Private heart failure clinic in London, same-day cardiology.

Symptoms

• Breathlessness on exertion, then on lying flat, then at rest
• Waking at night breathless, or needing extra pillows
• Swollen ankles, legs or abdomen, worse by the end of the day
• Fatigue and reduced exercise tolerance
• persistent cough or wheeze, particularly at night
• rapid weight gain from fluid, loss of appetite, and needing to pass urine at night

Two types

• Reduced ejection fraction (HFrEF) — the heart muscle is weakened and pumps out less than it should. This is where the four-drug treatment applies.
• Preserved ejection fraction (HFpEF) — the heart pumps normally but is stiff and does not fill well. Commoner in older people, women, and with high blood pressure, diabetes and obesity. Treatment focuses on fluid, blood pressure, weight and the SGLT2 inhibitors, which now have good evidence here too.

The four pillars

• These four together substantially reduce hospital admissions and deaths in reduced ejection fraction, and the benefit is additive — being on all four matters.
• Doses are increased gradually to target over weeks to months, with blood pressure, kidney function and potassium monitored.
• Feeling worse briefly when starting a beta-blocker is expected and is not a reason to stop — the benefit builds over months.
• Diuretics control fluid and symptoms but do not improve survival; they are adjusted around the other four.
• Devices — ICDs and cardiac resynchronisation — are considered for selected people.

Managing it day to day