Heart failure is a lifelong (chronic) medical condition that can cause symptoms such as shortness of breath, extreme fatigue, coughing, and swelling in the legs.

A few simple lifestyle habits can really go a long way in helping to manage this condition.

These basic tips—combined with medications and medical procedures recommended by your health care professional—can help you stay well and out of the hospital.

Know Your Symptoms

Every patient who has heart failure has different symptoms that signal a worsening of the condition. When your heart failure symptoms get worse, prompt attention can help you recover faster and prevent the need for hospitalization.

Some people get swelling in the legs or in the abdomen. Others notice shortness of breath when walking, going up the stairs or lying flat in bed.

When fluid buildup becomes severe, you may notice chest tightness or pressure, loss of appetite, and shortness of breath even when at rest.

As soon as you notice any symptoms of a flare-up, seek medical attention. You may need to go to the hospital if your symptoms are bad enough.

Know When to Call Your Health Care Professional

Be sure to call your health care professional when you start to feel worse or your weight goes up.

Too often, patients wait too long before calling. Often this is because they do not want to bother their professional, or they want to see if things get better on their own. However, professionals are eager to hear from their patients with heart failure, especially when they are experiencing symptoms.

Over the phone or during a quick office visit, your professional can do many things to help, such as increase diuretics (water pills), adjust other heart failure medications or help you choose a healthier, lower-salt diet. The earlier patients call, the more health care professionals can help without having to recommend hospitalization.

Take Your Medications Without Missing Doses

Medications for heart failure can truly be lifesaving, but they can often be hard to remember to take. Sometimes, health care professionals prescribe pills that have to be taken three times a day to work appropriately. Patients who successfully take all their medicine without missing doses have the best chance of keeping their heart failure symptoms controlled.  

A useful tip is to use a pillbox that contains multiple compartments for each day of the week. Some patients also set alarms on their smartphones to help them remember the mid-day and evening doses.

Calling for refills promptly is also really important.

The tricky part is that you may not feel any different if you forget some medications, but your heart may be working a lot harder because of the missed doses. Just a few days without heart failure medications can cause severe worsening of symptoms and a trip to the hospital.

Limit Your Salt and Fluid Intake

Fluid buildup in a patient with heart failure is the result of water accumulating in the body. While clinicians prescribe diuretics (water pills) to help control the fluid buildup, it is also very important to be mindful of the total amount of salt and water being consumed. Salt, or sodium, is important because it causes your body to hold on to water.

Sodium is listed on food labels, and you should look at those labels before you eat. When cooking, try using herbs, lemon and spices. They can pack lots of flavor and help you cut down on the salt.

Log Your Weight Every Day

Patients should weigh themselves unclothed every morning at the same time (after using the bathroom) and write that weight down in a logbook. This is the time of day when your weight is the most stable from day to day.

A 3-pound gain in a day or a 5-pound gain in a week should prompt a call to your health care professional. The change might be an early tip-off to a worsening of your heart failure condition. Over such a brief period, this amount of weight gain results from a buildup of water, not from food.

Keeping a log of your weight is key. It is very hard to remember your weight from one day to the next. A quick glance at the log makes it easy to spot a worrisome trend in water weight gain.

Although heart failure is a chronic disease that sometimes worsens, patients with heart failure have a lot of control over how they feel. Following these simple tips can help you manage living with heart failure.

So you have heart failure, and the type you have makes it hard for your heart to pump enough blood to the rest of your body (called heart failure with reduced ejection fraction, HFrEF, or systolic heart failure). Now what?

You probably feel scared and overwhelmed, and flooded with questions about your diagnosis. But you are not alone.

A team at the American College of Cardiology has created “I Have Heart Failure with Reduced Ejection Fraction. Now What?” to help you and your care team talk through and make informed decisions about the best first steps for managing your condition.

Heart failure requires ongoing monitoring and management. Treatment can help you feel better, live longer, and avoid hospital stays. That’s why it’s so important for you to take an active role in your care plan from the start.

