Understanding heart failure

Heart failure is a chronic condition affecting millions of patients worldwide, and despite the treatments available, hospitalisation and mortality rates remain high.¹

What is heart failure? ¹,²

The heart is responsible to deliver oxygen and nutrients to all cells in the body, as well as removing waste via the bloodstream.

Heart failure describes the condition where the heart’s pumping capacity is reduced and the heart does not deliver enough blood to meet the body’s needs.

To compensate the heart does the following:

In order to increase the amount of blood pumped, the heart chambers grow and stretch, trying to have more powerful contractions. As a consequence, the body starts to retain fluid and the lungs can become congested, as well as potentially developing an irregular heartbeat.

Increases muscle mass

As the cells of the heart are contracting more strongly, the muscle mass increases. This helps the heart pump more powerfully. Though, over time, this diminishes and weakens the heart.

Pumps rapidly

Initially, as the heart beats more quickly, it can pump more blood. But, in the long run, acceleration in heart beats weakens the heart again.

Reasons for heart failure ¹,²

Heart failure is most commonly caused by damage to the heart muscle, potentially as the result of a heart attack or cardiomyopathy (disease of the heart).

Other causes may be congenital heart disease, viral infections of the heart muscle, abnormal heart rhythm and cancer treatments, like chemotherapy.

Ideally, modifiable risk factors, such as hypertension, diabetes, obesity, exercise, nutrition, cholesterol and smoking should be managed early to reduce the risk of developing heart failure.

Key facts about heart failure

25 million patients are suffering from heart failure worldwide.¹
Heart failure is the major cause for hospitalisation for patients over 65 years old.³
Patients with heart failure stay about 5 to 10 days in hospital, depending on the country.³
25% of patients return to hospital for worsening progression one month after having left the hospital.³,⁴
The number of heart failure patients is expected to increase by 46% between 2012 – 2030 and the related costs of care will double.⁵

What are the symptoms for heart failure?

Heart failure diagnosis remains challenging because symptoms are non-specific and at early stages patients do not present any symptoms.2

Shortness of breath
Edema (swelling of the legs, abdomen, ankles and feet)
Increased heart rate
Chronic coughing
Limited mobility
Reduced appetite

How is heart failure classified?

The New York Heart Association (NYHA) has a system that helps physicians to classify heart failure patients according to the severity of their symptoms and is split into four categories, called class I, II, III and IV². The higher the class is, the more patients are limited in their day-to-day activity and the more severe the disease is.

Class I

(no symptoms)
No limitation of physical activity. Ordinary physical activity does not cause unexpected breathlessness, fatigue, or palpitations.

Class II

(mid symptoms)
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class III

(moderate symptoms)
Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class IV

(severe symptoms)
Unable to carry out any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken, discomfort is increased.


  1. World Heart Failure Alliance. White Paper: Heart failure, preventing disease and death worldwide. Web: https://www.escardio.org/static_file/Escardio/Subspecialty/HFA/WHFA-whitepaper-15-May-14.pdf

  2. American Heart Association. Heart Failure. Web: http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp

  3. Cowie, M.R. et al. (2013) Improving care for patients are acute heart failure. Retrieved from: http://www.oxfordhealthpolicyforum.org/reports/acute-heart-failure/improving-care-for-patients-with-acute-heart-failure

  4. Krumholz HM, et al. (2009). Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes.;2(5):407-413

  5. Heidenreich PA. et al. (2013). Forecasting the Impact of Heart Failure in the United States. A Policy Statement from the American Heart Association. Circ Heart Fail. 6:00-00