No one wants to be diagnosed with heart failure, but there is hope. You have the opportunity every day to take actions that support your heart health and your wellbeing. If you’ve been diagnosed with heart failure (HF), you’re not alone. More than 6 million adults in the United States had heart failure between 2013 and 2016, up from 5.7 million between 2009 and 2012.¹ Heart failure impacts at least 26 million people globally, and numbers are growing.²

Read What is Heart Failure? Myth vs. Fact.

Heart failure is a serious, chronic condition, but you can take steps to improve your quality of life, lessen your symptoms, and even reverse some of the damage to your heart.³ Dietary changes, exercise plans, treatment adherence, and other lifestyle changes like quitting smoking are now more important than ever. Making changes to your daily routine and habits may be hard, but the result can be a more fulfilling life.

When you’re diagnosed with heart failure, your doctor will assess the class of your HF. Your healthcare provider will make recommendations for treatment based on the type and class of HF you have.

Classes of heart failure
HF is often classified by severity. Your doctor may give you a symptoms-based classification between I and IV and a stage-based classification between A and D. In both systems, the higher the number or letter, the more severe the condition. The two systems measure different variables, so your doctor may use both.⁴

Frequency of doctor visits
Once you receive an HF diagnosis, the frequency of your doctor visits will depend on the specifics of your condition. Ask your doctor how often you should see them and when you should have your next follow-up appointment. Over time, you may need to see the doctor more or less than when first diagnosed. Download the doctor discussion guide and bring it to your next visit to help make sure all your questions about heart failure are answered.

There are several types of treatments available to help manage your heart failure. Treatment and lifestyle changes have the ability to slow disease progression, decrease your symptoms, and in some cases, even reverse HF.³

It’s common to be prescribed more than one HF medication. It’s important that you take your medications exactly as your healthcare provider instructs. Your doctor may prescribe:

• ACE inhibitors to dilate the blood vessels and lower blood pressure. Examples include Capoten (Captopril), Vasotec (Enalapril), and Zestril (Lisinopril).
• Beta blockers to slow the heart rate and lower blood pressure. Lopressor (Metoprolol) and Zebeta (Bisoprolol) are common examples.
• Digoxin to strengthen heart muscle contractions.
• Diuretics, such as Aldactone (Spironolactone), to help remove excess water from the body.^3,4,6

Depending on your condition, your doctor may recommend surgery. Some types of surgery repair a problem such as blocked arteries, while other operations implant a medical device to regulate heart rhythm. In very severe cases, a heart transplant may be the only option. Examples of more common surgeries include:

• Coronary artery bypass grafting (CABG) grafts blood vessels onto the blocked coronary artery to provide an alternate route for blood to flow to the heart.
• Heart valve surgery replaces or repairs a heart valve to improve heart function.
• Implantable cardioverter defibrillator (ICD) is a small, battery-powered device surgically implanted to control life-threatening arrhythmias and prevent sudden cardiac arrest.
• Ventricular assist device (VAD) is a mechanical system that can take over the pumping function from one or both ventricles. A VAD can be a permanent solution but it can also be used while you recover from heart surgery or wait for a heart transplant.^3,4

Making treatment part of your routine
Sticking to your heart failure treatments is crucial to managing your health. Frequently forgetting to take your medicine or not following your doctor’s instructions can lead to worse HF symptoms and increase your risk of hospitalization and poor outcomes.⁷

Side effects
Unpleasant side effects sometimes cause people to stop taking their treatments. Common side effects for heart failure medications include headache, dizziness, drowsiness, insomnia, dry cough, nausea, and diarrhea. Depression can also be a side effect of medications such as Digoxin, Zestril (Lisinopril), Lopressor (Metoprolol), and Zebeta (Bisoprolol).

Talk to your healthcare provider if side effects are making it difficult for you to stick to your treatment plan.

Remembering your medication
Keeping track of your medications can be tricky, especially if you have multiple prescriptions and supplements for different conditions. Below are some tips for staying on top of your medication routine.

	Checklist Create a printed or digital checklist of your daily medications and check them off each day.
	Pill Organizer Keep track of each day’s medication with a labeled pill organizer. There are organizers available that have boxes for AM and PM medications.
	Alarms Use the alarm function on your phone to remind yourself to take your medicine. You can set multiple alarms for morning and evening doses.
	Apps Download a medication tracking app to remind you to take your prescriptions. Some apps have features that remind you to order refills.
	Ask for Help Let your family, friends, or caregiver know if you need help managing all of your medications.

