Heart Failure

Last Updated: February 15, 2023

Heart failure (HF), also known as congestive heart failure, is a progressive condition that occurs when the heart cannot pump enough blood to oxygenate the tissues in the brain and body. It is typically caused by other heart conditions that change the heart's structure and function. Heart failure is common, and is the leading cause of hospitalization for patients over age 65 in the U.S.

Heart Failure falls under theCardiovascular Healthcategory.

What is heart failure?

Heart failure is a progressive condition that occurs when the heart is not able to fully fill with blood and/or pump blood effectively. It is also known as “congestive heart failure”. The American College of Cardiology and American Heart Association have jointly identified four stages of heart failure. Stage A (at risk for HF) and stage B (pre-HF) occur when the heart begins to structurally and functionally change without symptoms. Most people are diagnosed with heart failure when the disease has progressed to stages C (symptomatic HF), when symptoms start to occur, or D (advanced HF).[1] The most common risk factors for heart failure are metabolic syndrome, obesity, coronary artery disease, and hypertension.

What are the main signs and symptoms of heart failure?

Heart failure symptoms occur at stages C and D, while heart failure stage A and B are asymptomatic.[1] Symptoms in stages C and D can include:[2]

  • Shortness of breath/coughing when lying down or with activity
  • Fatigue and weakness
  • Frequent urination
  • Chest pain and palpitations (rapid or irregular heartbeat)
  • Swelling of the lower legs and fluid retention
  • Nausea and poor appetite
  • Anxiety
How is heart failure diagnosed?

Heart failure is diagnosed when structural and functional changes to the heart are suspected due to risk factors, symptoms, physical exam, and medical history. The diagnosis is confirmed with an echocardiogram (ultrasound of the heart). Laboratory tests (e.g., serum B-type natriuretic peptide) and electrocardiogram can be used to characterize the degree of heart failure. After HF is diagnosed, it is then further classified based on severity and type. The two main types, which often have different causes, are: HF with reduced ejection fraction (HFrEF), in which the heart can’t squeeze with enough force to push out all the blood, and HF with preserved ejection fraction (HFpEF), in which the heart can’t fully relax to be filled with enough blood to supply the body.[2][1]

What are some of the main medical treatments for heart failure?

In recent years, there have been some major advances in medical treatments which improve the trajectory and symptoms of heart failure. For example, treatments for HF with reduced ejection fraction include a combination of sodium-glucose cotransporter-2 inhibitors (SGLT2i - commonly used drugs for diabetes), angiotensin receptor/neprilysin inhibitors (ARNi), certain beta-blockers, mineralocorticoid receptor antagonists (MRA), and as needed diuretics. Treatments for HF with preserved ejection fraction involves ensuring that conditions such as hypertension, atrial fibrillation, and diabetes are well controlled.[2] [1]

Depending on the cause of HF, implantation of electrical devices may be required to either synchronize the chambers of the heart (atria and ventricles) or to defibrillate (shock) the heart in the event of a ventricular arrhythmia. Although relatively uncommon, cardiac transplantation or the use of a mechanical pump for circulatory support may be considered in end-stage HF.

Have any supplements been studied for heart failure?

Some supplements studied for heart failure include coenzyme Q10, vitamin D, iron, L-carnitine, thiamine, and other B vitamins. For most supplements, evidence of benefit is very limited. However, for coenzyme Q10, a meta-analysis of 7 clinical studies in about 1800 participants with heart failure found that it may slightly reduce the risk of mortality compared to control.[3] In contrast, taking vitamin E has been linked with increased heart failure hospitalizations compared to control.[4]

What's the connection between diet and heart failure?

For those at risk for heart failure (stage A), plant-based diets such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet — which emphasize the intake of whole grains, fruits, vegetables, and legumes — can help prevent the development of heart failure. Also, following a diet with reduced salt (sodium) intake can help to prevent the development of heart failure in those at risk, and may reduce mortality in people with stages B–D heart failure.[3][4]

Are there any other treatments for heart failure?

Maintaining normal body weight has been shown to be effective for preventing the development of heart failure. There is strong evidence that bariatric surgery in severely obese persons is beneficial for prevention of HF, as well as reducing symptoms and hospitalizations in those with existing heart failure. There is strong evidence showing the benefit of exercise for heart failure, while only weak evidence suggests that mind-body modalities like mindfulness and tai chi are beneficial.[4]

What causes heart failure?

Chronic congestive heart failure is caused by abnormal structural and functional changes to the heart and a number of triggering factors. Most commonly, heart failure is caused by coronary artery disease (CAD) and heart attack,[2] which lead to an initial injury to the heart and numerous downstream effects. Other triggering factors of heart failure include:[2]

  • Arrhythmia (uncontrolled)
  • Myocarditis (inflammation of the heart caused by infection or autoimmune disease)
  • Cardiomyopathy
  • Chronic obstructive pulmonary disease (COPD)
  • Congenital heart disease
  • Diabetes
  • Endocarditis
  • Heart valve diseases
  • Hypertension
  • Obesity
  • Pulmonary embolism (blood clot in the lungs)

Looking for a Supplement guide?

