Cardiology · Clinical Programs

Heart Failure Clinic

Helping you breathe easier and live better with heart failure

Also known as: heart failure management · CHF clinic · congestive heart failure treatment · weak heart treatment

Medically reviewed by Dr Kunal Ajay Patankar, DrNB (Cardiology) · September 2026

What it is

Think of the heart as a pump that has to refill between every beat. If its squeeze weakens, less blood moves forward. If the muscle becomes stiff, the pump needs higher pressure to refill even when its squeeze looks normal. That pressure can back up towards the lungs and cause breathlessness; fluid can also collect in the legs or abdomen. This is why heart failure can happen with either a weak or a stiff heart.

An echo report often gives an ejection fraction, or EF: the percentage of blood the main pumping chamber pushes out with each beat. It helps guide treatment, but it is not the percentage of your heart that is alive, and it does not tell the whole story. Reduced EF, preserved EF and EF that has improved with treatment need different conversations. A normal-looking EF alone does not rule out heart failure.

The clinic is an ongoing programme of care, rather than a single operation. A prescription is the starting point. Medicines need to be matched to your condition, introduced and adjusted safely, and checked against your breathing, blood pressure, kidney function and daily life. If tablets are not enough, the next step may be a device, treatment of an underlying valve or artery problem, or referral to an advanced heart failure service.

Heart failure is serious, but the name does not tell us what your future will be. Some people regain substantial heart function; others live with a continuing limitation. The purpose of follow-up is to improve what can be improved and help you and your family make decisions as your needs change.

Who it's for

People with diagnosed heart failure, whether the ejection fraction is reduced, mildly reduced or preserved
Anyone recently discharged after an admission for heart failure or fluid in the lungs
A low EF found on an echo, even if symptoms are mild or absent — early treatment may prevent progression
Persistent breathlessness, swelling or reduced stamina that needs assessment; these symptoms can also have non-cardiac causes
People whose heart function has improved and who need a plan for continuing treatment
Repeated admissions, difficult medication side effects or continuing symptoms despite treatment — reasons to reassess the plan

Symptoms to pay attention to

Becoming breathless on a walk or a flight of stairs you could previously manage
Needing extra pillows to breathe comfortably, or waking at night short of breath
Increasing ankle swelling, a swollen abdomen or an unexpected rise in weight over a few days
Unusual tiredness, loss of appetite or a persistent drop in your usual activity
New or worsening symptoms need prompt medical advice; do not wait for the next routine visit
Severe breathlessness at rest, chest pain, fainting or new confusion needs emergency assessment now — use the nearest emergency department, not a routine clinic booking

Understanding your condition

Your story and examination — when symptoms began, previous admissions, blood pressure, pulse, weight and signs of fluid retention
Echocardiography — checks the squeeze, filling, valves and right side of the heart; an EF number is interpreted alongside the rest of the study
ECG — looks for abnormal rhythms, electrical delay or evidence of previous heart damage
BNP or NT-proBNP — blood markers that help assess heart strain; kidney disease and atrial fibrillation may raise them, while obesity can lower them, so no result is read in isolation
Blood tests — kidney function, sodium, potassium, blood count, glucose control and thyroid function; iron studies can identify deficiency even without anaemia
Finding the cause — high blood pressure, coronary disease, valve disease, rhythm problems or heart-muscle disease; family history, alcohol, cancer treatment and pregnancy-related illness may also matter
Further tests only when they answer a question — chest X-ray, cardiac MRI, coronary assessment or selected tests for inherited disease or amyloidosis; not everyone needs an angiogram or every scan

How the programme works

Start with what has changed

Bring your reports and every medicine you take. We discuss what you can do comfortably, what has become difficult and what matters most to you — sleeping flat, walking to the shops or returning to work. Examination and selected tests establish the type, likely cause and current severity of heart failure.

