Heart failure caused by damage to the heart that has developed over time can't be cured. But it can be treated, quite often with strategies to improve symptoms.
Successful treatment depends on your willingness to get involved in managing this condition, whether you're the patient or a caregiver. You and your loved ones are an active part of the healthcare team.
Your *treatment plan may include:
*Treatment information provided at the sole discretion of the American Heart Association and the guidance of our science staff and volunteers.
Regardless of your treatment, you need to follow all of your doctor's recommendations and make the necessary changes in diet, exercise and lifestyle to give you the highest possible quality of life.
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This content was last reviewed May 2017.
Heart failure is a serious condition in which the heart is unable to pump enough blood to meet the needs of the body. Although often life threatening, the typical symptoms of heart failure (breathlessness, swollen limbs and fatigue) are usually less dramatic than those associated with a heart attack. In economically developed countries, up to one person in five is expected to develop heart failure at some point in their life and even more people will be affected as family members, friends or healthcare professionals.
Heart failure survival rates remain poor across the globe
Across the globe, 17–45% of patients admitted to a hospital with heart failure die within 1 year of admission and the majority die within 5 years of admission (Figure 2).[3-24]
In recent years, survival rates for patients with heart failure have improved in many parts of the world, in parallel with the introduction of modern evidence-based therapies and patient management systems.[3, 25-31] Nevertheless, about 2–17% of individuals admitted to a hospital with heart failure die while in a hospital (Figure 2). Survival rates are better for those treated in outpatient clinics, who typically have less severe symptoms than those treated in a hospital.[22, 32] However, even the latest therapies may only relieve symptoms in many patients, without slowing the progression of their disease or prolonging life.[33, 34] This is because heart failure can arise from a number of different underlying problems with the structure or function of the heart, some of which are more difficult to treat than others (see Section on Preventing Heart Failure in High-risk Groups).
Despite improvements in care over the past 20 years, the outlook for patients with heart failure remains poor, and survival rates are worse than those for bowel, breast or prostate cancer.[35-37]
Heart failure is common, and patient numbers are increasing
About 26 million adults worldwide are living with heart failure, leading some to describe it as a global pandemic. In comparison, 32 million are living with cancer and 34 million with HIV/AIDS. In many countries, population-based studies have found that about 1–2% of people have heart failure, and similar or higher proportions have been reported in single-centre studies (Figure 3).[4, 8, 9, 11, 42-46]
Heart failure becomes more common with increasing age. In North America and Europe, few patients with heart failure are 50 years of age or younger[50-52] and more than 80% are 65 years of age or older. The number of patients with heart failure is predicted to increase in countries with ageing populations. Japan, in particular, has the most rapidly ageing population of all economically developed nations. In the USA, there were 5.8 million patients living with heart failure in 2012, and this is expected to rise to 8.5 million by 2030. Another contributing factor to these increasing numbers is the improvement in treating heart attacks and other cardiovascular diseases that damage or place an extra burden on the heart. More patients with these conditions are surviving now than did in the past, but those who survive are at high risk of going on to develop heart failure.
In economically developing areas, such as parts of Latin America and Asia, the numbers of patients with heart failure are also increasing.[55-58] The increase is largely a result of the shift towards a Western-type lifestyle and its associated diseases, for example, conditions such as diabetes increase the risk of developing heart failure (see Section on Preventing Heart Failure in High-risk Groups). This is despite reductions in the number of cases caused by Chagas disease in urban areas of Latin America and reductions in the number of cases of Davies disease (a disorder in which the heart muscle becomes rigid) in tropical areas.
Infections remain a common cause of heart failure in many parts of the world and can strike at any age. Heart failure is not a disease of the elderly in sub-Saharan Africa, where half of patients hospitalized with the disease are 55 years of age or younger. Patients in the Asia Pacific region also tend to be younger than those in Western regions. Rheumatic fever due to preventable bacterial infections is a prominent cause of heart failure in Africa, Asia, Australasia and Latin America. HIV infection is also a major contributor to heart-related disease across the world. In areas of Latin America where Chagas disease is common, nearly half of all heart failure cases are a direct result of this preventable parasitic infection.
