Heart failure: symptoms, treatments and outcomes

Heart failure is the leading cause of hospital admissions in adults over 65 in the UK and the prognosis is often worse than some types of cancer. Over one million people in the UK  have heart failure with around 200,000 people diagnosed each year. Heart failure occurs when your heart muscle becomes weak or tired and consequently, can’t pump blood around your body effectively. 

Symptoms of heart failure

Heart failure causes a variety of symptoms, including breathlessness, reduced exercise tolerance, fatigue, tiredness, swollen ankles and difficulty breathing when sleeping at night. 

Early symptoms can often be quite subtle ie a slight reduction in your stamina when exercising or being slightly more breathless when walking up the stairs. Given the life-limiting nature of heart failure, which can also be fatal, it is important to pick up these symptoms early and seek medical help as soon as possible. 

Late diagnosis can significantly reduce your lifespan; currently, half of all individuals diagnosed with heart failure in the UK do not survive beyond five years from their diagnosis. 

Causes of heart failure

There are many reasons why your heart may become weak or tired. Possible causes of heart failure include a previous heart attack or coronary artery disease, heart valve disease, high blood pressure, diabetes, poor kidney function (eg due to chronic kidney disease), a family history of the condition (a genetic predisposition) or certain drugs such as chemotherapy. 

Drinking too much alcohol or certain infections can also increase your risk of heart failure. 

Types of heart failure 

There are two main types of heart failure: systolic heart failure, also known as heart failure with reduced ejection fraction (HFrEF) and diastolic heart failure, also known as heart failure with preserved ejection (HFpEF).

Systolic heart failure refers to a weak or tired heart muscle that can’t effectively pump blood around your body. This may be the result of various causes such as high blood pressure, coronary artery disease or an inherited disease. 

Diastolic heart failure also prevents effective pumping of the blood around the body and produces the same symptoms as systolic heart failure. However, when the heart is imaged, it appears to be contracting normally. The underlying cause of diastolic heart failure isn’t clear but may be due to stiffness in the heart muscle, specifically in the lower left chamber (left ventricle). 

Diagnosing heart failure

Heart failure is underdiagnosed in the UK; individuals are often diagnosed with other conditions such as acid reflux, anxiety, asthma and depression. This is because the symptoms of heart failure are varied and aren’t always easy to interpret. 

If you’re concerned that you have symptoms of heart failure, it is important to see your GP who will ask you about your medical history and symptoms. They can then refer you for a simple blood test called a natriuretic peptide test. This tests for a substance made by the heart called NT-proBNP. High NT-proBNP levels suggest you may have heart failure. 

You will then be referred for an imaging test called echocardiogram, which will capture images of your heart to check for changes in the muscle. You may then need further tests to investigate your heart function, which will help determine your treatment plan. 

Treating heart failure

Treatment for heart failure involves advanced pharmacotherapy ie advanced medications. 

For individuals with systolic heart failure, there are four main medications that are prescribed together: beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), mineralocorticoid receptor antagonists (MRAs) and sodium-glucose co-transporter 2 inhibitors (SGLT2i).

If these medications alone aren’t enough to significantly improve the function of your heart, your doctor may recommend device therapy. This involves using a pacemaker to ‘re-synchronise’ your heart allowing it to pump blood more effectively or using a defibrillator to detect life-threatening changes in your cardiac rhythm (arrhythmia) and subsequently restart your heart or stop the arrhythmia, respectively.

Outcomes for heart failure 

Heart failure is a persistent, progressive disease that results in a gradual decline in your health. Without treatment, this gradual decline can be punctuated with periods of severe deterioration in your health where hospitalisation is needed. Over time, with worsening symptoms, there is an increased risk of sudden death. 

In contrast, with treatment, it is possible to prolong your life and significantly improve your quality of life so you can remain active. With the advent of device therapy, data on the health of your heart can be sent remotely to your doctor. This allows for closer monitoring so interventions can be made to help you avoid going into hospital. 

Reducing your risk of heart failure

The key to reducing your risk of heart failure is following a heart-healthy lifestyle. This means exercising regularly, following a healthy, balanced diet, quitting smoking and only drinking alcohol in moderation, so that you can minimise conditions that put you at risk of heart failure (eg diabetes and high blood pressure). 

Living with heart failure

It is important to take your medication as prescribed in addition to following a healthy lifestyle. Hopefully, with optimal treatment, you should be able to continue with life as normal.

If you have a pacemaker or defibrillator, you will need to discuss how this may affect your ability to drive. If your symptoms are stable, you can still fly and engage in sexual activity. 

It is important to make sure your vaccinations are up to date, such as your annual influenza, pneumococcal and COVID vaccinations. 

Author biography

Dr Matthew Kahn is a Consultant Cardiologist at Spire Manchester Hospital, Spire Kenmore Clinic and the NHS Liverpool Heart and Chest Hospital. He is the Cheshire and Mersey Network Lead for Heart Failure and Complex Devices, and our local Heart Failure and pacemaker specialist at Spire Healthcare. He has a special interest in heart failure and complex pacing and defibrillator implantation. He is accredited by the European Heart Rhythm Association and holds a PhD from the University of Leeds. You can find out more about Dr Kahn on his website.

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