Our Supplement Guides give you unbiased research-based recommendations that you can immediately apply to improve your health. Heart Failure is related to the following Supplement Guide:
Examine Database: Heart Failure
What works and what doesn't?

Unlock the full potential of Examine

Get started

Don't miss out on the latest research

References
  1. ^Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation.(2022-May-03)
  2. ^Malik A, Brito D, Vaqar S, Chhabra LCongestive Heart FailureStatPearls.(2022-11)
  3. ^Khan MS, Khan F, Fonarow GC, Sreenivasan J, Greene SJ, Khan SU, Usman MS, Vaduganathan M, Fudim M, Anker SD, Butler JDietary interventions and nutritional supplements for heart failure: a systematic appraisal and evidence map.Eur J Heart Fail.(2021-Sep)
  4. ^Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, Gaggin H, Freeman AM, Allen K, Madan S, Massera D, Litwin SE,Lifestyle Modifications for Preventing and Treating Heart Failure.J Am Coll Cardiol.(2018-Nov-06)
Examine Database References
  1. Exercise Capacity (with Heart Conditions) - Zeng XH, Zeng XJ, Li YYEfficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathyAm J Cardiol.(2003 Jul 15)
  2. Exercise Capacity (with Heart Conditions) - Juan José Orozco-Gutiérrez, Lilia Castillo-Martínez, Arturo Orea-Tejeda, Oscar Vázquez-Díaz, Adrián Valdespino-Trejo, René Narváez-David, Candace Keirns-Davis, Olín Carrasco-Ortiz, Adolfo Navarro-Navarro, Rocío Sánchez-SantillánEffect of L-arginine or L-citrulline oral supplementation on blood pressure and right ventricular function in heart failure patients with preserved ejection fractionCardiol J.(2010)
  3. Blood Pressure - Karla Balderas-Munoz, Lilia Castillo-Martínez, Arturo Orea-Tejeda, Oscar Infante-Vázquez, Marcelo Utrera-Lagunas, Raúl Martínez-Memije, Candace Keirns-Davis, Bryan Becerra-Luna, Gabriela Sánchez-VidalImprovement of ventricular function in systolic heart failure patients with oral L-citrulline supplementationCardiol J.(2012)
  4. Exercise Capacity (with Heart Conditions) - Beyranvand MR, Khalafi MK, Roshan VD, Choobineh S, Parsa SA, Piranfar MAEffect of taurine supplementation on exercise capacity of patients with heart failureJ Cardiol.(2011 May)
  5. Exercise Capacity (with Heart Conditions) - K Adarsh, H Kaur, V MohanCoenzyme Q10 (CoQ10) in isolated diastolic heart failure in hypertrophic cardiomyopathy (HCM)Biofactors.(2008)
  6. Exercise Capacity (with Heart Conditions) - Fumagalli S, Fattirolli F, Guarducci L, Cellai T, Baldasseroni S, Tarantini F, Di Bari M, Masotti G, Marchionni NCoenzyme Q10 terclatrate and creatine in chronic heart failure: a randomized, placebo-controlled, double-blind studyClin Cardiol.(2011 Apr)
  7. Exercise Capacity (with Heart Conditions) - Belardinelli R, Muçaj A, Lacalaprice F, Solenghi M, Seddaiu G, Principi F, Tiano L, Littarru GPCoenzyme Q10 and exercise training in chronic heart failureEur Heart J.(2006 Nov)
  8. Left Ventricular Ejection Fraction - Lei L, Liu YEfficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials.BMC Cardiovasc Disord.(2017-Jul-24)
  9. Exercise Capacity (with Heart Conditions) - Kuethe F, Krack A, Richartz BM, Figulla HRCreatine supplementation improves muscle strength in patients with congestive heart failurePharmazie.(2006 Mar)
  10. Exercise Capacity (with Heart Conditions) - Basford JR, Oh JK, Allison TG, Sheffield CG, Manahan BG, Hodge DO, Tajik AJ, Rodeheffer RJ, Tei CSafety, acceptance, and physiologic effects of sauna bathing in people with chronic heart failure: a pilot report.Arch Phys Med Rehabil.(2009-Jan)
  11. Blood Pressure - Kuwahata S, Miyata M, Fujita S, Kubozono T, Shinsato T, Ikeda Y, Hamasaki S, Kuwaki T, Tei CImprovement of autonomic nervous activity by Waon therapy in patients with chronic heart failure.J Cardiol.(2011-Jan)