Your Input Keeps Your Treatment On Track

Knowing how you feel and what to tell your care team can help you better manage your condition. 

It’s often said that medicine is just as much of an art as a science. That applies to managing heart failure, too.

For example, if you have heart failure, your health care team relies on regular exams, bloodwork and imaging tests to help gauge how well—or poorly—your heart is pumping. Taken together, these tests can help show how well your treatment is working.

But there’s another essential piece of the puzzle when it comes to tailoring your treatment plan: your report of how you are faring from one day to the next. This includes what you can or can’t do because of your symptoms. 

It’s Important to Speak Up

By telling your care team how you are doing at home and work, you help paint a more complete picture of how heart failure is affecting your life. You might also hear this called your quality of life. Like with your bloodwork or echocardiogram results, your health care professional ideally needs this input to help adjust your care plan.  

Unfortunately, sometimes people don’t want to speak up or bother their health care professional, but your input is important. Your care team should know if your condition prevents you from fulfilling your goals, like traveling or going to special celebrations of life events. 

How Do You Feel Each Day?

Listen to your body and take note of what activities are easy or hard for you to do from one day to the next. This is one of the best ways to tell how you—and your heart—are doing. 

You might start by:

» Learning what a good day looks and feels like. What about a bad day?

When and how do you feel limited by your symptoms? Many people say they know their heart failure is getting worse when they feel very drained, zapped of energy or more easily out of breath even though they haven’t been doing very much.

This is different and separate from feeling tired after traveling or a big event, which is often expected with—and without—heart failure.

» Asking yourself a few questions. 

• Overall, how do I feel today? Be sure to share how you are doing both physically and emotionally. 
• Compared with a typical or average day with heart failure, today I feel: 
    Better 
   Worse 
   About the same 
   Different—In what way(s)? 
  
• What activities am I able to do, or not do, because of my heart failure? 

» Watching for—and reporting—signs that your heart failure may be getting worse. If you know the signs, you can do something about them.

Knowing your body and reporting new or worsening symptoms when you first notice them can help you stay out of the hospital and avoid prolonged illness. Your input will also allow you and your care team make the best decisions about your treatment over time. 

Call your care team if you experience:

• Feeling short of breath or much more tired than usual, even with small bouts of activity
• Any obvious swelling in your feet, ankle or legs or abdomen
• Sudden weight gain, which can be a red flag that fluid is building up in your body
  • Weigh yourself each morning before breakfast—the danger zone  is gaining 3 pounds in a 24-hour period or 5 pounds or more in a week
• Needing to sit upright in a chair or use pillows to prop yourself up to sleep or breath easier
• A stubborn, dry cough

If you feel uneasy or know something is not quite right, speak up! Other people living with heart failure say it’s important to follow your gut. 

Note Your Triggers

Many people living with heart failure have, over time, learned what can trigger a flare-up of their heart failure. 

For example:

• Eating a heavy meal 
• Not limiting salt (sodium) enough   
• Not taking medications as prescribed
• Traveling, which some patients admit has led them to skip a diuretic (water pill) or forgo recording a daily weight
• Not having other medical conditions under control (for example, diabetes, blockages in the arteries, atrial fibrillation)
• Infections such as influenza, pneumonia or even a common cold
• Feeling overly stressed, which can make sticking with your treatment plan more difficult 
• For some, drinking too much liquid; talk with your health care provider to see if this applies to you 

Be sure to tell your health care team about these and other possible triggers. Together, you can talk through how to plan for and avoid things that might aggravate your heart failure. For example, you might need more information or nutritional counseling on limiting salt or perhaps annual reminders to get vaccines against the flu and pneumonia. Remember that many of these triggers are more likely to take place during the holidays, at special celebrations or when you are traveling.

Bumps in the Road

People often describe living with heart failure as a journey. They share that there will be bumps in the road, and to expect good days and bad ones. At times, it can feel pretty overwhelming, especially as you learn what’s needed to manage the disease well. At times you may feel like crying or yelling. That’s OK.

