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ALL ABOUT HEART FAILURE

THE HEARTBROTHERS FOUNDATION's
HEART FAILURE AWARENESS CAMPAIGN

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Here to Help You Live Your Healthiest Life

HEART FAILURE AWARENESS

Your Healthiest Life Begins Today

As Heart Failure patients and caregivers ourselves, we know how it feels to hear your physician first utter the words Heart Failure after a medical exam. Waves of emotion and uncertainty, a flood of questions, and lots of medical jargon often take over. At The HeartBrothers Foundation, we are here to hold your hand through that moment of diagnosis, to look in your eyes and let you know you can do this, and to help you wade through the sea of information that exists to inform you about a life with Heart Failure.

 

Whether you are a newly diagnosed patient, a caregiver or loved one of someone recently diagnosed, or you may be at risk for developing Heart Failure, we are here for you.

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We have meticulously curated the following Heart Failure Awareness resources from leaders in the Heart Failure field to help you understand—in layman’s terms—how Heart Failure may impact you, or your loved ones, and steps you can take to minimize its impact on your life, and possibly even prevent it from developing in the first place. Though some types of Heart Failure are genetic and not preventable, researchers have discovered that many types of Heart Failure can be prevented when risk factors are identified early, and healthy lifestyle changes are implemented. Likewise, if you have contracted Heart Failure, the earlier you intervene and implement a healthy lifestyle, the more you can minimize your disease, leading to the longest, healthiest life possible.

 

With all our hearts, we care for you and your well-being, and we thank you for choosing the HeartBrothers Foundation as your Heart Failure Awareness resource. You will find our sources hyperlinked within the text you’re reading—in case you’d like to dive deeper into the science of Heart Failure. We intend this resource to be evergreen—perpetually growing and evolving as the newest and best research, medicine, and treatments emerge on the scene. If you have questions or thoughts about how we can improve or expand this resource at any time, please don’t hesitate to contact us.

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Click text below to jump to each section.

WHAT IS HEART FAILURE?

Heart Failure, Defined

Contrary to its name, the term Heart Failure (HF) does not refer to a heart that has stopped working. Heart Failure is a condition in which your heart cannot pump blood adequately to meet your body’s needs.

HF Definition

HEART FAILURE RISK FACTORS & CAUSES

As the American Heart Association points out, in some ways, we are all at risk for Heart Failure, especially as we age. One out of five Americans over 40 will develop Heart Failure in their lifetime.

According to a scientific statement from several councils of the American Heart Association, your likelihood of developing Heart Failure increases with the following risk factors:

 

HF Risk Factors and Causes

HEART FAILURE STAGES

In April 2022, the American College of Cardiology (ACC) and American Heart Association (AHA) released the following updated stages of Heart Failure, with the goal of identifying Heart Failure risk factors early (at Stage A)—before structural changes and signs of weakening heart function begin (Stage B)—to maximize the number of people who may never need to receive a Heart Failure diagnosis at all.

STAGE A

At Risk for Heart Failure

In Heart Failure Stage A, you are symptom-free, and without any structural heart disease, but at significant risk to develop Heart Failure if you have one or more of the following risk factors:
 

  • Advancing Age

  • High Blood Pressure (hypertension)

  • Smoking

  • Elevated cholesterol or fats/lipids in the blood (dyslipidemia)

  • Diabetes

  • Obesity

  • Toxins, medications, or treatments that damage the heart (chemotherapy drugs included)

  • Family history of Heart Failure
     

The identification of Stage A has been critically important, as it is the most opportune moment to intervene and potentially prevent Heart Failure from developing in the first place. If you identify with any of the above risk factors, contact your doctor as soon as possible to discuss steps you can take to reduce your risk of Heart Failure.

STAGE B

Pre-Heart Failure

In Heart Failure Stage B, though you still have no symptoms or signs of HF, there is evidence of one of the following:
 

  • Structural Heart Disease, including, but not limited to:

    • Hypertrophy (enlarging heart)

    • LVH (left ventricular hypertrophy) Wall-thickening of the heart’s main pumping chamber

    • Heart Valve Disease (problem with heart valves’ opening/closing to control blood flow)

    • Cardiomyopathy (disease involving the heart muscle)

    • Reduced Ejection Fraction (heart not pumping as well as normal)

  • Infarction (obstruction of blood supply, causing tissue death)

  • Accelerated Cell Death

  • Fibrosis (hardening/scarring tissue)

  • Dilation (heart’s main pumping chamber/left ventricle thins, stretches, and grows larger)

  • Increased Filling Pressures (Diastolic Dysfunction)

  • Stage A Risk Factors plus indicators of heart muscle injury (discovered via testing)
     

Stage B of Heart Failure is the second best moment to intervene, change lifestyle choices, and therefore delay or even prevent HF from progressing to the symptomatic and advanced Heart Failure Stages C and D. If you identify with any of the above risk factors, contact your doctor as soon as possible to discuss reducing your risk of Heart Failure.

