Patient information from BMJ

Heart failure

Last published:Jan 19, 2024

Heart failure is a serious condition that can be frightening to hear about. But it doesn't mean that your heart is about to stop working. There are treatments that can help, and people can live with heart failure for many years.

What is heart failure?

Heart failure means your heart isn't filling up with blood properly or it isn’t pumping blood around your body as well as it should. It usually happens because your heart has been damaged by another medical condition. For example, a heart attack can damage your heart and lead to heart failure. Other reasons might be high blood pressure, problems with the valves in your heart, or diabetes.

There are two main types of heart failure.

• Heart failure with preserved ejection fraction is sometimes known as ‘diastolic’ heart failure. This is when your heart is too stiff or rigid and can’t fill up with blood properly.

• Heart failure with reduced ejection fraction is sometimes known as ‘systolic’ heart failure. This is when your heart is too weak to pump blood around your body the way it should.

What are the symptoms?

One of the main symptoms of heart failure is feeling breathless. It's normal to gasp for breath after exercise, but if you have heart failure, you may get out of breath doing everyday things.

You may find it especially hard to breathe when you're lying down. Many people with heart failure prop themselves up with pillows at night to help with this.

Heart failure can also make you feel weak and tired. This is because your heart can't pump enough blood to your muscles to give them the energy they need.

Heart failure also causes your body to hold onto too much water. This extra water can sometimes leak into your lungs and make you cough up pink, frothy phlegm. You may find the extra water makes your feet, legs, and ankles swollen and puffy too.

Your doctor will need to examine you carefully and do some tests before they can say for sure you have heart failure. Normally, this will involve blood tests, a chest x-ray, and specific tests that will look at how your heart is working.

What treatments work?

There are several treatments that can help if you have heart failure. These medicines aim to:

• Keep your symptoms under control

• Stop your condition from getting worse

• Improve your heart health

• Reduce your risk of going to hospital, and

• Help you live longer.

One of the main reasons that people with heart failure end up in hospital is because they stop taking their medicine. Even if you don't like taking them, don't stop taking them without talking to your doctor.

Eating healthily and exercising can also help if you have heart failure. Speak to your doctor for more advice on how to get started. You can also read our leaflet Heart failure: how can I help myself? for advice on self-care.

Common medicines for heart failure

You'll probably need to take several medicines together. The medicines you take will depend on the type of heart failure you have.

• Diuretics help your body get rid of extra water. This reduces the amount of fluid in your veins and arteries, which helps to lower your blood pressure. You may need to take them for a while to help you feel less breathless and reduce the swelling in your feet and legs.

• Aldosterone antagonists are a type of diuretic that also protects your heart from a hormone that can make heart failure worse.

• ACE inhibitors, sacubitril/valsartan, and angiotensin-II receptor antagonists widen your blood vessels, which takes some of the strain off your heart.

• Beta-blockers work by slowing your heart down so it doesn't need as much oxygen.

• Sodium-glucose co-transporter 2 (SGLT2) inhibitors are generally used in the treatment of diabetes, but can help patients with heart failure too. Research has shown they have a few benefits, including reducing your risk of going to hospital because of your heart failure.

All medicines can have side effects. Depending on the medicines your doctor prescribes, you might experience cough, dizziness, tiredness, or nausea. Talk to your doctor if you get symptoms that you think are caused by your treatments. You may be able to change to a different type or dose.

Other treatments

If you're taking your treatment and you still get symptoms, make sure you see your doctor. They may suggest you try different drugs.

Surgery may also be used to treat heart failure in some cases. If the blood vessels in your heart are blocked or damaged, surgery may help to repair them. Surgery could also help if your heart failure is caused by problems with your heart valves.

For some patients, an implantable device might be recommended. If your heart doesn't beat at the right speed, or the different parts of your heart don't beat together, your doctor may suggest having a pacemaker inserted in your chest 

Or you may also have a device inserted that can shock your heart into starting again if it stops beating. This is called a defibrillator. Defibrillators are sometimes combined with pacemakers.

If you have severe heart failure, you may be considered for a left ventricular assist device or a heart transplant. A left ventricular assist device helps the left side of your heart to pump blood properly. Your doctor will give you more information about this if you reach that stage.

What will happen to me?

Being told you have a serious illness can come as a big shock. You may be wondering how heart failure will affect your future, or be worried that it will shorten your life.

It’s difficult to say exactly what will happen to you. Heart failure is a complicated illness, and it affects people differently. But lots of people with heart failure are treated successfully and live for many years.

If your heart failure gets worse for a time, you may need to go into hospital for treatment and be looked after. You may also need extra treatments at this time.

You're likely to do better if you try to keep healthy and make sure you take your medicines. Speak to your doctor about how to maintain a healthy lifestyle. You can also read our leaflet Heart failure: how can I help myself? for advice on self-care.

In cases of severe heart failure, your treatment may stop helping. If you reach this stage, your doctor may speak to you about palliative care. This is care that makes you as comfortable as possible when you have a condition that can no longer be treated.

Where to get more help and support

Heart failure is a serious condition, and it's important to get all the help and support that's available. Many people find it useful to talk to other people with heart failure. You could ask your doctor about support groups in your area. For example, in the UK, the British Heart Foundation (bhf.org.uk) keeps a list of all the heart support groups in England and Wales. You can also search online for more information.