And if you do experience setbacks—for example, feeling badly or having to go to the hospital—don’t get discouraged. 

It might help to remember that you are in the driver’s seat, but you’re also not alone. You can take steps mentioned in this article to feel more on top of your heart failure and make sure you feel supported. 

Staying Upbeat

In talking with your health care team about how you’re feeling, don’t forget your emotional health and well-being. And remember that there is power in positive thinking.

Studies show that it helps to remain hopeful and stay connected with people and activities that you enjoy and give you a sense of purpose. Finding peers—other people who have your type of heart failure—with whom you can share tips and ask for advice can be super helpful and life-giving.

Although heart failure is part of your life, it does not define you. You may need to do things a little differently now. But you can live your life. Giving your health care team a glimpse into how heart failure may affect what you do and sharing your goals for treatment can help you along the way. 

 

Remember that managing heart failure means ongoing care and monitoring of your health.

Following your treatment plan is essential. Be sure to keep any follow-up appointments and tests. Following a low-salt diet and taking your medications reliably is very important. It’s often helpful to keep a log with your daily weight, blood pressure and physical activity.

Today, there are many life-saving medications and therapies that help people live well with the disease.

What You Can Do

• Create a support team
• Check and record your weight every day, along with a log of your daily blood pressure and exercise
• Listen to your body and know when the condition might be getting worse. For example, do you notice:
  • swelling
  • rapid weight gain
  • labored breathing, especially when laying down
  • not being able to concentrate
• Report problems right away—stay connected with your heart failure team and report changes in weight or new symptoms
• Accept your new normal
  • Stay connected to the things you love to do, even if it means you might need to participate in a different way or cut back a bit
  • It’s OK if daily tasks seem to take longer
• Share your concerns—for example, many people are scared about over-exerting their heart, but exercise is very important
• Take your medications exactly as directed
• Ask about and take advantage of cardiac rehabilitation
• Bring a trusted friend or family member to your appointments
• Make sure you have a living will and advanced directives in place.

Talking to Your Care Team

It is important to talk openly with your health care team about how you are feeling and share any concerns you have related to your condition or treatment. Heart failure can get worse over time, so keep your doctor up to speed on how you’re feeling, and if you have trouble doing certain activities.

Questions to ask:

• What type of heart failure do I have?
• What health checks should I be doing and recording on a daily basis (weight, blood pressure, pulse)?
• How will I know if my condition is getting worse? When should I call 9-1-1?
• What is my goal weight?
• If I notice that I am weighing more, at what point should I call you?
• How much exercise can I do and what activities are best? Is it safe for me to exercise on my own?
• Can you review each of the medications I am taking and what they do?
• How much salt can I consume daily?
• How much water/fluids can I drink a day?
• Would I benefit from an ICD?
• Would I benefit from cardiac rehabilitation?
• How often will I need to have my heart checked?

Heart failure is a lifelong condition that needs to be managed. There are a number of treatment options, which will ultimately depend on:

• The underlying reason for the heart failure – for example, if you had a prior heart attack, or have high blood pressure or a valve problem.
• Your type of heart failure – often based on your ejection fraction (normal vs. low).
• How severe your heart failure is; there is a very wide range of severity from very mild to extremely severe. This is estimated based on your symptoms.
• Other existing conditions such as your kidney function.

Lifestyle Changes

When you live with heart failure, you must take steps to make your health a priority. Adopting healthier habits can help support you heart health. That means finding ways to:

• Eat low salt, low-fat foods
• Exercise regularly
• Not smoke
• Lose weight if you need to
• Monitor your fluid intake (ask how much water or fluid you can drink each day)
• Keep other conditions in check – many people with heart failure also have other health issues such as high blood pressure, diabetes, or chronic obstructive pulmonary disease

Cardiac Rehabilitation

Cardiac rehabilitation provides you with a supervised exercise program that’s geared toward your fitness level and health needs. It also provides a support system to help you adopt lifelong healthy behaviors and monitor your progress.