STAGE C

Symptomatic Heart Failure

Symptomatic Heart Failure begins in Stage C. At this stage, your doctor has discovered some form of structural heart disease—likely one from the Stage B list, above—and you have, or have had, any or all of the Heart Failure symptoms listed in the section below.

Following your doctor’s guidance and adjusting your lifestyle accordingly is critically important to your quality of life in Stage C. If you haven’t done so already, be sure to find Heart Failure Specialists near you—cardiologists, nurses, pharmacists, dieticians, mental health professionals, primary care doctors, and social workers who have extensive HF experience. If you’re unsure where to start on your search for a Heart Failure Specialist, contact us. 

Patients with Stage C Heart Failure must learn to continuously reduce and monitor sodium intake, stay (appropriately) physically active, remain up-to-date on all vaccinations, and take all prescribed medications. There can be a learning curve to this stage for both patients and caregivers, and Team HeartBrothers Ambassadors are here to help you find your footing.

STAGE D

Advanced Heart Failure

By Stage D, your Heart Failure is Advanced—and also referred to as End-Stage Heart Failure.

At this point, your Heart Failure symptoms are ever-present, difficult to manage, interfere with your daily life, and you may be in and out of the hospital, even if you are following your doctor’s prescribed guidelines, medications, and therapies. Advanced therapies, including implanted ventricular assist devices (VADs), mechanical circulatory systems (MCS), and heart transplant may be recommended. Team HeartBrothers Ambassadors have been down this road, and are here to talk to you and your loved ones to help you through your journey.

HF Stages
HF Stage A
HF Stage B
HF Stage C
HF Stage D

NEW YORK HEART ASSOCIATION
FUNCTIONAL CLASSIFICATION OF HEART FAILURE

In addition to the above ACC/AHA Stages of Heart Failure, the complementary New York Heart Association (NYHA) Functional Classification of Heart Failure, used globally since 1902, assesses patients based on their limitations during physical activity, which is a strong predictor of patients’ prognoses.


STAGE I

No physical activity limitation. Ordinary physical activity does not create noteworthy fatigue, palpitations, or shortness of breath (dyspnea).


STAGE II
Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity leads to fatigue, palpitations, and/or shortness of breath (dyspnea).


STAGE III    
Significant physical activity limitation. Comfortable at rest. Less than ordinary activity causes fatigue, palpitations, and/or shortness of breath.


STAGE IV    
Severe physical activity limitation. Symptoms of Heart Failure at rest. Discomfort increases with any physical activity.

NYHA HF Stages

HEART FAILURE SYMPTOMS

Heart Failure symptoms can vary widely depending on your type and stage of HF.

The most common Heart Failure symptoms stem from your weakened heart’s reduced ability to pump blood throughout your body, which leads to fluid accumulation—AKA congestion—in your body tissues, and a reduced ability of your kidneys to expel sodium, which further increases your body’s fluid buildup.

In Heart Failure’s early stages, you may experience no symptoms, but as Heart Failure progresses, symptoms may include any or all of the following:

 

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LEFT-SIDED HEART FAILURE SYMPTOMS MAY INCLUDE:

RIGHT-SIDED HEART FAILURE SYMPTOMS MAY INCLUDE:

  • Swelling in abdomen, feet, ankles, legs, neck veins, organs, genital area

  • Weight gain (often rapid, due to fluid retention from swelling)

  • Abdominal pain (surrounding your stomach)

  • Nausea

  • Loss of appetite

  • Frequent urination—particularly at night. When you lie down at night, fluid accumulated in your legs during the day may move back to the kidneys for urine output.

 

Experiencing any of the above symptoms can also cause or exacerbate mental health symptoms of:

  • Depression

  • Anxiety

 

Consult your doctor if you notice new or worsening symptoms, or if you develop any symptoms suddenly.

HF Symptoms

TYPES OF HEART FAILURE

Visit a handful of leading Heart Failure websites, and you will discover different ways of categorizing types of Heart Failure. This is because there are a variety of factors to consider when describing and diagnosing any given patient’s HF. Each factor is critical to your medical team, as defining the type and cause of Heart Failure will determine your individual course of treatment.
 

