A short story: what would you do?
Follow Lola Cora to learn the warning signs and what to do. Turn on your sound for the narration.
What happens in heart failure
In heart failure, the heart cannot pump enough blood to meet the body's needs. Blood and fluid back up into the lungs, legs and belly. This causes shortness of breath, swelling and tiredness. [Ref: AHA What Is HF] [Ref: ESC 2026 HF]
An echocardiogram measures the ejection fraction: the share of blood the heart pumps out with each beat. This sorts heart failure into two main types that are treated differently. [Ref: ESC 2026 HF]
Weak pump (HFrEF)
Ejection fraction below 50%. The heart muscle squeezes weakly.
Stiff heart (HFpEF)
Ejection fraction 50% or higher. The heart squeezes normally, but it is stiff and does not fill well. Tests show changes in the heart's structure or filling.
If your ejection fraction improves
Treatment can make a weak heart pump better. This is good news, but it usually does not mean the heart is cured. In one study, 4 in 10 people who stopped their heart failure medicines got worse again within 6 months. Keep taking them unless your doctor tells you otherwise. [Ref: ESC 2026 HF]
Common causes: heart attack and blocked heart arteries, long-standing high blood pressure, heart valve disease, diabetes and obesity, diseases of the heart muscle (including a protein build-up called amyloid), some irregular heart rhythms, some cancer treatments, and heavy alcohol or drug use. [Ref: ESC 2026 HF]
Why follow-up matters
About 56 million people worldwide were living with heart failure in 2023. [Data: GBD 2023 HF] After a hospital stay for heart failure, about 4 in 10 people go back to hospital within a year. Starting the right medicines and seeing your doctor often in the weeks after discharge lowers this risk. [Ref: ESC 2026 HF]
The four stages
Heart failure develops in stages. The European and American guidelines now use the same four stages. Treatment at the earliest stages can prevent or delay heart failure. [Ref: ESC 2026 HF] [Ref: AHA/ACC/HFSA 2022 HF]
| Stage | What it means | What to do |
|---|---|---|
| A: At risk | You have a risk factor such as high blood pressure, diabetes, obesity or heart artery disease. You have no symptoms and no changes in the heart. | Control your risk factors with your doctor's help |
| B: Pre-heart failure | Tests show changes in the heart's structure or pumping, or raised heart blood tests, but you have no symptoms. | Regular check-ups; your doctor may start medicines |
| C: Heart failure | You have, or have had, symptoms or signs of heart failure caused by a problem in the heart. | Treatment and regular follow-up with your doctor |
| D: Advanced heart failure | Symptoms are severe and keep coming back despite the best medicines, devices and procedures. | Care from a specialist heart failure team |
Your doctor will tell you how often to come back. Visits are more frequent after a hospital stay or a change in medicines. [Ref: ESC 2026 HF]
Preventing heart failure (stages A and B)
- If you have high blood pressure, keep the top number below 130 if you can.
- Keep a healthy weight, eat a balanced diet, move more and sit less.
- Do not smoke. Avoid heavy drinking and drugs such as shabu and other amphetamines, cocaine and anabolic steroids.
- If you have type 2 diabetes, ask your doctor if a diabetes medicine that also protects the heart is right for you.
- If tests show stage B, your doctor may start heart medicines even before symptoms appear.
[Ref: ESC 2026 HF]
Symptoms
Shortness of breathWith activity, when lying flat, or waking you at night. You may need extra pillows.
SwellingIn the feet, ankles, legs or belly, often with weight gain.
TirednessEveryday tasks like walking or climbing stairs feel hard, and you take longer to recover.
Other signsA cough at night or a wheeze, a bloated feeling, poor appetite, a racing heartbeat, dizziness, or getting breathless when bending forward. Older adults may become confused.
[Ref: ESC 2026 HF] [Ref: AHA Heart Failure Warning Signs]
Call your doctor within a day if you have heart failure and:
- your weight goes up by more than 1 kg overnight, or more than 2 kg in 3 days
- you are more breathless or swollen than usual
- you need more pillows to sleep
[Ref: HFA Heart Failure Matters 2026] [Ref: AHA Heart Failure Warning Signs]
What happens at your check-up
Your check-up starts with your symptoms, an examination, an ECG, a chest X-ray and a blood test called NT-proBNP or BNP, which rises when the heart is under strain. [Ref: ESC 2026 HF]
An echocardiogram (heart ultrasound) confirms the diagnosis and shows the type. [Ref: ESC 2026 HF]
Many other conditions change these results, so your doctor reads them together with your symptoms and examination. [Ref: ESC 2026 HF]
Blood and urine tests also check the kidneys (including protein in the urine), sugar, cholesterol, thyroid, liver, blood count and iron. Some people need a heart MRI or other tests to find the cause, such as checks for blocked heart arteries or amyloid. [Ref: ESC 2026 HF]
Your doctor decides which tests you need and explains what the results mean for you.
Breathless, swollen or tired? Get your heart checked.
