Heart failure tends to become worse over time, as the heart muscle becomes increasingly unable to pump blood properly. This causes the symptoms to worsen and become more frequent. Although heart failure cannot be reversed, there are treatments that can control the symptoms and slow the progression of the disease. That’s why it is so important to start treatment as soon as heart failure is diagnosed, and continue it for life.

Acute episodes
People with advanced heart failure may experience a sudden worsening of their symptoms that requires emergency medical treatment. This is known as an acute episode, an acute exacerbation, or acute decompensated heart failure. Acute episodes of heart failure are very serious and need to be treated in hospital, usually with intravenous medications and oxygen.

Factors that can cause an acute episode are listed in the box; however many acute episodes can be prevented simply by following medical advice and taking treatments as prescribed.

Factors thought to cause acute heart failure Failure to take heart failure medications as prescribed* Infection (especially lung infection) Sudden increase in dietary salt intake* Development of new heart rhythm abnormalities (arrhythmia) Failure to seek medical advice for new or worsening symptoms* Excessive fluid intake* Not following the recommended diet* Heart attack (myocardial infarction) * These are all avoidable causes

Heart failure classification
Doctors classify the severity of heart failure depending on a patient’s symptoms and how much his/her capacity for physical activity is affected. This helps doctors to determine how serious the heart failure is, and to judge if the treatment prescribed for it is effective. The ‘New York Heart Association’ (NYHA) classification system is often used.

The “New York Heart Association” classification for heart failure severity Class I – No symptoms Patients suffer no symptoms or limitation in physical activity. Heart condition predisposing for heart failure may be detected coincidentally during other medical tests or investigations. Class II – Mild Patients have a slight limitation in physical activity. They are comfortable at rest or with mild exertion but not with more strenuous activity (eg, walking on steep inclines or several flights of steps) causes shortness of breath. Patients can continue to have an almost normal lifestyle and employment. Class III – Moderate Patients have more marked limitation of physical activity that interferes with work. They are comfortable only when resting; walking on the flat produces symptoms. Class IV – Severe Patients are unable to carry out any physical activity without symptoms. They are breathless even when resting and are usually confined to their bed or chair. NB: The symptoms listed above may be caused by conditions other than heart failure. The NYHA Classification is not used to diagnose heart failure, but to assess patients who are known to have heart failure.

Additional information