A misleading name. The heart has not failed, it is pumping less efficiently and modern treatment works well.
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The name is the first problem. Heart failure does not mean the heart has stopped or is about to. It means the heart is not pumping as efficiently as it should, so the body compensates — and the symptoms come largely from that compensation.
Around a million people in the UK live with it. Modern treatment has changed the outlook substantially over the last two decades, and someone diagnosed today has a considerably better prospect than the name suggests.
There are two broad types, and the distinction matters because the treatments differ. In one the heart muscle is weakened and pumps out too little with each beat. In the other the pumping strength is preserved but the heart has become stiff and fills poorly — this type is commoner in older people, in women, and alongside high blood pressure and diabetes, and it is more often missed.
The three that matter most are breathlessness, ankle swelling and fatigue. Individually they are common and unremarkable; together they are worth a blood test.
The pillow question and the weight question are the two most informative things you can be asked, and both are easy to answer before an appointment.
NT-proBNP is the test that opens or closes the question. It is a marker released when the heart muscle is under strain, and UK guidance uses it to decide who needs an echocardiogram and how urgently.
That last line is genuinely useful. A normal NT-proBNP largely rules heart failure out, which spares a great many people an unnecessary wait and points the investigation elsewhere.
Obesity lowers NT-proBNP, so a borderline result in someone with a high BMI carries more weight than the number suggests. Atrial fibrillation, kidney impairment and older age raise it without heart failure being present.
An ultrasound of the heart measures the ejection fraction — the proportion of blood pumped out with each beat — and looks at the valves and the heart muscle. This is what separates the reduced-ejection type from the preserved-ejection type, and that distinction determines treatment.
ECG, full blood count, kidney and thyroid function, HbA1c and iron studies. Iron deficiency is present in a large proportion of people with heart failure and treating it improves symptoms independently — it is one of the most consistently missed opportunities in this condition.
Lung disease, obesity, anaemia, thyroid disease, kidney disease and simple deconditioning all cause breathlessness. Ankle swelling alone is far more often venous insufficiency, a calcium channel blocker such as amlodipine, or immobility than it is the heart.
Heart failure cannot be diagnosed remotely, and it should not be managed remotely as a first line either. Diagnosis needs a blood test, an echocardiogram and an examination, and treatment is titrated by a specialist team.
We do not initiate or titrate heart failure medication remotely. Those drugs are started and adjusted with close monitoring of kidney function and potassium, usually by a specialist heart failure nurse, and that is the right place for it.
Call 999 if:
Seek same-day assessment if:
Book a routine consultation for: gradual breathlessness on exertion with ankle swelling that has developed over weeks or months and not yet been assessed, or to discuss an existing diagnosis.
Same scales, same time each morning, after the toilet and before breakfast, and write it down. A gain of 2kg or more over two or three days means fluid is accumulating, and acting on it early frequently prevents a hospital admission.
Many people are given a diuretic plan to adjust themselves on that basis. If you have not been offered one, it is worth asking.
Anti-inflammatory painkillers such as ibuprofen and naproxen. They cause fluid retention, work against diuretics and can precipitate an admission. This is one of the commonest avoidable causes of heart failure worsening, and it is rarely explained clearly.
Effervescent and soluble tablets, which can carry a surprising sodium load.
Essentially all of the care that matters in heart failure, and it does it well.
If heart failure is suspected or confirmed, the NHS pathway is where you should be. We would say that plainly rather than compete with it.
This page follows NICE NG106, Chronic heart failure in adults: diagnosis and management.
Beta blockers used in heart failure are specific licensed ones started at very low dose and increased slowly under supervision. This is not the same as taking a beta blocker for another reason, and the distinction matters.
Reviewed against NICE NG106 current at the date shown above.
No, and the name is genuinely misleading. It means the heart is pumping less efficiently than it should, not that it is failing to work.
Many people live for many years with well-treated heart failure, and treatment has improved substantially.
It is the proportion of blood pumped out with each beat. Normal is roughly 50 to 70%.
A low number does not map neatly onto how you feel — some people with a low ejection fraction manage well, and some with a normal one are very symptomatic.
Because sudden weight gain is fluid, and it is the earliest warning you get. More than 2kg over two or three days means act now.
Catching it early often avoids an admission, and it is the most useful thing you can do at home.
Best avoided. Anti-inflammatories cause fluid retention, oppose your diuretic and can trigger a deterioration.
This is one of the commonest avoidable causes of worsening heart failure, and it is often bought over the counter without anyone knowing.
No — the opposite. Exercise-based cardiac rehabilitation improves symptoms and quality of life in stable heart failure.
The old advice to rest has been overturned, and rehab remains badly under-used.
Not everyone does. It is advised in some situations and not others.
Follow the plan you were actually given rather than restricting on your own — unnecessary restriction causes its own problems.
Quite possibly. Breathlessness with ankle swelling can be lung disease, anaemia, thyroid disease, kidney problems, or a side effect of amlodipine.
That is exactly what the NT-proBNP test is for — a low result points the search elsewhere.
Sometimes, and it is worth asking. Heart failure caused by alcohol, by a fast uncontrolled heart rhythm, or by a treatable valve problem can improve substantially when the cause is addressed.
Yes — you are eligible for it free, along with the pneumococcal vaccine.
Chest infections are a common trigger for decompensation, so this is prevention rather than a formality.
August 30, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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