In tropical areas, Davies disease has historically been a common cause of heart failure. The underlying reasons for the development of Davies disease have not been fully established but candidates include childhood malnutrition, dietary toxins and inflammation, as well as infections. In the Kerala region in south India in recent years, the number of new cases of Davies disease has declined in parallel with improvements in socioeconomic and health status.
Heart failure exacts severe economic, social and personal costs
Globally, the increasing burden of heart failure is taking its toll on society, in particular on patients, caregivers and healthcare systems.
As a primary diagnosis, heart failure accounts for about 1–4% of all hospital admissions in economically developed countries (Figure 4).[14, 64-67] This is likely to be an underestimate because heart failure may be recorded as a secondary diagnosis, or may even go unrecorded, especially in the large number of patients who have other cardiovascular diseases. Country-wide information is sparse in other regions, highlighting the need to set up new national registries to quantify accurately the burden of heart failure.
Caring for patients with heart failure comes at a high economic cost and accounts for about 1–3% of total healthcare expenditure in North America, Western Europe and Latin America. In comparison, the total global expenditure on all healthcare goods and services in 2010 was in the region of $6.5tn.[71, 72] In Germany, the total medical costs attributable to heart failure were estimated at €2.9bn in 2006. This figure includes costs for inpatient, outpatient and day care services, as well as drugs, devices and other medical products. In the USA, the total hospital, physician, prescription and home healthcare costs associated with heart failure were estimated at $20.9bn in 2012 and are projected to rise to $53.1bn by 2030. The 2012 figure is comparable with the annual capital spend required to ensure clean, safe drinking water for the entire nation.
The lengthy and repeated hospital stays that are typically required by patients with heart failure account for the majority of this economic burden.[45, 70] Across the globe, the average length of hospital stay is about 5–10 days.[3, 5, 6, 11, 12, 14, 19, 20, 24, 43] Over the past two decades, the length of stay has become shorter in Europe, North America and Australasia.[3, 5, 11, 43] Nevertheless, in Europe and North America, about a quarter of patients admitted to a hospital with heart failure are readmitted within a month and up to two-thirds within a year, usually for recurrence of heart failure. Individuals who are readmitted with worsening or recurrent symptoms of heart failure are at a high risk of terminal decline. Hospital readmission can improve survival rates amongst patients with worsening heart failure; however, identifying those for whom long-term monitoring is a suitable alternative may be a more efficient use of resources (Section on Future Directions in Care: Urgent Unmet Needs).
Heart failure markedly affects patients' quality of life. Fear, anxiety and depression are common, and work, travel and day-to-day social and leisure activities are difficult for those with breathlessness and extreme fatigue. The emotional, physical and financial costs are also high for caregivers looking after a family member with heart failure.
I'm not depressed… not really depressed… it's just a low feeling and it's not a happy feeling, and you just never feel your life's worth anything at times.
At night, when he's lying in bed and I don't hear him breathe for a while, it gives me the nerves. Then I start counting. And suddenly I hear him breathing again. Then I think, oh dear, one morning I will wake up and then he's gone.
I don't mean to complain but if you are used to going out and now you have to stay home all the time, you know all the time. My daughter lives around the corner and I go out a lot with her, with the dog, to keep my mind off things…
I dare not stay away much longer. My daughter wants me to come along to go to the seaside and we will also take the dog with us, but I am afraid to go. To go out for a whole day is much too long.
Heart failure causes large numbers of deaths and widespread ill health and exacts huge economic and social costs—and the problem is becoming worse. Now is the time for coordinated public heart failure awareness programmes and strategic and political initiatives to improve care across the globe.