Understanding heart failure
A compassionate, clear guide to what heart failure is, what causes it, and how it can be managed.
Heart failure affects over a million people in the UK, yet it remains widely misunderstood. This guide is here to help, whether you have received a diagnosis, are supporting a loved one, or simply want to learn more about this condition.
What is Heart Failure?
Heart failure is a complex condition in which the heart fails to deliver enough blood, oxygen, nutrients, and hormones to meet the body's demands. Despite its name, it does not mean the heart has stopped working altogether. Rather, it is not functioning as efficiently as it should be.
This can occur for several reasons:
The heart muscle is too weak to pump effectively
The heart is too stiff and cannot relax properly between beats
There are structural abnormalities that affect blood flow through the heart
Heart Failure in the UK: Key Facts
Heart failure is far more common than many people realise. The following figures highlight the scale of this condition across the country. Currently, over a million people are living with heart failure in the UK. 200 thousand people are diagnosed in the UK every year, and it is estimated that 400 thousand people are living with heart failure and remain undiagnosed. 2% of the entire NHS budget is attributed to managing heart failure.
It is estimated that the number of people diagnosed with heart failure will double by 2040, largely driven by rising rates of high blood pressure, obesity, and type 2 diabetes.
Encouragingly, heart failure can be treated successfully, particularly with early specialist care. Most people receive their diagnosis in hospital, despite having experienced symptoms that could have prompted an earlier diagnosis in the community.
What Causes Heart Failure?
There are many different reasons why the heart may struggle to meet the body's demands. Some of the most common causes include the following:
Damage to the heart muscle caused by a heart attack
High blood pressure (hypertension)
Abnormal heart rhythms (arrhythmias)
Excessive alcohol intake
Certain medications
Viral and bacterial infections
Heart valve problems
Hereditary (genetic) conditions
What Symptoms Does Heart Failure Cause?
Symptoms can vary considerably from person to person and may develop gradually over time. Common symptoms include the following:
Breathlessness (dyspnoea), particularly on exertion or when lying flat
Swelling of the legs and ankles (oedema)
Fatigue that is often overwhelming and not proportionate to activity levels
Difficulty lying flat due to breathlessness, known as orthopnoea
Waking suddenly breathless during the night, known as paroxysmal nocturnal dyspnoea (PND)
A reduced appetite, nausea, or a persistent feeling of fullness
Unexplained weight loss or weight gain
An awareness of your own heartbeat, known as palpitations
Dizziness or light-headedness
If you are experiencing any of these symptoms, particularly breathlessness or swelling in the legs, it is important to seek medical advice promptly.
How is Heart Failure Diagnosed?
A thorough assessment of a person's history, symptoms, and clinical findings is essential. If heart failure is suspected, the following investigations are typically recommended:
A blood test called a BNP (B-type natriuretic peptide), which is a heart failure marker
A 12-lead ECG (electrocardiogram)
An echocardiogram, which is an ultrasound of the heart
In some cases, an MRI scan of the heart
Understanding your BNP result (NICE guidance 2018)
BNP Level: What It Means. Under 400: Normal — heart failure is unlikely. 400 to 2,000Referral for echocardiogram within 6 weeks. Over 2,000Urgent referral for echocardiogram within 2 weeks
How is Heart Failure Treated?
It is important that people with heart failure are seen and treated by a specialist as early as possible. Treatment is highly effective when started promptly, and may include the following:
Diuretics to remove excess fluid from the body
Beta blockers to slow and steady the heartbeat
MRAs and SGLT2 inhibitors to prevent fluid accumulation and help protect the heart
ACE inhibitors or ARBs to support the strength of the heart's pumping action
Certain types of pacemakers, depending on the underlying cause
Lifestyle Strategies That Can Help
Being well-informed about your condition and making thoughtful lifestyle choices can dramatically improve your symptoms and quality of life, especially when combined with medical treatment. Some evidence-informed strategies to consider include the following:
Aiming for balanced blood sugars, even if you are not diabetic
Improving gut health through diet and daily habits
Managing stress using nervous system regulation techniques
Spending time in nature and getting early morning daylight exposure
Prioritising a consistent and restful sleep routine
Staying socially connected with friends, family, and your community
Avoiding ultra-processed foods and excess salt
These approaches reflect the holistic nature of heart health. The body and mind are deeply interconnected, and small, consistent changes made over time can have a genuinely meaningful impact on how you feel day to day.
Further Information and Support
There are several national charities that offer education and support to patients, their families, and carers. Please always seek professional medical advice if you have any concerns about your heart.
The Pumping Marvellous Foundationpumpingmarvellous.org
Cardiomyopathy UKcardiomyopathy.org
The British Heart Foundationbhf.org.uk
NICE Guidelinesnice.org.uk
Local Support Groups: Ask your GP or heart failure nurse about peer support groups in your local area.