You will probably hear a lot about eating a low-sodium diet after being diagnosed with heart failure. Eating too much salt causes your body to hold onto excess water and can increase your blood pressure. Minimizing salt in your diet is one of the best tools you have to support your health when you have HF.⁸

You should limit sodium to 1,500 to 2,000 milligrams per day.⁹ The U.S. Food and Drug Administration (FDA) recommends no more than 2,300 milligrams per day for the average adult.¹⁰

Here are some tips for reducing salt in your diet:

• Watch out for packaged and prepared foods: In the United States, the majority of sodium in our diets comes from packaged and prepared foods.¹¹ Items like chips or popcorn are obvious culprits, but items like canned chicken broth, salad dressing, and packaged deli meat can also be filled with sodium.
• Check labels: Always look at the nutritional information before purchasing a packaged item at the grocery store. Look for products with 350 milligrams or fewer of sodium per serving.⁸ Many brands offer low-sodium versions of their products. You should still look at the nutrition facts even if a product is marketed as “reduced sodium.” Learn more about salt labeling here.
• Experiment with other seasonings: Switch out salt for new seasonings. Experiment with store-bought salt-free herb blends, or herbs in your cabinet you rarely use. Search the internet for low-sodium recipes or pick up a low-sodium cookbook from the library. Changing your approach to cooking isn’t easy but you will find new favorites in time.
• Offer and ask for help: Holiday and family meals can be sodium-packed. If you’ve been invited to a friend of family member’s home, ask if you can bring a low-sodium dish to share. This will ensure you have something you know you can eat and can lessen the cooking burden for the host. Ask your host for simple favors that will help keep you on track – maybe they can serve salad dressing on the side or swap regular chicken broth for a low-sodium version. Chances are you’re not the only one at your family gathering who will benefit from a low-sodium diet.
• Eat out smart: Food at restaurants is often high in sodium. Ask your server to suggest low-sodium options. Local or national chains often have nutritional information on-hand. This can help you choose smarter options.

In addition to reducing your sodium intake, you should stick to nutrition recommendations for heart disease. These recommendations are good for your heart health and can help you manage conditions like type 2 diabetes and kidney disease, which are associated with various types of heart disease.^12,13

Exercise can help improve your heart health, your quality of life, your mood, and help you manage other conditions like type 2 diabetes or kidney disease.^13,14 Your doctor may even prescribe exercise as part of your treatment plan. Your doctor will make suggestions based on your overall health and your specific type and class of HF. Below are some exercise options your doctor might discuss with you.

Cardiac rehabilitation
Cardiac rehabilitation consists of exercise support, health education, and stress management. The program is designed to help people with heart failure, and people recovering from heart surgery or a heart attack. You need a referral from your doctor for most cardiac rehab programs – consider asking your doctor about cardiac rehab at your next visit.^15,16

Here’s what you can expect in a cardiac rehabilitation program:

• Medical evaluation to develop a personalized program
• Exercise instruction tailored to your current health and long-term goals
• Education and support for lifestyle changes like adopting a low-sodium diet and quitting smoking
• Support and counseling resources as needed¹⁵

Moderate aerobic exercise
This includes cycling, swimming, jogging, and brisk walking. Taking a walk is a great way to start exercising. Regular walking can improve your strength and endurance. You can start off with just five minutes a day and work up to a 20 or 30-minute walk five days a week. Remember to take breaks if you feel out of breath and avoid walking outside when it’s very cold or hot outside.¹⁷

Strength training
Lifting free weights, using weight machines, or using resistance bands can help increase muscle and bone strength, and help with weight control. General guidelines recommend weights under 10 pounds.¹⁸

Stretching
Include stretches as part of a warm-up and cool-down before and after workouts. Stretching can help to protect yourself from injury and minimize soreness. Flexibility exercises like yoga and tai chi can also improve balance, joint function, and reduce stress and anxiety.¹⁸

Exercise warning signs
It’s ok for exercise to be challenging but you shouldn’t feel excessively breathless, dizzy, or have an extremely fast or irregular heartbeat. If you feel any of these symptoms, stop and rest for 15 minutes. Call your doctor if symptoms don’t subside. Call 911 if you feel any symptoms of a heart attack.¹⁸

Being overweight puts makes your heart work harder. Taking steps to lose weight or working to maintain your current weight can help reduce any extra strain on your heart.^4,6 Changing your diet and adding exercise to your routine can help you lose or maintain weight.

Losing weight is easier said than done, especially if you’re struggling with fatigue or shortness of breath. Even if progress is slow, remember that a small amount of weight loss can have benefits.⁴ Always talk with your healthcare provider before starting a new diet or exercise regimen. Popular diet or exercise plans may not be appropriate for you.

Quitting smoking is one of the most important lifestyle changes you can make to improve your heart health. Smoking increases blood pressure and heart rate, among many other negative impacts on heart function.¹⁹ Talk to your healthcare provider if you need help quitting smoking. There are prescription medications, over-the-counter aids, and support groups to help you stop smoking.

