Heart Failure: New Horizons for Treatment and Better Quality of Life

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Introduction This article is based on the most recent review paper, “Advances in Management of Heart Failure” (2024), published in the highly respected medical journal The BMJ (British Medical Journal), authored by Professor Paul Heidenreich and Dr. Alexander Sandhu from Stanford University School of Medicine and the VA Palo Alto Health Care System, USA. Both researchers are leading clinicians and scientists in the field of cardiovascular disease, with Prof. Heidenreich serving as chair of the latest U.S. heart failure guidelines. The information presented here reflects the newest data from clinical trials, international expert recommendations, and summarizes key advice relevant to anyone facing a heart failure diagnosis. This text is entirely based on scientific findings published in the above-mentioned article and is not intended to replace consultation with your healthcare provider.

“Modern heart failure therapy can reduce the risk of death by nearly 75% – timely and proper treatment is the key to a longer, better life.”

What the Experts Say

Heart failure is one of the most serious and growing medical challenges worldwide. As populations age, the number of people affected by heart failure continues to rise—along with the need for timely and modern medical care. In recent years, there has been a real revolution in heart failure treatment and diagnostics: new medications have been introduced, devices have improved, and the criteria for early diagnosis have expanded. Yet even the latest international guidelines lag behind the speed at which scientific evidence is emerging. This article highlights five of the most important and up-to-date expert insights and scientific summaries from leading specialists, aimed at helping patients and their loved ones better understand today’s treatment and prevention options.

1. How dangerous is heart failure, and what does the diagnosis mean for life expectancy?

"Survival following a diagnosis of heart failure is poor and is highly influenced by age. In the UK, survival approaches 80% at five years for people aged 45-64 but is closer to 20% at five years for those aged ≥85. Fortunately, survival rates have improved since 2000, particularly among younger patients."

Explanation: A diagnosis of heart failure is not a death sentence, but it remains a high-risk condition. Thanks to modern therapies, survival rates are gradually improving. Age and other health conditions are key factors influencing outcomes.

2. Why is early diagnosis so important, and what are the best modern methods for detecting heart failure?

"Prompt recognition is critical. In the UK, more than 80% of first diagnoses of heart failure are made in the hospital, and more than 40% of these patients have symptoms that should promote earlier assessment... Women were noted to take six times longer to receive a diagnosis of heart failure and were twice as likely to be misdiagnosed."

Explanation: A high percentage of patients only learn about their condition in the hospital, often when complications have already developed. Screening with natriuretic peptides (BNP, NT-proBNP) and echocardiography are powerful tools for early detection. Women are particularly vulnerable to delayed or incorrect diagnosis, requiring increased awareness from healthcare providers and family members.

3. What’s new in medication for heart failure, and which drugs are proven to extend life?

"For patients with heart failure and a reduced left ventricular ejection fraction to ≤40% (HFrEF), four classes of drugs are now known to improve survival... renin-angiotensin system inhibitors including ACE inhibitors and ARBs or ARNI; β blockers; mineralocorticoid receptor antagonists (MRAs); and SGLT2 inhibitors... combination of the four pillars of HFrEF therapy will lead to a 73% relative risk reduction in mortality."

Explanation: Modern heart failure treatment is built around four main classes of drugs: ACE inhibitors/ARBs/ARNI, beta blockers, MRAs, and SGLT2 inhibitors. Using all four together leads to dramatically improved outcomes—reducing the risk of death by nearly 75% compared to no treatment. It is especially important to start these medications quickly after diagnosis.

4. What is recommended for heart failure with preserved or mildly reduced ejection fraction (HFpEF and HFmrEF)?

"SGLT2 inhibitors are recommended as the first line medication for patients with mildly reduced or preserved LVEF... Of the other treatments for HFrEF, ARNI, ACE inhibitors, ARBs, and MRAs are second line therapies as the evidence for benefit is much weaker than for patients with HFrEF."

Explanation: For patients whose heart pumping function is only mildly reduced or preserved, SGLT2 inhibitors are the first-line recommended therapy with strong supporting evidence. Other drug classes (ARNI, ACE inhibitors, ARBs, MRAs) may be considered as add-ons but have weaker data for benefit in these groups.

