their legally authorized scope of practice and the applicable requirements governing healthcare facilities in Viet Nam.

This article does not endorse any particular commercial diet, fluid-management program, exercise service, supplement, monitoring device, medication brand or healthcare provider. Identifiable patient information must be handled in accordance with applicable confidentiality and personal data protection requirements.

The content reflects the scientific evidence, clinical recommendations and regulatory information reviewed as of October 30, 2026, and may require updating as research and applicable Vietnamese requirements evolve.