Living with heart failure can be emotionally taxing. You may feel scared, angry, sad, hopeless, or any combination of feelings. All of these feelings are completely normal. Support from friends, family, and others living with heart failure can help you work through these difficult feelings, stay motivated to stick to your lifestyle changes, and find solutions to challenges that arise on your journey.

Connecting with other people living with heart failure at in-person support groups and on MyHeartDiseaseTeam can help you feel less alone and provide an opportunity to learn from others with the same condition. Speaking with a counselor is another good option to help you deal with the challenges of life with heart failure.

In some cases, feelings of sadness and anxiety about heart failure can develop into depression. Talk to your doctor if you experience prolonged feelings of sadness, hopelessness, or worthlessness. Your healthcare provider can refer you to a mental health professional.

Understanding what symptoms indicate a worsening of your condition and what symptoms may be completely unrelated can calm anxiety and help you take care of your health.

Many of the symptoms of heart failure are similar to general symptoms of heart disease, but there are a few that differ.

Heart failure is associated with other health conditions like type 2 diabetes, kidney disease, anemia, sleep-disordered breathing, and chronic obstructive pulmonary disease (COPD). Your specific type of heart failure and your previous health history can impact your risk for developing certain conditions. Some of the same steps you’re taking to manage your heart failure – things like sticking to a low-sodium diet and staying physically active – will help you minimize the risk of developing conditions like type 2 diabetes and kidney disease.^12,13 Your doctor can help you evaluate the best ways to reduce your risk of developing conditions associated with HF or manage them if you do have them.

Connect with others living with heart failure at MyHeartDiseaseTeam.

References

1. What is Heart Failure? (2017, May 31). Retrieved June 2019, from https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure

2. Savarese, G., & Lund, L. H. (2017). Global Public Health Burden of Heart Failure. Cardiac Failure Review,03(01), 7-11. doi:10.15420/cfr.2016:25:2

3. Heart Failure Treatment. (n.d.). Retrieved June 2019, from https://www.ucsfhealth.org/conditions/heart_failure/treatment.html

4. Heart failure - Diagnosis & treatment. (2017, December 23). Retrieved June 2019, from https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148

5. Heart failure - Symptoms & causes. (2017, December 23). Retrieved June 2019, from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142

6. Heart Failure. (n.d.). Retrieved June 2019, from https://www.nhlbi.nih.gov/health-topics/heart-failure

7. Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar‐Jacob, J. M. (2016). Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials. Journal of the American Heart Association,5(6), 1-18. doi:10.1161/jaha.115.002606

8. Diet and Congestive Heart Failure. (n.d.). Retrieved June 2019, from https://www.ucsfhealth.org/education/diet_and_congestive_heart_failure/

9. Nutrition tips for congestive heart failure. (2019, January 3). Retrieved June 2019, from https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=/common/healthAndWellness/conditions/heartDisease/chfNutrition.html

10. Use the Nutrition Facts Label to Reduce Your Sodium Intake. (2018, June 8). Retrieved June 2019, from https://www.fda.gov/food/nutrition-education-resources-and-materials/use-nutrition-facts-label-reduce-your-intake-sodium-your-diet

11. Get the Scoop on Sodium and Salt. (2018, April 16). Retrieved June 2019, from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-and-salt

12. Mentz, R. J., Kelly, J. P., Von Leuder, T. G., Voors, A. A., Lam, C. S., Cowie, M. R., ... O'Connor, C. M. (2014). Noncardiac Comorbidities in Heart Failure With Reduced Versus Preserved Ejection Fraction. Journal of the American College of Cardiology,64(21), 2281-2293. doi:10.1016/j.jacc.2014.08.036

13. Chronic kidney disease (CKD). (n.d.). Retrieved June 2019, from http://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/

14. Physical Activity is Important. (n.d.). Retrieved July 2019, from http://www.diabetes.org/food-and-fitness/fitness/physical-activity-is-important.html

15. What is Cardiac Rehabilitation? (2016, July 31). Retrieved June 2019, from https://www.heart.org/en/health-topics/cardiac-rehab/what-is-cardiac-rehabilitation

16. Cardiac Rehab: Frequently Asked Questions. (2016, July 31). Retrieved June 2019, from https://www.heart.org/en/health-topics/cardiac-rehab/cardiac-rehab-faq

17. Heart Failure: Exercise Living With. (2018, November 27). Retrieved June 2019 from https://my.clevelandclinic.org/health/diseases/17075-heart-failure-exercise/living-with

18. Heart Failure - Exercise. (2018, November 27). Retrieved June 2019, from https://my.clevelandclinic.org/health/diseases/17075-heart-failure-exercise

19. Smoking and Your Heart. (n.d.). Retrieved June 2019, from https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart

20. Warning Signs of Heart Failure. (2017, May 31). Retrieved June 2019, from https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure