Heart failure is a long-term condition where the heart struggles to pump enough blood to meet the body’s needs. Although the name sounds frightening, it doesn’t mean the heart has stopped working. Instead, it means the heart needs support to work better. This condition affects millions of people worldwide and can develop gradually over many years, or sometimes appear suddenly after an injury or illness.
How Common Is Heart Failure?
Heart failure is a widespread health concern that touches the lives of many families around the world. In the United States alone, more than 6 million adults aged 20 or older are currently living with this condition.[5] The number continues to grow as populations age and as more people survive heart attacks and other cardiovascular events that can damage the heart muscle over time.[3]
This condition becomes more common as people get older. Heart failure is the leading reason why people over the age of 65 need to be admitted to the hospital.[6] While it can happen to anyone at any age, older adults face a higher risk because aging naturally weakens and stiffens the heart muscle, making it harder for the heart to do its job effectively.[7]
The impact of heart failure extends beyond individual patients. In 2023, heart failure was mentioned on more than 450,000 death certificates in the United States, accounting for nearly 15% of all deaths from various causes.[5] The economic burden is also substantial. In 2012, heart failure cost the nation an estimated $30.7 billion, including the cost of medical services, medications to treat the condition, and lost productivity from missed days of work.[5]
Geography also plays a role in heart failure outcomes. Some areas of the United States experience higher rates of death from heart failure than others. Counties with the highest death rates are concentrated primarily in states like Mississippi, Louisiana, Arkansas, Oklahoma, Texas, Kentucky, Tennessee, Indiana, Illinois, and Wisconsin. There are also pockets of high-rate counties in Oregon, Utah, Montana, South Dakota, and Nebraska.[5]
What Causes Heart Failure?
Heart failure usually develops when something damages or weakens the heart muscle, making it harder for the heart to pump blood effectively. Most of the time, heart failure doesn’t happen overnight. Instead, it builds up slowly over months or years as the result of one or more underlying medical conditions.[7]
The most common cause of heart failure is coronary artery disease, a condition where the arteries that supply blood to the heart become clogged with fatty substances called atherosclerosis.[4] This blockage can reduce blood flow to the heart muscle itself, weakening it over time. When a complete blockage occurs, it causes a heart attack, which can damage a section of the heart muscle permanently.[6]
High blood pressure, also called hypertension, is another major contributor to heart failure. When blood pressure remains elevated for a long time, the heart has to work much harder to push blood through the blood vessels. This extra strain can cause the heart muscle to become thick and stiff, or simply too worn out to pump effectively.[4]
Conditions that directly affect the heart muscle itself, known as cardiomyopathy, can also lead to heart failure. These conditions may be inherited genetically or caused by viral infections that inflame and damage the heart.[6] Problems with the heart’s rhythm, called arrhythmias, particularly a condition called atrial fibrillation, can also contribute to heart failure by causing the heart to beat in an irregular or inefficient pattern.[4]
Heart valve diseases are another important cause. The heart has four valves that act like doors, opening and closing to control blood flow through the heart’s chambers. When these valves become damaged or don’t work properly, the heart must work harder to move blood, which can eventually lead to heart failure.[1]
Some people are born with heart defects, known as congenital heart disease, which can affect how well the heart works from the very beginning of life.[6] Other medical conditions that can contribute to heart failure include diabetes, kidney disease, sleep apnea, obesity, and infections like HIV or COVID-19.[7]
Who Is at Higher Risk?
Certain groups of people face a higher chance of developing heart failure based on a combination of age, health history, lifestyle habits, and other medical conditions. Understanding these risk factors can help people take steps to protect their heart health and seek medical care when needed.[7]
Age is one of the strongest risk factors. People who are 65 years old or older are much more likely to develop heart failure because the natural aging process causes the heart muscle to weaken and become stiffer. This makes it harder for the heart to fill with blood and pump it out to the body efficiently.[7]
Family history also matters. If you have close relatives who have experienced heart failure, you may be at increased risk. Some people inherit genetic changes that affect their heart tissue, making them more vulnerable to developing heart problems later in life.[6]
Lifestyle habits play a significant role in heart failure risk. Smoking tobacco products damages blood vessels and reduces the amount of oxygen that reaches the heart. Eating foods high in fat, cholesterol, and salt can contribute to high blood pressure and clogged arteries. Leading an inactive lifestyle without regular physical activity weakens the heart and cardiovascular system. Excessive alcohol use and illegal drug use, including cocaine, can also damage the heart muscle directly.[7]
Many existing medical conditions increase the risk of heart failure. These include any heart or blood vessel conditions, coronary artery disease, high blood pressure, diabetes, obesity, chronic kidney disease, anemia, thyroid problems, and serious lung diseases such as COPD (chronic obstructive pulmonary disease).[7] People who have had a heart attack face a particularly high risk because the damaged heart muscle may not recover fully.[6]
Certain cancer treatments can also increase heart failure risk. Radiation therapy aimed at the chest and some chemotherapy drugs can harm the heart muscle, sometimes causing problems years after the cancer treatment has ended.[7]
African Americans face a disproportionately high risk of developing heart failure. They are more likely to develop the condition and tend to experience more serious cases at younger ages compared to people of other racial backgrounds. Factors such as discrimination, income, education, and geographic location can also affect their risk and access to quality healthcare.[7]
What Does Heart Failure Feel Like?
The symptoms of heart failure can vary widely from person to person. Some people experience severe symptoms that make daily activities difficult, while others may have only mild symptoms or none at all, especially in the early stages. However, even when symptoms are mild or absent, the heart may still be struggling, and the condition requires medical attention.[6]
One of the most common and often earliest symptoms is shortness of breath, medically called dyspnea. People with heart failure often notice they feel breathless when doing activities that didn’t used to bother them, such as climbing stairs, walking to the mailbox, or even getting dressed. As the condition worsens, shortness of breath can occur even when resting or lying down.[1] Some people wake up suddenly at night gasping for air and need to prop themselves up with extra pillows to breathe more comfortably.[4]
Fatigue and weakness are also very common. People with heart failure often feel tired most of the time, even after resting. Activities that were once easy become exhausting. This happens because the body’s organs and muscles aren’t getting enough oxygen-rich blood to work properly.[4]
Swelling, called edema, is another hallmark symptom of heart failure. Fluid tends to collect in the lower parts of the body, causing the ankles, feet, and legs to swell. The swelling may be worse at the end of the day or after sitting or standing for long periods. Some people also experience swelling in the abdomen, which can make the belly feel full, bloated, or hard to the touch.[1]
Weight gain can happen quickly when the body retains too much fluid. A person might gain several pounds in just a few days without eating more food. This rapid weight gain is an important warning sign that should be reported to a doctor right away.[4]
Other symptoms may include a rapid or irregular heartbeat, a persistent dry cough (sometimes producing white or pink mucus), feeling lightheaded or dizzy, chest pain, a need to urinate frequently during the night, and loss of appetite or nausea.[1] Some people may also experience wheezing or difficulty concentrating and remembering things because the brain isn’t getting enough oxygen.[1]
The symptoms of heart failure often come and go, and they can range from mild to severe. Unfortunately, heart failure usually gets worse over time. As it progresses, symptoms may become more frequent or intense, or new symptoms may appear.[6]
Can Heart Failure Be Prevented?
While some risk factors for heart failure, such as age and family history, cannot be changed, there are many steps people can take to lower their risk or slow the progression of heart disease. Prevention focuses on adopting a heart-healthy lifestyle and managing medical conditions that can damage the heart.[11]
Eating a healthy, balanced diet is one of the most important prevention strategies. A heart-healthy diet should include plenty of fruits and vegetables, aiming for at least five portions a day. Meals should be based on starchy foods like potatoes, bread, rice, or pasta, preferably whole grain varieties. Include some dairy or dairy alternatives, and choose sources of protein such as beans, pulses, fish, eggs, and lean meat. Most importantly, limit foods high in saturated fat, salt, and sugar.[4]
Reducing salt intake is particularly important because too much sodium can cause the body to retain fluid, which puts extra strain on the heart. Many people consume far more salt than they realize, especially from processed foods, restaurant meals, and packaged snacks. Learning to read food labels and choosing low-sodium options can make a big difference.[11]
Staying physically active helps keep the heart strong and the body at a healthy weight. Regular exercise improves circulation, lowers blood pressure, and reduces the risk of developing conditions like diabetes and high cholesterol. Even moderate activities like walking, gardening, or dancing can provide significant benefits.[4]
Maintaining a healthy weight is crucial because carrying extra pounds makes the heart work harder. For people who are overweight or obese, even a modest weight loss can reduce the strain on the heart and lower the risk of heart failure.[11]
Quitting smoking is one of the best things anyone can do for heart health. Smoking damages blood vessels, reduces oxygen in the blood, and increases the risk of heart attacks and heart failure. Support and resources are available to help people quit, including counseling and medications.[11]
Limiting or avoiding alcohol is also important. Excessive drinking can weaken the heart muscle and contribute to high blood pressure. People should talk to their doctor about how much alcohol, if any, is safe for them.[11]
Managing existing health conditions can prevent or delay the development of heart failure. This includes keeping blood pressure under control, managing diabetes by monitoring blood sugar levels, and treating high cholesterol. Regular checkups with a healthcare provider allow for early detection and treatment of problems before they cause serious damage.[11]
Getting vaccinated can also protect heart health. People should get the flu vaccine every year and stay up to date on COVID-19 vaccines. A pneumococcal vaccine is also recommended to protect against a serious type of pneumonia. Infections can put extra stress on the heart, especially in people who already have heart problems.[4]
How the Heart Changes in Heart Failure
To understand heart failure, it helps to know what happens inside the body when the heart isn’t working as it should. Heart failure is not just a problem with the heart itself, but a condition that affects the entire circulatory system and multiple organs.[8]
The heart is a muscular pump with four chambers: two upper chambers called atria and two lower chambers called ventricles. In a healthy heart, the left ventricle fills with oxygen-rich blood from the lungs and then contracts powerfully to push that blood out to the entire body. The right ventricle pumps blood that has returned from the body to the lungs to pick up more oxygen.[1]
In heart failure, the heart becomes unable to pump blood effectively. This can happen in two main ways. First, the heart muscle may become too weak to squeeze hard enough to push blood out. This is called heart failure with reduced ejection fraction. Second, the heart muscle may become too thick or stiff to relax and fill properly with blood between beats. This is called heart failure with preserved ejection fraction.[3]
When the heart can’t pump efficiently, blood begins to back up in the blood vessels. If the left side of the heart is failing, blood backs up into the lungs. This causes fluid to leak from the blood vessels into the lung tissue, leading to a buildup called pulmonary edema. This is why people with heart failure feel short of breath, especially when lying flat.[1]
If the right side of the heart is failing, blood backs up in the veins that return blood from the body to the heart. This causes fluid to leak out into the tissues, particularly in the legs, ankles, and feet, causing swelling. Fluid can also accumulate in the abdomen and liver.[6]
Because blood flow slows down and organs don’t receive enough oxygen and nutrients, the body tries to compensate in several ways. The heart may beat faster to pump more blood. The heart chambers may stretch and enlarge to hold more blood. The heart muscle may thicken to pump more forcefully. The body may redirect blood away from less vital organs to protect the brain and heart. The kidneys may retain more salt and water to increase blood volume.[1]
While these compensatory mechanisms help in the short term, they eventually make the problem worse. The heart works harder and becomes more damaged. The increased fluid retention worsens swelling and shortness of breath. Over time, the heart’s ability to pump continues to decline, and symptoms worsen.[1]
Heart failure can also lead to complications in other organs. The reduced blood flow can damage the kidneys, making them less able to remove waste and excess fluid from the body. The liver can become congested with blood, impairing its ability to function. Poor circulation can cause blood clots to form. The strain on the heart can lead to dangerous irregular heart rhythms or even sudden cardiac arrest.[6]