Cardiac rehab is approved for some patients living with heart failure. Participating in this program can help you feel better, make your heart stronger and may reduce your need to go to the hospital.

Medications

Medications are an important part of treating heart failure. Your doctor may recommend one or a combination of the following:

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) relax your blood vessels and reduce strain on your heart and improve blood flow. They also lower blood pressure.

Angiotensin receptor-neprilysin inhibitor (ARNI) is a combination of an ARB and a medicine that inhibits the production of neprilysin, an enzyme. This enzyme breaks down natural substances in the body that widen blood vessels and reduce sodium retention. The effect is to lower blood pressure and decrease strain on the heart.

Beta blockers can slow a rapid heart rate and lower your blood pressure.

Digoxin slows heart rate and strengthens heart muscle contractions to pump more blood. It can make you feel better.

Diuretics, also called water or fluid pills, help keep fluid from building up in your body or lungs – they will also make you urinate more often.

Mineralocorticoid receptor antagonists help the body to get rid of salt and water through urine. This lowers the volume of blood that the heart must pump.

Nitrates and hydralazine is a combination of drugs that has been shown to improve outcomes in African American patients. It is often used if someone is allergic to or can’t take ACE inhibitors or ARBs.

Sinoatrial node modulator (ivabradine) is a drug used with beta blockers when they cannot lower your heart rate enough. It helps reduce the amount of oxygen your heart needs and the amount of work your heart does to pump blood through the body.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were originally used to treat diabetes. These medicines have clear benefits for people with heart failure, including fewer heart-related deaths and hospitalizations.

Soluble guanylase cyclase stimulator (vericiguat) can result in beneficial relaxation of blood vessels and decrease strain on the heart. This medication may result in fewer heart-related deaths and hospitalizations in people with heart failure who have recently been hospitalized and are already on optimal medical therapy with ARNI, beta blockers, aldosterone antagonists, and SGLT2 inhibitors.

Choosing Heart Failure Drugs

About half of patients with heart failure (HF) have a weak heart. These patients have been shown to live longer and feel better if they take a drug that stops the renin-angiotensin hormone pathway.

Some of these medicines have been around for a long time, work well, and are available as generics with low cost to patients.

A newer medicine has been shown to work better than the older medicines in patients with HFrEF, or heart failure with reduced ejection fraction, but it tends to come at a higher cost. Ejection fraction is a measure of how well your heart is pumping.

If you have HFrEF and are trying to decide which medicine to take to stop the renin-angiotensin hormone pathway, use this four-page decision aid to better understand your options. Then decide with your doctor or a member of your care team what treatment is right for you.

Devices

Many people with heart failure also have a problem with the way their heart beats (arrhythmia). Many patients with a low ejection fraction—when the amount of blood the heart is able to squeeze out is much less than what it normally would be—may benefit from small electric devices implanted in the chest, just under the skin, with wires going to the heart.

These devices can be useful to prevent sudden cardiac death or help the heart beat in a more coordinated manner in select patients.

• Implantable cardioverter defibrillator (ICD) – a battery-powered device that keeps track of your heart rate and releases an electric shock if it detects a dangerously fast heart rate, resetting the heart rhythm
• Cardiac resynchronization therapy (CRT) – this small device is implanted just below the collarbone. It sends electric signals to the lower chambers of the heart so that they beat together in a more synchronized way, helping the heart to pump better.

Studies show that these devices can help improve quality of life and may prolong survival in properly selected patients.

For very late stages of the disease, a person may need a left ventricular assist device—a mechanical heart pump—to help the heart move blood through the body. This is often used in individuals who are awaiting a heart transplant.

Who gets heart failure? Some people are more likely to develop the condition. For example, because the heart’s squeezing ability tends to grow weaker over time, heart failure is more common as we age. But heart failure can affect people of all ages.