For example, Acute Heart Failure may develop suddenly and be instantly severe—perhaps following sudden heart damage due to heart attack—but it might only last briefly and quickly improve, typically with intravenous medicine. On the other hand, Acute Heart Failure may also result from your body’s inability to function with Chronic Heart Failure, in which symptoms appear gradually, and worsen over time—most often, due to another medical problem (see Risk Factors and Causes, above). 

 

Before walking through the different types of Heart Failure, it’s important to understand ejection fraction.


Ejection Fraction is the amount of blood, measured as a percentage, your heart pumps out with each heartbeat or contraction.

  • Normal EF typically ranges between 50-70%.

  • Borderline EF of 41-49% may indicate damage (i.e. past heart attack) or developing heart failure.

  • Low EF, at 40% or below, may indicate HF or other heart muscle disease (cardiomyopathy).

  • High EF above 75% may be evidence of Hypertrophic Cardiomyopathy (HCM).


 

LEFT-SIDED HEART FAILURE (LV Heart Failure)
Left Ventricular Heart Failure, or Left-Sided Heart Failure, is the most common type of Heart Failure, and occurs when your left ventricle (the left side of your heart) cannot pump sufficient blood throughout your body. This results in a backup of blood in your pulmonary veins—the blood vessels carrying blood away from the lungs—and leads to shortness of breath, coughing, and breathing difficulty (particularly during exertion).

 

The two main subsets of Left-Sided Heart Failure are referred to by a variety of different terminology:

 

 

 

RIGHT-SIDED HEART FAILURE (RV Heart Failure)

Typically caused by Left-Sided Heart Failure, Right-Sided Heart Failure occurs when the right ventricle is too weak to pump blood to the lungs. This results in a backup of blood and increased pressure in your veins, forcing fluid from the veins into surrounding tissue, usually causing congestion (swelling) in the legs, ankles, abdomen, organs, neck veins, or genital area. Right-Sided Heart Failure may also be caused by damage to the heart muscle, valves, or elevated lung pressure.

 

BIVENTRICULAR HEART FAILURE

When Heart Failure affects both sides of the heart, it is considered Biventricular Heart Failure, and can result in the symptoms of both Left- and Right-Sided Heart Failure.


CONGESTIVE HEART FAILURE

Though Congestive Heart Failure has historically been used interchangeably with Heart Failure, today the American Heart Association defines Congestive Heart Failure (CHF) as a specific type of HF requiring urgent medical attention, in which blood flow from the heart slows down, leading to a backup in blood returning to the heart, causing subsequent swelling (AKA congestion, or edema) in surrounding body tissues—especially the legs and ankles.

As a result of CHF, pulmonary edema may develop—a build-up of fluid in the lungs, which can interfere with breathing, most noticeably at night. CHF can also reduce the kidneys’ functionality, preventing their ability to rid the body of water and sodium, which in turn worsens bodily swelling.

HF Types

HEART FAILURE TREATMENTS

LIFESTYLE CHANGES TO TREAT HEART FAILURE

These are virtually identical to Heart Failure Prevention tips—and with good reason: healthy lifestyle choices prevent disease onset are critical to delaying Heart Failure progression.

Changes to implement today:
 

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MEDICATIONS TO TREAT HEART FAILURE

Taking the medications directed by your doctor to manage your unique Heart Failure condition is critical to optimizing your health.

Your doctor may prescribe any combination of the following medications that work to…

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  • Remove Excess Fluid and reduce the amount of blood your heart must pump.

    • Diuretics, Aldosterone Antagonists
       

  • Relax Blood Vessels/Lower Blood Pressure, allowing your heart to pump more easily.

  • Slow Your Heart Rate and make it easier for your heart to pump blood.

    • Beta Blockers, Ivabradine
       

  • Make Your Heart Beat Stronger and pump more blood.

    • Cardiac Glycosides
       

  • Lower Blood Sugar by removing sugar via urine. Newly recommended in 2022, after studies showed that HF patients taking SGL2 inhibitors live longer.

    • SGL2 Inhibitors
       

MEDICAL PROCEDURES TO TREAT HEART FAILURE

If your Heart Failure progresses to an advanced stage, or your reduced ejection fraction worsens, your doctor may recommend the following surgical interventions:
 

  • ICD
    Surgically implanted, an implantable cardiodefibrillator, or ICD, monitors your heart rate and prevents sudden cardiac arrest via electrical pulses that correct irregular rhythms.
     

  • Pacemaker
    Also known as CRT (cardiac resynchronization therapy), an implanted pacemaker synchronizes both sides of your heartbeat, reducing Heart Failure symptoms.
     