Only an examination and the right tests can tell whether you have heart failure, what type it is and which treatment is right for you. Dr. Aaron Christopher P. Novales sees patients with heart failure.
Severe breathlessness, unable to lie flat, or chest pain? Do not wait for a clinic visit. Go to the emergency room now →
How heart failure is treated
About the medicines on this page
Medicines are described here only to help you understand your doctor's plan. Do not buy or take any medicine because you read about it here. Take only what your doctor prescribes for you, and never start, stop or change a dose on your own.
Medicines for a weak pump
For an ejection fraction below 50%, four groups of medicines are the foundation of treatment. Together they help people live longer and stay out of hospital. Your doctor starts them soon after diagnosis and adjusts the doses at regular check-ups. [Ref: ESC 2026 HF]
Medicines for a stiff heart
For an ejection fraction of 50% or higher, heart medicines prescribed by your doctor lower the risk of hospital stays and of your heart failure getting worse. Treating related conditions is also key: high blood pressure, atrial fibrillation, diabetes, kidney disease and excess weight. [Ref: ESC 2026 HF]
If you have obesity, losing weight with your doctor's guidance can improve symptoms. Some people may be prescribed a weight-loss medicine. [Ref: ESC 2026 HF]
Relief from fluid build-up
Water pills (diuretics) remove extra fluid and ease breathlessness and swelling. Your doctor adjusts the dose over time to the lowest dose that keeps the fluid off. [Ref: ESC 2026 HF]
Extra medicines for some people
Depending on your heart rate, heart rhythm and symptoms, your doctor may add other medicines. These are added on top of the foundation medicines, not in place of them. [Ref: ESC 2026 HF]
Devices and procedures for some people
Some people with a weak pump benefit from a device that prevents dangerous heart rhythms (ICD) or one that helps both sides of the heart beat together (CRT). Opening a blocked artery or fixing a narrowed or leaky valve can also help. For advanced heart failure, a heart pump (LVAD) or a heart transplant may be considered at a specialized center. [Ref: ESC 2026 HF]
During and after a hospital stay
Before you go home, your care team should check that the extra fluid is gone. Your heart medicines should be started before discharge and adjusted quickly, with frequent check-ups in the first 6 weeks. This lowers the chance of going back to hospital or dying. [Ref: ESC 2026 HF]
Daily self-care
Good self-care improves how you feel and lowers the chance of a hospital stay. It works best when your family or carer is involved and you make a plan with your care team. [Ref: ESC 2026 HF]
Weigh yourself every morningAt the same time each morning, after using the toilet and before breakfast. Write it down. [Ref: HFA Heart Failure Matters 2026] [Ref: ESC 2026 HF]
Take every medicineEven when you feel well or your heart gets better. Ask before stopping any of them. [Ref: ESC 2026 HF]
Limit saltAsk your care team whether you also need to limit fluids. [Ref: HFA Heart Failure Matters 2026]
Exercise regularlyA cardiac rehabilitation program is recommended once you are stable. Exercise improves fitness and lowers hospital stays. [Ref: ESC 2026 HF]
Get vaccinatedFlu, pneumonia, COVID-19 and RSV vaccines help prevent infections that strain the heart. Ask your doctor which ones you need. [Ref: ESC 2026 HF] [Ref: ACC 2026 Vaccines]
Check before taking pain relieversPain relievers called NSAIDs, such as ibuprofen, naproxen and mefenamic acid, can make heart failure and the kidneys worse. [Ref: ESC 2026 HF]
Avoid smoking and alcoholBoth make heart failure worse. [Ref: ESC 2026 HF]
Mind your moodWorry, sadness and memory problems are common. Tell your doctor, because help is available. [Ref: ESC 2026 HF]
Talk to your doctor about
Bring these questions to your visit.
- What is my ejection fraction, and has it changed?
- Am I on all the medicines that could help me?
- What weight gain should make me call you?
- How much salt and fluid can I have each day?
- Can I join a cardiac rehabilitation program?
- Which medicines, including pain relievers, should I avoid?
- Would a device or procedure help me?
Related conditions
Guideline sources for this page
- ESC 2026 HF: Køber L, Adamo M, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026;47:5346–5457.
- ACC 2026 Vaccines: American College of Cardiology. Concise clinical guidance on adult immunization in people with cardiovascular disease. J Am Coll Cardiol 2026.
- GBD 2023 HF: GBD 2023 Heart Failure Collaborators. Global, regional, and national burden of heart failure, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. JAMA Cardiol 2026.
- HFA Heart Failure Matters 2026: Heart Failure Association of the ESC. Heart Failure Matters patient pages: Weight gain in heart failure and Adjusting your diet: fluids. Updated March 2026.
- AHA/ACC/HFSA 2022 HF: Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure. Circulation 2022.
- AHA Heart Failure Warning Signs: American Heart Association. Warning signs of heart failure.
- AHA What Is HF: American Heart Association. What is heart failure?