Understanding heart failure


More than 6.5 million Americans are living with heart failure. By 2030, the American Heart Association estimates that number will reach over eight million, in part because of a growing percentage of older Americans.

What is heart failure?

Heart failure is a condition in which the heart is unable to pump enough blood to meet the body’s needs. The most common type of heart failure occurs when the heart does not squeeze well enough to pump blood throughout to the body.

Another type of heart failure occurs when the heart becomes stiff and does not fill easily with blood.

Heart failure does not actually mean a “failed” or stopped heart, but instead means a heart that is not working as well is it should.

Symptoms of heart failure

As a result of heart failure, fluid accumulates in the body and organs do not get as much blood as they need. The most common symptoms of heart failure are fatigue, shortness of breath, and swelling in the legs.

Tiredness and breathing difficulties are more noticeable with exertion or activity. Symptoms may occur gradually or may come suddenly.

When symptoms are ignored, they can often lead to a hospitalization. Hospitalization for heart failure is one of the most common reasons for hospitalization among those aged 65 and older. If you develop new or worsening symptoms, it is important that you bring them to the attention of your doctor.

Diagnosing heart failure

In order to diagnose heart failure, your doctor will usually start with questions about your symptoms. A doctor may then do a physical exam that will include listening to the heart and lungs, checking blood pressure, and looking for signs of swelling.

A doctor may order additional tests such as an electrocardiogram (EKG) to record the electrical activity of the heart, an echocardiogram to capture images of the heart in motion, and a coronary angiogram to look for blockages in the vessels that supply blood to the heart.

Treating heart failure

Treating the main risk factors for heart failure such as coronary artery disease and high blood pressure may prevent or delay the onset of heart failure. Additionally, lifestyle changes, prescription medications, and close monitoring can help patients with heart failure have a better quality of life and avoid worsening symptoms.

A healthy lifestyle is important in treating heart failure. A heart-friendly diet is rich in foods such as fruits, vegetables, whole grains, fish and healthy fats. Limiting salt and daily fluid intake is often necessary to control the symptoms of heart failure. It is also important maintain a healthy weight and to include a regular exercise program most days of the week.

Physicians can use a variety of prescription medications to treat and manage heart failure symptoms. Common heart failure medications can lower blood pressure and reduce the strain on the heart, remove excess fluid from the body, slow the heart rate, and make the heart beat more vigorously.

When heart failure symptoms become severe and are no longer manageable through lifestyle changes or medications, there are other options to consider. Some people with heart failure need pacemakers or implantable cardioverter defibrillators in order to manage irregular heart rhythms.  For some patients with very severe heart failure, a mechanical heart pump or even a heart transplant may be an option.

Effect on the Black community

Unfortunately, race or ethnicity is a factor that affects the likelihood of suffering from heart failure. African Americans have higher rates of heart failure and often face barriers to heart failure diagnosis and care.  

African American patients with heart failure experience worse health outcomes than White patients. The chance of dying from heart failure is more than two and half times higher in younger Black men than White men.

The prevention and management of heart disease risk factors such as high blood pressure is one example of strategy that is needed to eliminate the racial disparities in heart failure. Social determinants of health such as access to insurance, education, safe neighborhoods, housing and employment are also factors that worsen the disparities in heart failure.

Mosi Bennett, MD, PhD, is a board-certified heart failure and transplant cardiologist with the Minneapolis Heart Institute at Abbott Northwestern Hospital. He completed his undergraduate work at the University of Pennsylvania. He went on to attend medical school and graduate school at the Johns Hopkins University School of Medicine in Baltimore, Maryland. He completed his Internal Medicine residency at Johns Hopkins Hospital, and then cardiovascular disease and heart failure fellowships at the Cleveland Clinic.