Written from the perspective of a patient advocate, for patients and families
A Quiet Diagnosis That Changes Many Lives
Heart failure is a condition that often begins quietly.
For many people, it starts with fatigue that does not go away, breathlessness when climbing stairs, swelling in the legs, or disturbed sleep at night. These early signs are sometimes dismissed as simply “getting older,” “out of shape,” or “stressed.”
Then one day, a doctor delivers the diagnosis: “You have heart failure.”
Fear often follows immediately. Common questions from patients and families include:
- Does this mean the heart is about to stop?
- Is this the end?
- How long can life continue?
- What will happen to the family?
It is important to state clearly at the outset:
Heart failure does not mean the heart has failed.
It means the heart needs support — and today, that support exists.
Modern heart failure care has transformed lives. With the right treatment, education, and follow‑up, many people with heart failure live longer, better, and more active lives than ever before.
What Exactly Is Heart Failure?
Heart failure is a long‑term medical condition in which the heart cannot pump blood well enough to meet the body’s needs, or can only do so under high pressure.
This can result from:
- A weakened heart muscle
- A stiff heart that does not fill properly
- Damaged heart valves
- Abnormal heart rhythms
- Previous injury to the heart, sometimes without obvious symptoms
Importantly:
- Heart failure can develop slowly over years
- Or it can appear suddenly, especially after a heart attack or severe infection
According to ESC guidelines, heart failure is defined as a clinical syndrome — diagnosed by symptoms, physical findings, and tests together, not by a single number alone.
Common Symptoms Patients and Families Notice
Heart failure presents differently in each person. However, many patients experience:
- Breathlessness while walking, climbing stairs, or lying flat
- Extreme tiredness and weakness
- Swelling of feet, ankles, legs, or abdomen
- Sudden weight gain due to fluid retention
- Waking up breathless at night
- Reduced appetite or abdominal bloating
- Confusion or poor concentration in advanced stages
Families often notice:
- Reduced activity
- Withdrawal from social life
- Irritability or low mood
- Fear of exertion
These symptoms are not “in the mind.” They are real signals from a struggling heart.
Understanding Ejection Fraction: A Number, Not Destiny
Many patients are told about a number called ejection fraction (EF).
In simple terms:
- EF measures how much blood the heart pumps out with each beat
- A normal EF is usually 55–70%
Heart failure is categorized using EF:
- Heart Failure with Reduced Ejection Fraction (HFrEF)
- EF ≤ 40%
- The heart muscle is weak and pumps less forcefully
- Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)
- EF between 41–49%
- A middle group with features of both weakness and stiffness
- Heart Failure with Preserved Ejection Fraction (HFpEF)
- EF ≥ 50%
- The heart pumps well but is stiff and does not fill properly
A key message from the ESC guidelines is this:
People with “normal” EF can still have serious heart failure.
Symptoms matter more than numbers alone.
Why Did Heart Failure Happen?
Heart failure is usually the final pathway of many heart problems, not a disease that appears out of nowhere.
Common causes include:
- Previous heart attack
- Long-standing high blood pressure
- Diabetes
- Heart valve disease
- Irregular heart rhythm such as atrial fibrillation
- Cardiomyopathies (heart muscle diseases)
- Severe infections affecting the heart
- Long-term alcohol misuse
- Certain cancer treatments
Often, more than one cause is present at the same time.
How Is Heart Failure Diagnosed?
Heart failure diagnosis is a step-by-step process, not a single test.
According to ESC guidelines, doctors usually combine:
- Clinical assessment
- Symptoms and physical examination
- Blood tests
- Especially natriuretic peptides (BNP or NT-proBNP), which rise when the heart is under strain
- Echocardiography (heart ultrasound)
- Shows pumping strength, stiffness, valve problems, and pressures
- Electrocardiogram (ECG)
- Assesses heart rhythm and prior damage
- Additional tests
- Depending on cause: stress tests, CT scans, MRI, angiography
This careful evaluation helps clinicians choose the right treatment for each patient.
Treatment Goals: What Modern Heart Failure Care Aims to Achieve
Heart failure treatment today is not only about symptom relief. According to ESC guidelines, treatment aims to:
- Reduce symptoms
- Improve quality of life
- Prevent hospital admissions
- Slow disease progression
- Prolong survival
Importantly:
Treatment should begin early and be intensified step by step.
Medicines That Protect the Heart and Save Lives
For patients with reduced or mildly reduced ejection fraction, four groups of medicines form the foundation of care:
- ACE inhibitors or ARNI
- Relax blood vessels
- Reduce strain on the heart
- Improve survival
- Beta-blockers
- Slow heart rate
- Protect against dangerous rhythms
- Allow the heart muscle to recover
- Mineralocorticoid receptor antagonists
- Reduce fluid retention and scarring
- SGLT2 inhibitors
- Originally diabetes medicines
- Proven to reduce heart failure worsening and death — even in people without diabetes
These medicines are started early in low doses and increased gradually as tolerated.
Diuretics: Relieving Breathlessness and Swelling
Diuretics, also called “water tablets,” help:
- Remove excess fluid
- Reduce breathlessness and swelling
- Improve comfort
While they do not cure heart failure, they greatly improve day-to-day living.
Patients should never change diuretic doses without medical advice.
Devices That Support the Heart’s Rhythm and Strength
Some patients benefit from heart devices:
- Implantable cardioverter-defibrillator (ICD)
- Prevents sudden cardiac death
- Cardiac resynchronization therapy (CRT)
- Helps both sides of the heart beat together
These options are offered after careful evaluation and have been proven to improve survival in selected patients.
Heart Failure with Preserved Ejection Fraction: A Different Challenge
In HFpEF:
- The heart pumps well but is stiff
- Symptoms are real and disabling
- Patients are often older, with diabetes, obesity, or high blood pressure
Treatment focuses on:
- Controlling blood pressure
- Managing fluid overload
- Treating diabetes and kidney disease
- Exercise training
- Preventing hospital admissions
SGLT2 inhibitors have also shown benefit in this group.
Lifestyle and Self-Care: The Patient as Part of the Treatment Team
Medicines alone are not enough. ESC guidelines strongly emphasize:
- Daily weight monitoring
- Salt moderation
- Fluid awareness
- Regular physical activity suited to capacity
- Vaccinations
- Smoking cessation
- Avoiding harmful alcohol use
Patients who understand their condition do better than those who do not.
When Heart Failure Becomes Advanced
Some patients progress despite the best treatment.
Advanced heart failure may require:
- Frequent hospitalizations
- Advanced drug support
- Mechanical heart pumps
- Heart transplantation
- Palliative care focused on comfort and dignity
Palliative care does not mean giving up.
It means prioritizing quality of life and symptom relief alongside medical care.
Living with Heart Failure: A Message of Hope
Heart failure is a serious condition — but it is not a hopeless one.
With:
- Early diagnosis
- Evidence-based medicines
- Regular follow-up
- Family involvement
- Patient education
many individuals live meaningful, productive lives for years and decades.
HHIF encourages every patient and caregiver to remember:
They are not alone. Heart failure is a journey — and today, it is a journey with science, support, and hope walking beside them.
Join the Heart Health India Foundation community — a collective of heart patients, families, and healthcare professionals who share evidence-based knowledge and lived experiences to help you separate misinformation from reality.
Your journey to reliable, patient-led heart-health learning begins here. Click here to join.