  12. Blood Pressure - Kihara T, Biro S, Ikeda Y, Fukudome T, Shinsato T, Masuda A, Miyata M, Hamasaki S, Otsuji Y, Minagoe S, Akiba S, Tei CEffects of repeated sauna treatment on ventricular arrhythmias in patients with chronic heart failure.Circ J.(2004-Dec)
  13. Blood Pressure - Fujita S, Ikeda Y, Miyata M, Shinsato T, Kubozono T, Kuwahata S, Hamada N, Miyauchi T, Yamaguchi T, Torii H, Hamasaki S, Tei CEffect of Waon therapy on oxidative stress in chronic heart failure.Circ J.(2011)
  14. Left Ventricular Ejection Fraction - Miyata M, Kihara T, Kubozono T, Ikeda Y, Shinsato T, Izumi T, Matsuzaki M, Yamaguchi T, Kasanuki H, Daida H, Nagayama M, Nishigami K, Hirata K, Kihara K, Tei CBeneficial effects of Waon therapy on patients with chronic heart failure: results of a prospective multicenter study.J Cardiol.(2008-Oct)
  15. Brain Natriuretic Peptide - Tei C, Imamura T, Kinugawa K, Inoue T, Masuyama T, Inoue H, Noike H, Muramatsu T, Takeishi Y, Saku K, Harada K, Daida H, Kobayashi Y, Hagiwara N, Nagayama M, Momomura S, Yonezawa K, Ito H, Gojo S, Akaishi M, Miyata M, Ohishi M, Waon Therapy for Managing Chronic Heart Failure - Results From a Multicenter Prospective Randomized WAON-CHF Study.Circ J.(2016)
  16. Brain Natriuretic Peptide - Ichiki T, Burnett JC, Scott CG, Heublein DM, Miyata M, Kinugawa K, Inoue T, Tei C, Neurohumoral Modulation During Waon Therapy in Chronic Heart Failure - Subanalysis of Waon-CHF Study.Circ J.(2017-Apr-25)
  17. Depression Symptoms - Masuda A, Nakazato M, Kihara T, Minagoe S, Tei CRepeated thermal therapy diminishes appetite loss and subjective complaints in mildly depressed patients.Psychosom Med.(2005)
  18. Quality of Life - Mei Z, Chen J, Luo S, Jin L, Liu Q, Chen YComparative efficacy of intravenous and oral iron supplements for the treatment of iron deficiency in patients with heart failure: A network meta-analysis of randomized controlled trials.Pharmacol Res.(2022-Aug)
  19. Left Ventricular Ejection Fraction - Hamed M, Elseidy SA, Ahmed A, Thakker R, Mansoor H, Khalili H, Mohsen A, Mamas MA, Banerjee S, Kumbhani DJ, Elgendy IY, Elbadawi AIntravenous iron therapy among patients with heart failure and iron deficiency: An updated meta-analysis of randomized controlled trials.Heliyon.(2023-Jun)
  20. Cardiovascular Mortality - Hamza M, Sattar Y, Manasrah N, Patel NN, Rashdi A, Khanal R, Naveed H, Zafar M, Khan AM, Alharbi A, Aamir M, Gonuguntla K, Raina S, Balla SMeta-Analysis of Efficacy and Safety of Intravenous Iron in Patients With Iron Deficiency and Heart Failure With Reduced Ejection Fraction.Am J Cardiol.(2023-Sep-01)
  21. Glycogen Resynthesis - Omran H, Illien S, MacCarter D, St Cyr J, Lüderitz BD-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility studyEur J Heart Fail.(2003 Oct)
  22. Mitochondrial Protection - Pam R Taub, Israel Ramirez-Sanchez, Theodore P Ciaraldi, Guy Perkins, Anne N Murphy, Robert Naviaux, Michael Hogan, Alan S Maisel, Robert R Henry, Guillermo Ceballos, Francisco VillarrealAlterations in skeletal muscle indicators of mitochondrial structure and biogenesis in patients with type 2 diabetes and heart failure: effects of epicatechin rich cocoaClin Transl Sci.(2012 Feb)
  23. Blood Flow - Andrew B. Petrone, J. Michael Gaziano, Luc DjousséEffects of Dark Chocolate and Cocoa Products on Endothelial Function: A Meta-AnalysisCurrent Nutrition Reports.()
  24. Left Ventricular Ejection Fraction - Bharani A, Ganguly A, Bhargava KDSalutary effect of Terminalia Arjuna in patients with severe refractory heart failureInt J Cardiol.(1995 May)
  25. Heart Rate - Gomes ME, El Messaoudi S, Lenders JW, Bellersen L, Verheugt FW, Smits P, Tack CJHigh dose ascorbic acid does not reverse central sympathetic overactivity in chronic heart failureJ Clin Pharm Ther.(2011 Oct)