Heart failure living in older adults

Overview

Heart failure is a long-term condition where the heart doesn't pump blood as well as it should. This does not mean the heart has stopped or is about to stop. It can cause tiredness, breathlessness, and swelling in the legs and feet. With proper care, many people manage well for years.

Yes, heart failure is one of the most common reasons older adults go to hospital. In the UK, about 1 in 5 people over 65 have some form of heart failure.

Heart failure mostly affects older adults, especially those over 65. People with high blood pressure, coronary artery disease, or a history of heart attack are at higher risk. However, it can also occur in younger people due to certain conditions or treatments.

Symptoms

Common symptoms

• Shortness of breath, especially during activity or when lying down
• Feeling very tired or weak
• Swollen ankles, feet, or legs (oedema)
• Rapid or irregular heartbeat
• Persistent cough or wheezing, sometimes with white or pink mucus
• Needing to urinate more often at night

Symptoms in children

• Heart failure in children is rare. Symptoms may include poor feeding, slow weight gain, excessive sweating, and difficulty breathing.

Symptoms in older adults

• Shortness of breath with daily activities
• Swelling in the lower legs or feet
• Confusion or trouble thinking clearly
• Dizziness or light-headedness
• Reduced ability to walk or do chores
• Worsening kidney function

Causes

Main causes

• Coronary artery disease (narrowing of the heart's arteries)
• High blood pressure (hypertension)
• Previous heart attack that damaged the heart muscle
• Faulty heart valves (valvular heart disease)
• Cardiomyopathy (weakening of the heart muscle)

Risk factors

• Being over 65
• Having diabetes
• Being overweight or obese
• Smoking
• Family history of heart problems
• High cholesterol

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe breathlessness or chest pain
• If you cough up pink, frothy mucus
• If you faint or feel light-headed

Book a routine appointment if:

• If you notice new or worsening swelling in your ankles, feet, or legs
• If you feel more tired than usual during daily activities
• If you experience a persistent cough or wheeze
• If you have difficulty sleeping because of breathlessness

Diagnosis

Your doctor will ask about your symptoms and medical history, listen to your heart and lungs, and check for swelling. They will then arrange tests to confirm the diagnosis and find the cause.

Tests that may be done

• Blood tests (including BNP or NT-proBNP)
• Echocardiogram (ultrasound of the heart)
• Electrocardiogram (ECG) to check heart rhythm
• Chest X-ray
• Stress test (exercise or chemical)

What to expect at your appointment

You may be referred to a heart specialist (cardiologist) for further tests and treatment. Your care team will work with you to create a personal management plan. You will have regular follow-ups to monitor your condition and adjust treatments.

Treatment

Treatment for heart failure focuses on relieving symptoms, slowing the disease, and improving quality of life. It involves a combination of lifestyle changes, medicines, and sometimes medical devices or surgery.

Self-care at home

• Monitor your weight daily and report sudden increases to your doctor
• Limit salt in your diet (aim for less than 6g per day)
• Stay as active as your condition allows (talk to your doctor first)
• Avoid or limit alcohol and do not smoke
• Get enough rest and pace your activities

Medical treatments

Medicines are the mainstay of heart failure treatment. Common types include diuretics (water pills) to remove excess fluid, ACE inhibitors or ARBs to relax blood vessels, beta blockers to slow the heart and reduce workload, and aldosterone antagonists. Some patients may need a combined approach. Your doctor will decide which medicines are best for you.

When is surgery considered?

For some people, surgery may help. This can include heart valve repair or replacement, coronary artery bypass grafting (CABG) to improve blood flow, or implantation of a device such as a pacemaker or implantable cardioverter-defibrillator (ICD). In advanced cases, a heart transplant may be considered.

Living with this condition

Living with heart failure means planning your day to manage energy. Rest when you need to, and ask for help with tasks that tire you. Keep a diary of your weight and symptoms, and bring it to your appointments.

Lifestyle tips

• Check your weight every morning and record it
• Weigh yourself daily (same time, same scale, after urinating, before eating)
• Limit fluids if your doctor advises
• Avoid alcohol and smoking
• Manage stress with relaxation techniques or talking to someone

Diet and exercise

Eat a heart-healthy diet: plenty of fruits and vegetables, whole grains, lean proteins, and low-fat dairy. Limit salt, saturated fats, and added sugars. For exercise, start with gentle activities like walking or cycling. A cardiac rehabilitation programme can help you find the right level of activity. Always ask your doctor before starting new exercises.

Mental health and emotional wellbeing

Heart failure can cause anxiety, depression, and stress. It is normal to feel worried. Talk to your doctor if your mood affects your daily life. Support groups and counselling can help.

Prevention

Heart failure cannot always be prevented, but you can lower your risk by controlling high blood pressure, managing diabetes, staying active, eating healthily, not smoking, and limiting alcohol. Early treatment of heart attacks and valve problems also helps.

Vaccines

It is important to have the flu vaccine every year and the pneumonia vaccine if your doctor recommends it, as infections can worsen heart failure.

Screening programmes

There is no routine screening test for heart failure in the general population. However, if you have risk factors such as high blood pressure, diabetes, or a family history, your doctor may recommend regular check-ups to spot early signs.

Complications

If left untreated

• Fluid buildup in the lungs (pulmonary oedema) causing severe breathlessness
• Kidney damage or failure
• Liver damage
• Irregular heart rhythms (arrhythmias) that can be dangerous
• Hospital stays and reduced quality of life

Long-term outlook

Heart failure is a serious condition, but many people live well for years with the right treatment. The outlook depends on your age, overall health, and how well you follow your care plan. With modern medicines and lifestyle changes, most people can manage symptoms and stay active for a long time.

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