Heart failure


Heart failure
Heart failure

Heart failure means that the heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff.

It's sometimes called "congestive" heart failure, although this name isn't widely used now.

Heart failure does not mean your heart has stopped working. It means it needs some support to help it work better.

It can occur at any age, but is most common in older people.

Heart failure is a long-term condition that tends to get gradually worse over time.

It cannot usually be cured, but the symptoms can often be controlled for many years.

Symptoms of heart failure

The main symptoms of heart failure are:

  • breathlessness after activity or at rest
  • feeling tired most of the time and finding exercise exhausting
  • feeling lightheaded or fainting
  • swollen ankles and legs

Some people also experience other symptoms, such as a persistent cough, a fast heart rate, and dizziness.

Symptoms can develop quickly (acute heart failure) or gradually over weeks or months (chronic heart failure).

When to get medical advice

See a GP if you experience persistent or gradually worsening symptoms of heart failure.

Call 999 for an ambulance or go to your nearest A&E department as soon as possible if you have sudden or very severe symptoms.

A number of tests can be used to help check how well your heart is working, including blood tests, an ECG and an echocardiogram.

Causes of heart failure

Heart failure is often the result of a number of problems affecting the heart at the same time.

Conditions that can lead to heart failure include:

Sometimes obesity, anaemia, drinking too much alcohol consumption, an overactive thyroid, or high pressure in the lungs (pulmonary hypertension) can also lead to heart failure.

Treatments for heart failure

Treatment for heart failure usually aims to control the symptoms for as long as possible and slow down the progression of the condition.

Common treatments include:

  • lifestyle changes – including eating a healthy diet, exercising regularly and stopping smoking
  • medication – a range of medicines can help; many people need to take two or three different types
  • devices implanted in your chest – these can help control your heart rhythm
  • surgery – such as a bypass operation or a heart transplant

Treatment will usually be needed for life.

A cure may be possible when heart failure has a treatable cause. For example, if your heart valves are damaged, replacing or repairing them may cure the condition.

Outlook for heart failure

Heart failure is a serious long-term condition that will usually continue to get slowly worse over time.

It can severely limit the activities you're able to do and is often eventually fatal.

But it's very difficult to predict how the condition will progress on an individual basis.

It's very unpredictable. Lots people remain stable for many years, while in some cases it may get worse quickly.


The symptoms of heart failure can vary from person to person. They may start suddenly or develop gradually over weeks or months.

Main symptoms

The most common symptoms of heart failure are:

  • breathlessness – this may occur after activity or at rest; it may be worse when you're lying down, and you may wake up at night needing to catch your breath
  • fatigue – you may feel tired most of the time and find exercise exhausting
  • swollen ankles and legs – this is caused by a build-up of fluid (oedema); it may be better in the morning and get worse later in the day
  • feeling lightheaded and fainting

Less common symptoms

Other symptoms of heart failure can include:

  • a persistent cough, which may be worse at night
  • wheezing
  • a bloated tummy
  • loss of appetite
  • weight gain or weight loss
  • confusion
  • a fast heart rate
  • a pounding, fluttering or irregular heartbeat (palpitations)

Some people with heart failure may also experience feelings of depression and anxiety.

When to get medical advice

See your GP if you experience persistent or gradually worsening symptoms of heart failure.

The symptoms can be caused by other, less serious conditions, so it's a good idea to get them checked out.

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department as soon as possible if you have sudden or very severe symptoms.

This is a medical emergency that may require immediate treatment in hospital.


If you have symptoms of heart failure, your GP should offer you some checks and a blood test to see how well your heart is working.

If your blood test shows you might have heart failure, your GP should refer you to a specialist heart failure team and you may be offered further tests.

Tests for heart failure

Tests you may have to diagnose heart failure include:

  • blood tests – to check whether there's anything in your blood that might indicate heart failure or another illness
  • an electrocardiogram (ECG) – this records the electrical activity of your heart to check for problems
  • an echocardiogram – a type of ultrasound scan where sound waves are used to examine your heart
  • breathing tests – you may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness; common tests include spirometry and a peak flow test
  • a chest X-ray – to check whether your heart is bigger than it should be, whether there is fluid in your lungs (a sign of heart failure), or whether a lung condition could be causing your symptoms

You can read more about tests for heart conditions on the British Heart Foundation website

Stages of heart failure

When you're diagnosed with heart failure, your doctor will usually be able to tell you what stage it is.

