Heart Condition

Heart Failure

Heart failure is a leading cause of hospitalisation in the UK and globally, with approximately 900,000 people living with heart failure in the UK.

The term heart failure means that the heart fails to pump enough blood around the body.

Heart failure is a long-term condition that typically gets worse over time, and is often the results of another, underlying condition.

The causes of heart failure are varied, but common causes include coronary heart disease, heart attacks, cardiomyopathy and high blood pressure. Other conditions such as arrhythmias, valve disease and congenital heart disease may also cause heart failure.

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Key Facts

Over 1 million people in the UK are estimated to have heart failure.

Causes over 100,000 admissions to hospital each year

80% of heart failure diagnoses are made in hospital

More Information on Heart Failure

In this section you can find out more about the types, causes, diagnosis, treatment and ongoing preventative measures for Heart Failure

1. Heart Failure with Reduced Ejection Fraction (HFrEF)
•       Ejection fraction (EF) ≤ 40% – The heart muscle is weakened and cannot pump blood effectively.
•       Most commonly caused by coronary artery disease, previous heart attacks, or cardiomyopathy.
•       Primary treatment focuses on medications (ACE inhibitors, beta-blockers, SGLT2 inhibitors) and device therapy (ICDs, CRTs).

2. Heart Failure with Preserved Ejection Fraction (HFpEF)
•       Ejection fraction ≥ 50% – The heart muscle contracts normally but is too stiff to fill properly.
•       Often linked to hypertension, obesity, diabetes, and atrial fibrillation.
•       Management focuses on treating underlying conditions, diuretics for symptom relief, and lifestyle interventions.

3. Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)
•       Ejection fraction 41-49%, an intermediate category.
•       Shares treatment approaches with HFrEF, though clinical management is evolving.

Stages & Classification of Heart Failure

NYHA (New York Heart Association) Functional Classification

NYHA Class       Symptoms
Class I                     No symptoms with normal activity.
Class II                   Mild symptoms with moderate activity.
Class III                 Marked limitation, symptoms with mild exertion.
Class IV                  Severe symptoms, even at rest.

ACC/AHA Staging System (Disease Progression)

  • Stage A – At risk but no structural heart disease (e.g., hypertension, diabetes).
  • Stage B – Structural heart disease but no symptoms (e.g., previous heart attack, LV hypertrophy).
  • Stage C – Structural disease with symptoms (clinically diagnosed heart failure).
  • Stage D – End-stage heart failure, requiring specialized interventions (e.g., transplant, LVAD).

Primary Causes

  • Coronary artery disease (CAD) – Blockages in heart arteries reduce blood flow.
  • Hypertension (High blood pressure) – Increases heart workload, leading to thickened walls.
  • Heart attacks (Myocardial infarction) – Damage to heart muscle reduces pumping ability.
  • Valvular heart disease – Faulty heart valves cause strain on the heart.
  • Cardiomyopathies – Genetic or acquired diseases of the heart muscle.
  • Arrhythmias (e.g., Atrial fibrillation) – Can weaken the heart over time.

Other Contributing Factors

  • Diabetes – Affects blood vessels and increases risk of HFpEF
  • Obesity & Metabolic Syndrome – Excess weight increases cardiac workload
  • Alcohol & Drug-Induced Cardiomyopathy – Chronic alcohol use, cocaine, or chemotherapy drugs
  • Thyroid Disorders – Both hypothyroidism and hyperthyroidism affect heart function
  • Viral Myocarditis – Infections can cause inflammation of the heart muscle.

Common Symptoms:

  • Shortness of breath (Dyspnea) – Worse with activity or lying flat (orthopnea).
  • Swelling (Edema) – Fluid buildup in ankles, legs, abdomen (ascites).
  • Fatigue & Weakness – Due to poor circulation and reduced oxygen delivery.

Other Key Symptoms:

  • Persistent Cough (Pink, Frothy Sputum) – A sign of pulmonary congestion.
  • Nocturnal Dyspnea – Waking up breathless at night.
  • Rapid or Irregular Heartbeat (Palpitations) – Can indicate arrhythmias.
  • Sudden Weight Gain – Fluid retention can lead to rapid weight increase.
  • Confusion & Memory Issues – Reduced oxygen to the brain can cause cognitive impairment.

Key Diagnostic Tests:

  • Echocardiogram (Echo) – Measures ejection fraction (EF) and heart structure.
  • BNP & NT-proBNP Blood Tests – Markers of heart failure severity.
  • Chest X-Ray – Checks for fluid in the lungs.
  • ECG (Electrocardiogram) – Identifies arrhythmias or past heart damage.
  • Cardiac MRI & CT Scan – Provides detailed imaging of the heart muscle.

1. Medications

First-Line Therapy (Proven to Improve Survival):

  • ACE Inhibitors / ARBs / ARNIs (Sacubitril-Valsartan) – Improve outcomes.
  • Beta-Blockers (Bisoprolol, Carvedilol, Metoprolol) – Reduce mortality.
  • SGLT2 Inhibitors (Dapagliflozin, Empagliflozin) – New, highly effective treatment for both HFrEF and HFpEF.

Symptom-Relief Medications:

  • Diuretics (Furosemide, Bumetanide) – Reduce congestion.
  • Mineralocorticoid Receptor Antagonists (Spironolactone, Eplerenone) – Helps prevent fluid retention.
  • Ivabradine – For heart rate control when beta-blockers are insufficient.

2. Device-Based Therapy

For Severe Heart Failure (Stage C/D)

  • Implantable Cardioverter Defibrillator (ICD) – Prevents sudden cardiac death.
  • Cardiac Resynchronization Therapy (CRT) – Improves coordination of heartbeats.
  • Left Ventricular Assist Device (LVAD) – A mechanical pump for end-stage HF.
  • Heart Transplant – A last-resort option for Stage D heart failure.

Lifestyle Modifications & Cardiac Rehabilitation

  • Sodium Restriction (<2g per day) – Reduces fluid overload.
  • Fluid Management – Monitoring daily fluid intake in severe cases.
  • Exercise & Cardiac Rehab – Supervised programs improve heart function.
  • Daily Weight Monitoring – Helps detect fluid retention early.

Complications of Heart Failure

If Left Untreated, HF Can Lead To:

  • Pulmonary Edema – Fluid buildup in the lungs.
  • Kidney Dysfunction – Reduced blood flow to kidneys.
  • Liver Congestion (Cardiac Cirrhosis) – Right-sided HF can cause liver damage.
  • Arrhythmias – Increased risk of AFib, VT, or VF.
  • Sudden Cardiac Death (SCD) – Risk of fatal arrhythmias.
  • Gene Therapy – Modifying genes to improve heart function.
  • Stem Cell Therapy – Investigating ways to regenerate damaged heart tissue.
  • AI & Digital Health – AI-enhanced diagnostics for early HF detection.

Health and lifestyle tips

Disclaimer: If you have a heart condition, please consult with your GP before making significant changes to your lifestyle.

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