Introduction

The term ‘heart failure’ can be frightening for a patient or family members which is why many healthcare professionals and patient support groups prefer to call it ‘heart inefficiency’ or just ‘HF’. A simple explanation as to what this means can be helpful. For example, staff could say that the heart is not pumping properly so is less efficient at sending oxygenated blood around the body. 

An analogy that is sometimes used is that of a central heating pump no longer able to send as much water around the heating system. 

There are many reasons why a patient may develop heart failure including high blood pressure, a heart attack (many more patients now survive a heart attack but with residual damage to heart muscle that leads to HF), heart valve disease, disease of the cardiac muscle, diabetes and sometimes excess alcohol or toxicity from other medications. 

Regardless of the cause, common symptoms of HF often include: 

• Fluid retention: swelling of the ankles, legs or abdomen
• Chronic lack of energy or tiredness
• Shortness of breath especially on exertion or when lying flat (e.g., in bed).

Whatever the cause or type of HF, if there is fluid retention diuretics will be required. Additional treatment recommendations depend on the type of HF and are based on the evidence from randomised controlled trials showing reduced mortality and/or improved quality of life. Medication doses will need to be individualised depending on the patient’s symptoms, observations such as blood pressure, heart rate, fluid balance and blood test results and any co-morbidities.

For a patient with a new diagnosis of HF, specialist services in community or hospital teams (depending on local services) will initiate, titrate, and monitor treatment and once optimised refer to GP for on-going review.