5. What is the role of new devices and invasive treatment methods?

"Implantable cardiac defibrillators and cardiac resynchronization therapy remain mainstays of HFrEF therapy... Pulmonary artery pressure monitoring can be used to guide adjustment of medication and monitor for signs of decompensation... In the initial CHAMPION trial, the CardioMEMS device reduced hospital admissions for heart failure and improved patient reported health status among 550 patients..."

Explanation: Implantable defibrillators and cardiac resynchronization therapy are standard treatments for certain heart failure patients. New devices like CardioMEMS allow remote monitoring of pulmonary artery pressure to detect early signs of worsening heart failure—reducing hospitalizations and improving quality of life.

Questions and Answers

1. Can heart failure be prevented, and what are the main risk factors? 

Answer: Yes, heart failure can often be prevented or delayed by managing risk factors. The most common risk is uncontrolled high blood pressure, which can increase the likelihood of developing heart failure by up to 40% even with optimal treatment. Patients with diabetes and/or chronic kidney disease are also at higher risk. For them, SGLT2 inhibitors and the drug finerenone have shown benefits in lowering heart failure risk. Prevention is possible through a healthy lifestyle, regular checkups, and proper management of chronic conditions.

2. What tests are needed for an accurate diagnosis, and can heart failure be mistaken for other conditions? 

Answer: Diagnosis requires both characteristic symptoms (such as shortness of breath, fatigue, swelling) and objective evidence of impaired heart function (like reduced ejection fraction or increased filling pressure). This is determined through echocardiography, blood tests for BNP/NT-proBNP, and sometimes cardiac MRI. Notably, women are far more likely to experience delayed or incorrect diagnosis—often taking six times longer to be diagnosed and being twice as likely to be misdiagnosed compared to men.

3. If treatment helps and my heart function improves, can I stop taking my medications? 

Answer: Even if your heart function appears to improve (e.g., ejection fraction rises above 50% and symptoms go away), the risk of relapse remains high. One study found that 46% of patients who stopped their medication had a recurrence within six months, while none who stayed on therapy experienced relapse during the same period. For this reason, experts strongly advise against stopping medications unless there is a clear, reversible cause—and even then, only under close medical supervision.

4. Are there dietary changes or special diets needed for heart failure? 

Answer: A moderate reduction in sodium (table salt) is typically recommended to ease symptoms. However, recent studies (like the SODIUM-HF trial) show that overly strict diets (under 1500 mg/day) don’t lower mortality or hospitalizations, though patients report a slight improvement in quality of life. A balanced diet that avoids malnutrition is crucial. Fluid restriction isn’t universally proven beneficial and should be personalized based on the patient’s condition.

5. Why is tracking quality of life so important, and how is it done in heart failure? Answer: Heart failure not only threatens life but significantly impacts daily well-being—causing fatigue, limited mobility, and social isolation. That’s why global experts recommend regular use of standardized quality-of-life questionnaires (such as the Kansas City Cardiomyopathy Questionnaire or the Minnesota Living with Heart Failure Questionnaire). These tools help both patients and doctors make better treatment decisions. In fact, their scores often correlate more closely with a patient’s actual health status and prognosis than traditional medical assessments. However, routine use of these questionnaires in clinical settings is still limited, despite their potential to improve care.

Conclusion

Modern medicine offers a rich array of proven tools for early diagnosis, effective therapy, and long-term management of heart failure. Conversations between patients and their doctors should be informed, evidence-based, and personalized. Drawing on the comprehensive knowledge and expert analysis of Prof. Heidenreich and Dr. Sandhu, published in The BMJ (2024), this article aims to provide clarity and confidence for patients and their families—emphasizing the importance of prevention, early diagnosis, optimal treatment, and quality-of-life tracking. Following current medical guidelines is the key to a better prognosis and a better life with heart failure.

Source: Heidenreich P, Sandhu A. Advances in management of heart failure. BMJ 2024;385:e077025. DOI: 10.1136/bmj-2023-077025