Overview
Heart failure is a condition where the heart cannot pump blood efficiently enough to meet the body's needs. Despite the name, the heart does not stop. Instead it pumps too weakly (systolic failure) or cannot fill adequately (diastolic failure). It causes breathlessness, fluid retention, and fatigue that progressively worsen without treatment.
How common is it?
Heart failure affects approximately 1 million people in the UK and accounts for around 5% of all medical emergency admissions.
Causes and risk factors
Heart failure usually develops when an underlying condition damages or overloads the heart muscle over time, reducing its pumping efficiency.
Common risk factors
- Coronary artery disease and previous heart attacks
- High blood pressure
- Cardiomyopathy (disease of the heart muscle)
- Heart valve disease
- Atrial fibrillation
- Diabetes
- Alcohol excess
- Obesity
Symptoms
- Breathlessness on exertion that worsens over time
- Orthopnoea: difficulty breathing when lying flat
- Paroxysmal nocturnal dyspnoea: waking suddenly gasping for breath
- Ankle and leg swelling (oedema)
- Fatigue and weakness
- Rapid or irregular heartbeat
- Persistent cough, sometimes with white or pink mucus
When to see a doctor
Seek emergency care for sudden severe breathlessness, inability to lie flat, or coughing up pink frothy sputum (acute pulmonary oedema). See a doctor for increasing breathlessness or leg swelling.
Diagnosis
NT-proBNP blood test is a highly sensitive marker for heart failure. Echocardiogram measures heart pumping function (ejection fraction) and identifies the cause. ECG, chest X-ray, and blood tests complete the assessment.
Treatments
ACE inhibitors and ARBs / ARNI
Reduce the workload on the heart, slow progression, and significantly reduce mortality. Now often prescribed as sacubitril/valsartan (Entresto) for systolic heart failure.
Beta-blockers
Reduce heart rate and improve cardiac efficiency. Bisoprolol, carvedilol, and metoprolol are the three licensed for heart failure.
SGLT2 inhibitors and diuretics
SGLT2 inhibitors (dapagliflozin, empagliflozin) are transformative new treatments reducing hospitalisation and death. Diuretics (furosemide) relieve fluid congestion symptoms.
Self-care and lifestyle
- Weigh yourself daily: a gain of more than 2kg in 2 days indicates fluid accumulation requiring medical review
- Restrict fluid intake to 1.5 to 2 litres daily if advised by your doctor
- Reduce dietary salt as sodium drives fluid retention
- Enrol in a heart failure monitoring programme with specialist nurse support
Prevention
Treating high blood pressure, coronary artery disease, diabetes, and obesity prevents many cases of heart failure. Early treatment of any heart attack to minimise muscle damage is critical.