Chronic Heart Failure

Chronic heart failure is a long-term condition in which the heart can no longer pump or fill with blood as the body needs, but the symptoms are relatively stable with treatment. The majority of people with heart failure live with this chronic form and continue their daily activities, with occasional episodes of worsening that are covered on the Acute Heart Failure page.

Chronic heart failure is still classified by ejection fraction, the percentage of blood pumped out of the left ventricle with each beat: reduced, mid-range or mildly reduced, and preserved. The type determines the choice of medicines, while the recommended daily routine is basically similar. The cause is also still looked for and treated, because coronary artery disease, hypertension, valve disease, or rhythm disorders that are under control can make heart failure more stable. In some people, pumping function even improves after the cause is treated.

Measuring How Severe Symptoms Are

Doctors use the NYHA class to describe how severe the complaints are. Class I means no complaints during ordinary activity. Class II means shortness of breath or fatigue during ordinary activity, such as climbing stairs. Class III means complaints appear with light activity, and class IV means complaints are present even at rest. The class can go up or down with treatment, so it helps assess progress.

Your Role in Your Care

Self-care is a key part of treatment. ESC guidelines recommend that patients understand their medicines, weigh themselves every day, limit salt, stay active, and recognize signs of worsening early. The guidelines also recommend a care program run by a team of doctors, nurses, and other health professionals, because it has been shown to reduce hospital admissions. Family members who also understand the care plan are very helpful, especially for older adults. A daily record of body weight, blood pressure, and complaints also makes it easier for your doctor to adjust your medicines at follow-up visits.

When Symptoms Get Worse

In some people, heart failure keeps progressing even with complete treatment. This is called advanced heart failure. The team will discuss options such as a mechanical heart pump, a heart transplant, or palliative care that focuses on comfort and quality of life. Palliative care can be given alongside other treatments and is not only for the end of life.

Diagnosing chronic heart failure follows the same steps as heart failure in general: an assessment of complaints, a physical examination, an ECG, an NT-proBNP or BNP test, and echocardiography to determine the type by ejection fraction. The doctor also looks for the cause, for example with coronary angiography or cardiac MRI.

After diagnosis, regular tests are used for monitoring. Blood tests for kidney function and potassium are checked after a medicine is started or its dose is increased. Iron levels are checked regularly because iron deficiency is common and treatable. Echocardiography is repeated if symptoms change or to help decide on device implantation. For people with an implanted device, data from the device can be monitored remotely. A six-minute walk test or a cardiopulmonary exercise test helps assess physical capacity.

Attend your follow-up visits as scheduled even when you feel well, because medicine doses often need to be adjusted step by step. Contact your doctor or heart failure care team sooner if any of the following occur.

• Your weight goes up by 2 kg or more in 3 days.
• Shortness of breath or swelling increases, or you need more pillows.
• You feel dizzy or weak, or you pass much less urine, after a change in medicines.
• You have a fever, diarrhea, or vomiting, because your diuretic dose may need adjusting.
• Go to the emergency room right away if you have severe shortness of breath at rest, chest pain, or fainting.