The most common causes of heart failure include coronary artery disease, high blood pressure, and heart attack. Other factors or conditions that can put you at risk include:

• Diabetes
• Heart rhythm problems
• Valve problems
• Certain congenital heart defects or other heart conditions that have damaged or place added strain on the heart
• Obesity
• Family history

In addition, some treatments for cancer (chemotherapy), certain thyroid conditions, and heavy alcohol or drug use have also been linked to damage to the heart muscle.

“Broken heart syndrome,” also known as Takotsubo cardiomyopathy, is usually brought on by severe stress.

African Americans are more likely to develop heart failure. Also, women tend to have more severe symptoms.

Exams and Tests

Heart failure is usually detected after a review of your full medical history, a physical exam and results from blood and/or cardiac imaging tests. Many patients first learn they have heart failure after going to the emergency room or hospital with symptoms, often shortness of breath with or without swelling.

Blood and/or imaging tests are used to assess any damage to your heart and to check how well it pumps blood. Your doctor may decide to order:

• B-type natriuretic peptide (BNP): this is a simple blood test that’s a good initial test if someone has symptoms such as shortness of breath, but it is unclear if the heart is the reason
• Standard blood tests such as kidney function, electrolytes, and thyroid function
• ECG, chest X-ray
• Heart imaging: usually an echocardiogram (ultrasound), or possibly a cardiac MRI scan
• Cardiac catheterization, if needed

Many of these tests may be repeated over time to determine if your heart function is the same, better or worse with treatment.

Many people who have heart failure will have symptoms that include:

• Shortness of breath (even when doing simple tasks like dressing or walking a flight of stairs)
• Swelling in the ankles, feet, legs, abdomen, or veins in the neck
• Extreme tiredness (fatigue)
• Feelings of weakness
• Rapid or irregular heartbeat
• Fast weight gain, or rapid fluctuations in weight
• Pressure or heaviness in the chest when lying flat

Late in the disease, people may notice:

• A lack of appetite or that they feel full more quickly
• Weight loss (cardiac cachexia)

If you have – or think you have – heart failure, it’s normal to feel scared. But you’re not alone. More than 6 million Americans have heart failure.

Contrary to how it sounds, heart failure does not mean that your heart has stopped beating. It refers to a number of conditions that can affect the way the heart works, its structure, or both.

Over time, heart failure makes it harder for the heart to pump enough blood and oxygen to meet your body’s needs. That’s why most people with heart failure get short of breath, especially when they are active. Even climbing the stairs or carrying groceries may leave you winded. Of course, your symptoms will depend on the type of heart failure you have.

Because it’s a lifelong condition, you must take an active role in your care to stay well. The more informed and equipped you are to manage heart failure, the better you may feel. Use this condition center to learn more about heart failure and ways to help you feel your best.

Overview

Your heart is a pump. It moves blood and oxygen-rich nutrients through your body. If you have heart failure, your heart isn’t pumping as well as it should. As a result, fluid can build up in the body – most often in the legs and lungs.

Your heart also isn’t able to push out enough blood to meet your body’s needs for blood and oxygen. It’s no wonder then that if you have heart failure, you may tire more easily and feel short of breath.

There are two main types of heart failure:

• Heart failure with reduced ejection fraction (HFrEF): Muscle is too weak and cannot pump blood to the rest of the body with enough force. This is also called systolic heart failure.
• Heart failure with preserved ejection fraction (HFpEF): Muscle has trouble relaxing and can’t fill with enough blood. This is also called diastolic heart failure.

Ejection fraction is a measure of how much blood the heart is pumping out to the body. 

If you or a loved one has heart failure, you’re not alone. More than 6 million Americans have heart failure. It’s also the leading reason people 65 and older end up in the hospital.

Heart failure is a serious, lifelong condition. But by managing heart failure, people can live normal lives. The hope is to try to avoid emergency or “acute” episodes when someone would need to be in the hospital, and generally improve patients’ quality of life and ability to do the things they usually do.