Heart failure (HF) affects millions of people in the United States each year. If you or a loved one are living with heart failure, it’s important to be able to recognize the early warning signs that heart failure may be worsening. Being aware of these signs can guide you in seeking timely medical care, potentially preventing serious complications. Whether you have early symptoms of HF or have entered the more advanced stages of the diagnosis, the right care can help improve your quality of life.
Understanding Heart Failure
Heart failure is a chronic (long-term) condition that affects how well your heart muscle can pump blood. Over time, the heart muscle becomes progressively weaker. This can lead to symptoms like fatigue, shortness of breath, and fluid buildup in the body.
The Centers for Disease Control and Prevention (CDC) estimates that nearly 6.7 million people in the United States who are age 20 or older have HF. For around 42% of people, heart failure has a prognosis of five years.
Along with following your doctor’s recommendations for treatment, it’s important to know what can trigger worsening HF and what early warning signs to watch for.
Early Symptoms of Heart Failure
The early symptoms of heart failure can sometimes be subtle. People who experience them may mistake them for a normal sign of aging, for example, and some symptoms may only appear with exertion but not at rest. The Heart Failure Society of America uses the acronym FACES to describe these five early symptoms:
- F — fatigue: due to decreased oxygen circulation in the body, a person may feel more tired than usual.
- A — activity limitation: fatigue and shortness of breath may limit a person’s ability to perform their usual activities.
- C — congestion: as fluid begins to build up in the lungs, difficulty breathing, along with coughing and wheezing, may develop
- E — edema: fluid begins to build up in the ankles, legs, thighs, or belly, causing swelling and sometimes sudden weight gain.
- S — shortness of breath: this HF symptom is a result of decreased circulation of oxygen and fluid in the lungs, and often worsens at night when a person lies flat to sleep. They may notice they need to sleep propped up in bed or chair to breathe more comfortably.
It’s important to know that even in the early stages of heart failure, palliative care can be a helpful choice for managing symptoms and planning long-term care goals.
Advanced Symptoms of Heart Failure
There are four stages of heart failure. As heart failure progresses to the final stage, more advanced symptoms of heart failure appear, and are present even when a person is at rest. Some common signs of advanced HF include:
- Shortness of breath, even when resting
- Extreme fatigue and weakness, making everyday activities hard
- Persistent cough that produces white or pink blood tinged mucus
- Low blood pressure (hypotension)
- Anxiety (sometimes described as a “feeling of doom”)
- Rapid or irregular heartbeat
- Worsening edema in the feet, ankles, legs or abdomen
- Loss of appetite or nausea due to fluid accumulated in the abdomen
- Increased need to urinate at night
- Confusion or impaired thinking due to reduced blood flow to the brain
- Increase in visits to the hospital
Quality of Life and Prognosis
In the final two stages of heart failure, also known as stage C and stage D heart failure, quality of life can be affected. It is during these stages that life expectancy is also affected. Managing symptoms and reducing risks for exacerbating heart failure are especially important for those who are living with HF.
Healthy living tips to reduce risk of heart failure exacerbation may include avoiding these unhealthy behaviors:
- Smoking
- High-sodium foods
- Foods high in fat and cholesterol
- Drinking too much alcohol
- Drug use
Additionally, your doctor may suggest that you:
- Monitor your weight— sudden weight changes can signal fluid build-up. Weigh yourself every day and report significant changes to your doctor.
- Follow a heart-healthy diet— eat plenty of fruits, vegetables, whole grains, and lean proteins.
- Stay physically active— engage in regular, moderate exercise like walking. Consult your doctor before starting a new exercise routine.
- Take medicines as prescribed— ensure you take your medicines on schedule and as directed by your doctor.
- Limit fluid intake to prevent fluid overload.
- Manage stress— practice relaxation techniques like deep breathing, meditation, or yoga to reduce stress.
- Get enough rest— ensure you have a regular sleep schedule and take breaks to rest during the day.
- Go to all follow-up appointments— keep up with your medical appointments and communicate any new or worsening symptoms to your doctor.
- Correctly manage blood sugars, if you are diabetic.
- Maintain a healthy blood pressure— be sure to follow any guidelines your doctor provides and report blood pressure changes to your healthcare team.
Following your healthcare team’s recommendations can help ensure bothersome symptoms are reduced along with any episodes of worsening symptoms, also called congestive heart failure (CHF) or heart failure decompensation.
As heart failure progresses to end-stage congestive heart failure, it may be time to discuss hospice care as an option. Hospice can be elected if the patient’s physician certifies they have a prognosis of six months or less. This supportive care at the end-of-life can help ensure quality of life and that a patient’s wishes for care are honored in their final days.
No matter which treatment option you choose, having a plan for how to manage symptoms and when to call your doctor can help you face heart failure with confidence. At Amedisys, we believe in empowering you and your loved ones with the knowledge needed to effectively manage living with heart failure regardless of prognosis. Contact us today at or find a care center near you.
TeRonna Hall, RN, BSN, CCP, serves as a Clinical Content Development Specialist at Amedisys. With 36 years of healthcare experience, including 34 years in home health, she is dedicated to educating others on health-related topics.