The stage describes how severe your heart failure is.

It's usually given as a class from 1 to 4, with 1 being the least severe and 4 being the most severe:

  • class 1 – you don't have any symptoms during normal physical activity
  • class 2 – you're comfortable at rest, but normal physical activity triggers symptoms
  • class 3 – you're comfortable at rest, but minor physical activity triggers symptoms
  • class 4 – you're unable to carry out any physical activity without discomfort and you may have symptoms even when resting

Knowing the stage of your heart failure will help your doctors decide which treatments they think are best for you.


For most people, heart failure is a long-term condition that can't be cured. But treatment can help keep the symptoms under control, possibly for many years.

The main treatments are:

  • healthy lifestyle changes
  • medication
  • devices implanted in your chest to control your heart rhythm
  • surgery

In many cases, a combination of treatments will be required. 

Treatment will usually need to continue for the rest of your life.

Care plan

If you have heart failure, you and everyone involved in your care will be given a care plan.

This should include:

  • plans for managing your heart failure, including follow-up care, rehabilitation and access to social care
  • symptoms to look out for in case your condition worsens
  • details of how to contact your care team or specialist

The care plan should be reviewed at least every 6 months by your GP.

Lifestyle changes

Having a healthy lifestyle, including eating a balanced diet, doing exercise and not smoking, can help with your symptoms and reduce your risk of becoming seriously ill.

You should be offered an exercise-based cardiac rehabilitation programme.

Medicines for heart failure

Most people with heart failure are treated with medication. Often you'll need to take 2 or 3 different medicines.

Some of the main medicines for heart failure include:

  • ACE inhibitors
  • angiotensin-2 receptor blockers (ARBs orAIIRAs)
  • beta-blockers
  • mineralocorticoid receptor antagonists
  • diuretics
  • ivabradine
  • sacubitril valsartan
  • hydralazine with nitrate
  • digoxin
  • SGLT2 inhibitors

You may need to try a few different medicines before you find a combination that controls your symptoms but doesn't cause unpleasant side effects.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by relaxing and opening up your blood vessels, which makes it easier for your heart to pump blood around the body.

Examples of ACE inhibitors include ramipril, captopril, enalapril, lisinopril and perindopril.

The most common side effect of ACE inhibitors is a dry, irritating cough

If you have a troublesome cough, an ACE inhibitor may be switched to an ARB.

ACE inhibitors can also cause your blood pressure to fall too low, and they may cause kidney problems. Your GP will monitor this.

Angiotensin-2 receptor blockers (ARBs)

Angiotensin-2 receptor blockers (ARBs) work in a similar way to ACE inhibitors by relaxing blood vessels and reducing blood pressure.

They tend to be used as an alternative to ACE inhibitors because they don't usually cause a cough, although they may not be quite as effective as ACE inhibitors.

Examples of ARBs include candesartan, losartan, telmisartan and valsartan.

Side effects of ARBs can include low blood pressure and high levels of potassium in your blood.

Your doctor will carry out regular blood tests to monitor your potassium level.


Beta-blockers work by slowing your heart down and protecting your heart from the effects of adrenaline and noradrenaline, "fight or flight" chemicals produced by the body.

There are several different beta-blockers, but the main ones used to treat heart failure in the UK are bisoprolol, carvedilol and nebivolol.

Possible side effects of beta-blockers include dizziness, tiredness and blurred vision.

But most people taking them have either no or very mild side effects that become less troublesome with time.

Mineralocorticoid receptor antagonists (MRAs)

MRAs make you pass more urine, and help lower blood pressure and reduce fluid around the heart, but they don't reduce potassium levels.

The most widely used MRAs are spironolactone and eplerenone.

Spironolactone may cause enlarged breasts in men (gynaecomastia) and breast tenderness and increased hair growth in women.

Eplerenone can cause sleeping difficulties, dizziness and headaches.

The most serious side effect of these medicines is that they can cause the level of potassium in your blood to become dangerously high.

Your doctor will carry out regular blood tests to check for this.


Diuretics (water pills) make you pass more urine, and help relieve ankle swelling and breathlessness caused by heart failure.

There are many different types of diuretic, but the most widely used for heart failure are furosemide (also called frusemide) and bumetanide.

Possible side effects of diuretics include dehydration and reduced levels of sodium and potassium in the blood.


Ivabradine is a medicine that can help slow your heart down.

It's a useful alternative to beta blockers if you can't take them or they cause troublesome side effects.

It can also be used alongside beta blockers if they don't slow the heart enough.

Possible side effects include headaches, dizziness and blurred vision.

Sacubitril valsartan

Sacubitril valsartan is a single tablet that combines an ARB and a medication called a neprilysin inhibitor.

It's suitable for people with more severe heart failure, whose heart is only able to pump a reduced amount of oxygenated blood around the body despite taking other medication.

The most common side effects of sacubitril valsartan are low blood pressure, high potassium levels and kidney problems.

Hydralazine with nitrate

Hydralazine in combination with nitrate can help relax and open up the blood vessels.

These medicines are sometimes prescribed by heart specialists (cardiologists) for people who are unable to take an ACE inhibitor or ARB.

Side effects can include headaches, a fast heartbeat and a pounding, fluttering or irregular heartbeat (palpitations).


Digoxinan improve your symptoms by strengthening your heart muscle contractions and slowing down your heart rate.

It's normally only recommended for people who have symptoms despite treatment with ACE inhibitors, ARBs, beta-blockers and diuretics.

Possible side effects include dizziness, blurred vision, feeling and being sick, diarrhoea, and an irregular heartbeat.

SGLT2 inhibitors

SGLT2 inhibitors are tablets that can help lower your blood sugar levels.

Empagliflozin and dapagliflozin are types of SGLT2 inhibitor. They can be used to treat some types of heart failure, as an add-on to other medicines.

Possible side effects include thrush, peeing more than usual, a mild skin rash and back pain.

Take your medication

It's very important that you take any prescribed medication, even if you begin to feel better.

Check with your care team if:

  • other medicines might interfere with your medication
  • you experience any side effects

Devices for heart failure

Some people with heart failure will need to have a procedure to implant a small device in their chest that can help control their heart's rhythm.

The most commonly used devices are:

  • pacemakers
  • cardiac resynchronisation therapy (CRT) devices
  • implantable cardioverter defibrillators (ICDs)
  • CRT-Ds


You may need to have a pacemaker fitted if your heart beats too slowly.

A pacemaker monitors your heart rate continuously, and sends electrical pulses to your heart to keep it beating regularly and at the right speed.

The pacemaker is implanted under the skin by a cardiologist, usually under local anaesthetic.

You will usually need to stay in hospital overnight to check it's working properly. Serious complications are unusual.

Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic.

You will also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.

You can find out more about pacemakers on the British Heart Foundation website

Cardiac resynchronisation therapy

In some people with heart failure, the walls of the main pumping chamber (the left ventricle) do not work together and contract out of sync with each other.

Cardiac resynchronisation therapy (CRT) is a special type of pacemaker that can correct the problem by making the walls of the left ventricle all contract at the same time. This makes the heart pump more efficiently.

Most pacemakers only have 1 or 2 wires to the heart, but CRT requires an extra wire.

Implantable cardioverter defibrillators (ICDs)

People who have, or are at high risk of developing, an abnormal heart rhythm may need to have a device known as an implantable cardioverter defibrillator (ICD) fitted.

An ICD constantly monitors the heart rhythm.

If the heart starts beating dangerously fast, the ICD will try to bring it back to normal by giving it a small, controlled electrical shock (defibrillation). 

If this fails, the ICD will deliver a larger shock.

As with pacemakers, ICDs are implanted in hospital, usually under local anaesthetic.

Like pacemakers, you will need to avoid things that can interfere with the way the ICD works, such as airport security systems.

Read more about ICDs on the British Heart Foundation website


Devices that combine cardiac resynchronisation and defibrillation are implanted into patients who need both.

These combination devices are usually called CRT-Ds.

Pulmonary artery pressure sensors

Some people with chronic heart failure may need to have a device known as a pulmonary artery pressure sensor fitted.

It's implanted into your artery in hospital, under local anaesthetic.

The sensor sends blood pressure measurements to a monitor in your home. The monitor sends the measurements to your care team, to help them decide whether your treatment needs to be changed. This should help to manage your treatment and reduce the chance of you being admitted to hospital.

This is a new procedure that might not yet be available to everyone.

Improving muscle strength

If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.

This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.


Medicines are the main treatment for heart failure, but for some people surgery may help.

Operations that can help with heart failure include:

  • heart valve surgery
  • a coronary angioplasty or bypass
  • left ventricular assist devices
  • heart transplant

Heart valve surgery

If the valves of your heart are damaged or diseased, your doctor may suggest valve surgery.

There are 2 types of valve surgery: valve replacement and valve repair.

The type of surgery you have will depend on what is wrong with the valve and how serious the problem is.

Your doctor will discuss this with you.

Read about aortic valve replacement and surgery for mitral valve problems.

Angioplasty or bypass

If your heart failure is related to coronary heart disease, your doctor may recommend a:

These procedures will help make it easier for your heart to pump blood around your body.

Left ventricular assist devices

Left ventricular assist devices (LVADs) are mechanical pumps that can help if your left ventricle isn't working properly and medication alone isn't helping.

They may be used as a permanent treatment if you can't have a heart transplant, or as a temporary measure while you wait for a transplant.

In addition to the pump, LVADs also include an external battery. A wire connecting this to the pump will need to be placed under your skin during the operation.

Read more about LVADs on the British Heart Foundation website

Heart transplant

A heart transplant may be necessary if you develop severe heart failure that can't be treated effectively with medication or other types of surgery.

A heart transplant is a complex procedure that carries serious risks, so it's not suitable for everyone with severe heart failure.

There's also a shortage of hearts for transplantation, so some people have to wait years for a suitable donor heart to become available.

Read more about heart transplants.

Living with

If you have heart failure, it's important to look after your own health and wellbeing, with support from those involved in your care.

Looking after yourself

It's very important to take good care of yourself if you have heart failure.

Have a healthy diet

A healthy, balanced diet can help improve your symptoms and general health.

balanced diet should include:

  • plenty of fruit and vegetables – aim for at least 5 portions a day
  • meals based on starchy foods such as potatoes, bread, rice or pasta
  • some dairy or dairy alternatives
  • some beans or pulses, fish, eggs, meat and other sources of protein
  • low levels of saturated fat, salt and sugar

You may also be given advice about dietary changes that can specifically help with heart failure, such as limiting the amount of fluid you drink.

Exercise regularly

Regular physical activity can also help improve your symptoms and general health.

If you have heart failure, you should be offered an exercise-based cardiac rehabilitation programme.

These programmes vary widely across the country, but most cover 1 or more of the following:

  • exercise
  • education
  • emotional support

They're usually run in hospitals or community clinics by teams that include nurses, physiotherapists, occupational therapists and exercise specialists.

Before you start, you'll have an assessment to find out how much exercise you can safely do.

A programme of exercise can then be tailored specifically for you.

The education part of the programme will give you information on healthy eating and practical ways to reduce the risk of further damage to your heart.

Want to know more?

British Heart Foundation: cardiac rehabilitation

Stop smoking

If you smoke, stopping smoking can improve your overall health and reduce your risk of many other health problems.

If you want to give up smoking a good first step is to contact Help Me Quit on 0808 250 6061 or visit the Help Me Quit website.

Limit your alcohol consumption

You can usually continue to drink alcohol if you have heart failure, but it's advisable not to exceed the recommended limits of more than 14 alcohol units a week.

If your heart failure is directly related to drinking alcohol, you may be advised to stop entirely.

Get some tips on cutting down on alcohol.

Get vaccinated

Heart failure can put a significant strain on your body and mean that you're more vulnerable to infections.

Everyone with heart failure is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service.

Want to know more?

Regular reviews and monitoring

You'll have regular contact with your GP or care team to monitor your condition at least every 6 months.

These appointments may involve:

  • talking about your symptoms, such as whether they're affecting your normal activities or are getting worse
  • a discussion about your medication, including any side effects
  • tests to monitor your health

It's also a good opportunity to ask any questions you have or raise any other issues you'd like to discuss with your care team.

You may be asked to help monitor your condition between appointments.

For example, your care team may suggest weighing yourself regularly so any changes in your weight, which could be a sign of a problem, are picked up quickly.

Contact your GP or care team if your symptoms are getting worse or you develop new symptoms.

Your care team will advise you about when and where to seek advice if there's a potential problem.

Travelling and driving:


Having heart failure shouldn't prevent you travelling or going on holiday, as long as you feel well enough and your condition is well controlled. But check with your doctor before you travel.

It may be advisable to avoid travelling to high altitudes or hot, humid places because this may put extra strain on your heart.