  • Heart Pumps
    Surgically implanted ventricular assist devices (VADs or LVADs)—also referred to as mechanical circulatory support (MCS)—help the heart pump blood through the weakened heart chambers. A temporary total artificial heart (TAH) can alternatively replace the function of your heart and extend your life.
     

  • Heart Transplant
    End-stage Heart Failure patients who have progressed through other treatments may be advised to join a waitlist to undergo a heart transplant, receiving a healthy heart from a deceased donor. Many Team HeartBrothers Ambassadors have undergone this procedure, and are here to answer any questions you may have and guide you through your transplant journey.

PEER & MENTAL HEALTH SUPPORT
TO TREAT HEART FAILURE

As Heart Failure and transplant survivors ourselves, all of us at the HeartBrothers Foundation the emotional ups and downs that come with a Heart Failure diagnosis, the treatments involved, and the uncertain road you travel along. Emotional support and mental health are an absolutely critical component to your healing and well-being—we are honored to offer our peer and mental health support to you.
 

  • Team HeartBrothers Ambassadors
    Our 75+ Team HeartBrothers Ambassadors—Heart Failure survivors who journeyed through VADs, heart transplant, and beyond—provide emotional support and education to fellow Heart Failure patients and families. In person, virtually, or via phone, we visit with hospitalized and homebound HF, LVAD, and heart transplant patients—delivering hope when all seems hopeless. Our fully trained men and women are ready to answer questions regarding Heart Failure’s four diagnostic stages, the organ donation and transplant process, and draw from personal experiences to answer questions and empathize as only fellow survivors can.
     

  • HeartBrothers Patient Support Group
    In collaboration with New England Heart Failure Centers and Hospitals, the HeartBrothers hosts a FREE monthly virtual Patient Support Group, the second Thursday of each month at 6pm ET. Our Heart Failure Patient Support Group meetings are a gathering space for all Heart Failure patients and loved ones anywhere, to listen or share first-hand knowledge, information, experiences, and strategies on how to live your best life with Heart Failure and all its complications. Each meeting features Team HeartBrothers Ambassadors, fellow Heart Failure patients and caregivers, and social workers and staff from partnering transplant centers. 

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HF Treatments

HEART FAILURE PREVENTION

3 Steps to Help Prevent Heart Failure

Thanks to modern science, we now know there are many steps we all can take to prevent Heart Failure. We encourage you to follow these three steps to help prevent heart failure:

HF Prevention

STEP 1

Daily Lifestyle Choices to Prevent Heart Failure

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STEP 2

Simple Medical Interventions to Prevent Heart Failure

In addition to these basic lifestyle choices, if you are predisposed to developing Heart Failure due to any of the high risk factors below, follow the corresponding medical interventions to reduce your risk of Heart Failure:

 

  • Do you have a family member with Heart Failure?

    • Ask your doctor if you should undergo genetic screening to assess your HF risk.
       

  • Do you have high blood pressure?

    • Talk to your doctor about taking diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or beta-blockers. If you have already been prescribed these medications, continue to take them to reduce your HF risk.
       

  • Do you have high cholesterol?

    • Ask your doctor if you should be taking aspirin or statins.
       

  • Are you a cancer patient or survivor?

    • Chemotherapy can weaken your heart—talk to your doctor about whether your heart function should be monitored for HF risk.
       

  • Are you a Type 2 Diabetic?

    • Follow your doctor’s prescribed diabetic-management regimen to reduce blood sugar levels, with diet, exercise, and some diabetes medications (see below).
       

  • Do you have coronary artery disease (CAD), peripheral vascular disease (PVD), cerebrovascular disease, asymptomatic LV dysfunction, or diabetes?

    • Talk to your doctor about taking a beta-blocker or ACE inhibitor to reduce HF risk.

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STEP 3

Easy Social Steps to Help Prevent Heart Failure

  • Talk to your doctor about Heart Failure
    Even if you’re not aware of any risk factors, it is always a good idea to have a conversation with your doctor about Heart Failure, to monitor, reduce, and potentially even eliminate your lifetime risk of Heart Failure.
     

  • Share this page with everyone you know!

At the HeartBrothers Foundation, we want to do all we can to help in this effort.

Please help us spread the word—share this Heart Failure Awareness page with everyone you know, via email, text, and printed snail mail. When you share on social media, tag the HeartBrothers Foundation on Instagram, Facebook, Twitter, and LinkedIn, using the hashtags #PreventHeartFailure and #HBFPreventingHF.

With all our hearts, we encourage you to live your healthiest, most beautiful life!

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