Living with Heart Failure

What is Heart Failure?

Heart failure means the heart isn’t pumping blood sufficiently to keep up with the body’s needs. It can me quite mild or very severe and symptoms can include fluid build-up, breathlessness, swollen ankles/legs, needing extra pillows at night, and feeling tired. It can be both acute (comes on quickly and severely, requiring urgent attention) or chronic (long-lasting, with symptoms coming and going over many years).

There are two types of heart failure:

Where the pumping function of the heart is reduced and therefore it isn’t capable of pumping blood around the body as well. This is called Heart Failure with Reduced Ejection Fraction or HFrEF for short There are many different causes of this but common causes include heart attacks and cardiomyopathy (weakness of the heart muscle).
Where the heart muscle is stiff and doesn’t relax well. This creates a heart filling problem and is called Heart Failure with Preserved Ejection Fraction or HFpEF for short. There are a number of causes for this but it happens more commonly as the heart ages and also in people who have had high blood pressure for some time.

How is Heart Failure Diagnosed?

To be diagnosed with Heart Failure you must have:

Symptoms (like shortness of breath) and/or signs (like swelling of the ankles) of Heart Failure, as well as
Abnormal findings on heart tests such as the tests below:

Sometimes, more advanced tests such as a Coronary Angiogram or Heart MRI may be required.

How is Heart Failure Treated?

Treatment of Heart Failure may involve a team including your local doctor (GP), cardiologist (heart specialist) and other staff such as a heart failure nurse. The goal is to help patients live longer, stop hospital admissions and improve your quality of life.

Medications

The type of medications you will be prescribed depend on the type of Heart Failure. For HFrEF (weak heart pump), medications are the backbone of treatment and should be started as early as possible and taken every day. These include:

Medications that dilate (open up) the blood vessels to reduce the pressure that the heart has to pump against (examples include: Entresto, perindopril or telmisartan).
Medications that slow the heart rate and reduce how hard the heart has to pump, called Beta Blockers such as bisoprolol (Bicor) or carvedilol (Dilatrend).
Medications that help patients get rid of excess fluid from the body (called diuretics and examples include furosemide (Lasix), spironolactone (Aldactone) or dapagliflozin (Forixga).

When diagnosed, it is important to start medicines straight away. Often, the doses of these medications will be increased relatively quickly to provide as much help to the heart muscle as possible. Like all medications there can be some side effects and lowering blood pressure is an important consideration with heart failure medications. Many patients like to check their blood pressure at home to keep an eye on it.

For patients with HFpEF (stiffened heart muscle), treatment is aimed at controlling blood pressure, treating any coronary artery disease, keeping the heart in normal rhythm and getting rid of excess fluid with diuretics.

Rhythm Therapies for Heart Failure

Atrial fibrillation (AF) ablation

AF is common in Heart Failure and can make symptoms worse. In the right person, catheter ablation (a keyhole procedure that targets the areas causing AF) can reduce heart failure flare-ups, improve energy and breathlessness, and make patients live longer. If you have both AF and Heart Failure, we’ll discuss whether ablation could help you (see the section on ‘Atrial Fibrillation ablation’).

Defibrillators and Cardiac Resynchronisation Therapy (CRT)

Defibrillators may be implanted in patients with heart failure as some patients with heart failure are at an increased risk of cardiac arrest. A particular kind of pacemaker called a ‘biventricular pacemaker’ or ‘cardiac resynchronisatioin therapy’ may also be used in some patients with heart failure to make the heart beat more efficiently (see the section on ‘Implantable Defibrillators and Biventricular Pacing’).

Lifestyle Interventions for Heart Failure

There are also some important non medication things that you can do to help manage your heart failure.

1. Daily weights — the 4 W’s

Wake → Wee → Weigh → Write it down

Do this every morning after the toilet and before breakfast (use the same set of scales). Keep a simple log or phone note. Your doctor will set a personal ‘dry weight’ target (this is how much you weigh when your body has the correct amount of fluid). If your weight starts to go up then you may need to take more diuretic medications (fluid tablets). For example, if your weight increases by 2kg over 2 days, you may take an additional fluid tablet that day (you should discuss this plan with your cardiologist). Then, once you’re back to your ‘dry weight’, go back to your usual diuretic dose. We recommend you call your GP if you still need extra tablets for more than 3 days, or if you feel dizzy, light-headed, very thirsty, or you’re passing much less urine.

2. Fluids and salt

Most patients don’t require a strict fluid restriction and can drink when they feel thirsty. However, all Heart Failure patients should try and avoid very salty foods because excess salt can make you retain more fluid. This can worsen symptoms. If you’ve been asked to be on a fluid restriction, this is usually 1.5-2Litres per day. This includes ALL types of fluids including drinks, soups, ice blocks, coffee, etc.

3. Maintain a healthy diet and body weight

Keeping a healthy body weight will help with heart failure. Exercise is important here but diet in particular can help and some medications can also help with weight loss. See our section on a healthy heart diet for more information.

4. Regular Exercise

Daily exercise is encouraged and can help with improvement in heart function and symptoms. A good guide is to aim for at least 30 minutes of exercise on at least 5 days a week. This could include going for a walk or going to the gym. Exercise according to physical ability and if your usual exercise routine is becoming more difficult then this is often a reason to look at your fluid balance and see your doctor.

5. Reduce sedentary habits, cigarettes and alcohol

Keeping active will help to keep your heart fit and can help with weight. Stopping smoking is important for many different aspects of health, including heart disease and avoiding alcohol is also good for your health. If you do drink alcohol then the heart foundation recommends no more than 2 standard drinks a day and give yourself two days off a week.

6. Seek help if you are experiencing depression, anxiety or low mood

Depression and anxiety are more common in patients with heart failure and if you think you may feel depressed or anxious then speaking to your family doctor about this is a good place to start.

7. Keep vaccinations up to date

Patients with heart failure are more susceptible to common infections and these infections often have more serious consequences for heart failure patients. You should receive a yearly Influenza immunisation and others that may apply depending on your age (amongst other things).

When to seek help?

All patients with heart failure are different and patients will have different levels of comfort with managing things like their symptoms and their fluid tablets. Some things to look out for that mean you might need to contact your GP, cardiologist or heart-failure nurse are:

If your weight increases by 2 kg in 2 days, or steadily rises over a week.
More ankle/leg/tummy swelling, tighter shoes, or a new cough or wheeze.
Being short of breath climbing stairs you could previously manage.
Needing extra pillows to sleep, or waking up short of breath.