Flying won't usually cause problems, but if your heart failure is severe, your legs and ankles may swell and breathing may become more difficult.

If you're flying, inform the airline of your condition. They may provide a wheelchair or electric car so you can avoid having to walk long distances at the airport.

If you're travelling and sitting still for a long time, either in a car, coach or on a plane, you should do simple exercises to reduce the risk of blood clots. Wearing flight socks or compression stockings while flying should also help.

It may be a good idea to take 2 sets of medication with you when you travel. Carry them in different places in case you lose one, and make a list of the medication you take and what it's for.

Having heart failure should not stop you getting travel insurance, but you may have to find a specialist company that will insure you.


You may need to tell the DVLA if you have heart failure.

Read more about heart failure and driving on GOV.UK.

Emotions, relationships and sex

Being diagnosed with heart failure can be a shock. Some people feel scared, anxious, depressed or angry. These feelings are completely normal.

Some people also become depressed. Speak to your GP or care team if you feel unable to enjoy the things you used to, or cope with everyday life.

You may find your physical relationship with your partner changes after your diagnosis because of worries about having a heart attack, or because you lose interest in sex or are unable to get an erection, which can sometimes be caused by heart failure medicines.

You can discuss any worries or problems you have with your GP or care team if you feel unable to talk to your family or friends. They will be able to advise you and arrange support.

You may also find it helpful to join a heart support group, where you can talk to other people with heart conditions whose circumstances are similar to yours.

You can call the British Heart Foundation's heart helpline on 0300 330 3311 to find out about support groups in your area.

Work and financial help

Can I continue working?

If you're well enough, you can keep working for as long as you feel able. With the right support, staying in work can make you feel better and give you financial security.

Talk to your employer as soon as you feel your heart failure is affecting your ability to do your job so you can find a solution that suits both of you. For example, it may be possible for you to work part-time.

The Disability Discrimination Act 1995 requires employers to make reasonable adjustments to working practices or premises to help a person with a disability.

Where possible, this might include changing or modifying tasks, altering work patterns, installing special equipment, allowing time off to attend appointments, or helping with travel to work.

What happens if I can no longer work?

If you can't continue working as a result of heart failure, you may be able to claim disability and sickness benefits.

Find out more about benefits if you have a long-term illness or disability on GOV.UK

Help for carers

Carers may also be entitled to some benefits.

Find out more at GOV.UK

Caring for someone with heart failure

Looking after someone with heart failure can mean anything from helping with hospital or GP visits to collecting prescriptions, to full-time caring.

There are many ways you can support someone with heart failure.

Heart failure can be disabling and distressing, and many people with the condition find it a huge relief to share their concerns and fears with someone.

As a carer, if you can attend GP and hospital appointments with the person with heart failure, you can encourage them to ask the right questions while you note down the answers.

You could also provide the doctor with additional information or insights into the person's condition, which can be helpful for planning the right treatment.

Another way you can help is by watching for warning signs that the person's heart failure is getting worse, or if they are not responding to treatment. 

Contact the person's doctor if you notice a new symptom or their current symptoms are getting worse.

Signs to look out for include:

  • shortness of breath that is not related to usual exercise or activity
  • increased swelling of the legs or ankles
  • significant weight gain over a few days
  • swelling or pain in their tummy
  • trouble sleeping or waking up short of breath
  • a dry, hacking cough
  • increasing tiredness or feeling tired all the time

What will happen towards the end?

Heart failure usually gets gradually worse over time. It may eventually reach a point where it becomes very severe and it's unlikely the person will live much longer.

Palliative care will usually begin when heart failure reaches this stage.

This involves treatment to help you feel as comfortable as possible, as well as psychological, spiritual and social support for both you and your family.

You can choose whether you want palliative care and where you would like it to be provided. It can be provided:

  • at home
  • in a hospice
  • in hospital

Plan in advance

It's a good idea to plan for your care in advance, as you may not be able to make decisions about your treatment when you become severely ill.

Things you will need to consider include:

  • making a will – if you haven't made one already
  • writing an advance statement – this lets those close to you know about the type of care you would like and where you want it if you're not able to decide for yourself
  • whether you want to make a living will (an advance decision) – this allows you to refuse some or all forms of medical care in the future when you're unable to make your own decisions or tell doctors what they want
  • whether you want to be resuscitated if your heart stops
  • whether you would want your defibrillator turned off (if you have one)

The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 28/11/2022 15:43:10