Relieve excess fluid

If fluid has collected, a diuretic or water tablet helps the kidneys remove salt and water. The dose depends on congestion, blood pressure and kidney function. It may need to come down once you are less swollen. Severe congestion or low blood pressure may need hospital treatment before outpatient care is safe.

Build treatment for a weak squeeze

For heart failure with reduced EF, four medicine groups form the foundation when suitable: an ARNI such as sacubitril/valsartan, or an ACE inhibitor or ARB when appropriate; an evidence-based beta-blocker; an MRA such as spironolactone or eplerenone; and an SGLT2 inhibitor such as dapagliflozin or empagliflozin. They have different jobs. An SGLT2 inhibitor can help even without diabetes.

Treat a stiff heart differently

With preserved EF, the plan is tailored rather than copying the reduced-EF prescription. SGLT2 inhibitors, relief of congestion and treatment of high blood pressure, atrial fibrillation, kidney disease and obesity are central. Finerenone and medicines used for obesity may be options for selected patients. The choice depends on the evidence for your situation, kidney function, potassium, tolerability and access.

Adjust, then check

Treatment is introduced early and adjusted over the following weeks as safely tolerated. The aim is useful treatment across the appropriate medicine groups, not a large dose of one tablet at any cost. Blood pressure, pulse, kidney function and potassium guide changes. Beta-blockers are started or increased once fluid overload and the overall condition are stable.

Address the rest of your health

A rapid heart rhythm, iron deficiency, untreated sleep apnoea or poor nutrition can add to symptoms. Intravenous iron may help selected iron-deficient patients, particularly with reduced or mildly reduced EF; it is not a treatment for everyone who feels tired. We also discuss smoking, alcohol, vaccination, safe exercise and cardiac rehabilitation.

Consider more than medicines

Persistent symptoms or reduced function may justify assessment for CRT, an ICD, or treatment of important valve or coronary disease. Each has its own criteria; a low EF does not automatically mean an implant. Repeated admissions, worsening kidney function or inability to tolerate treatment may be reasons for early referral to an advanced heart failure team.

Leave with the next step clear

Your plan should state which medicines to take, which blood tests are due, when to return and what symptom changes to report. After an admission, follow-up is usually needed within one to two weeks, sometimes sooner. Confirm the date and contact route before discharge. Between visits, a simple record of weight and symptoms helps make the next decision.

The benefits

Less fluid-related breathlessness and swelling, with better comfort and ability to move around
For reduced-EF heart failure, appropriate disease-modifying medicines lower the risk of death and hospital admission
For preserved-EF heart failure, suitable treatments can reduce worsening episodes and admissions and improve quality of life; benefits differ between medicines
Regular checks create opportunities to recognise side effects, missed doses and deterioration before the next crisis
A clearer plan for you and your family, including what treatment can achieve and when another service should be involved

Treatment risks and monitoring

Dizziness or low blood pressure — especially after starting or increasing medicines; a slow pulse can occur with beta-blockers
Too much fluid removal can cause dehydration, cramps, low blood pressure or kidney problems; too little can leave congestion untreated
Potassium and kidney function can change with several heart failure medicines, so blood tests are part of treatment, even when you feel well
SGLT2 inhibitors can cause genital fungal infections and, rarely, ketoacidosis, including with a normal or only mildly raised blood sugar; ask for specific instructions around illness, fasting and surgery
ARNI and ACE-inhibitor treatment can rarely cause swelling of the lips, tongue or throat — this needs emergency care; an ARNI and an ACE inhibitor must not be taken together
Devices and procedures carry separate risks, including bleeding and infection, which need their own discussion before any decision

Other care we may discuss

Shared care once you are stable

Some people can be followed by their usual physician or cardiologist with an agreed heart failure plan. A dedicated clinic is particularly useful while the diagnosis is being clarified, medicines are changing or admissions are recurring. What matters is continuity, clear responsibility for reviewing blood tests and access to reassessment when things change.

A device or treatment of the cause

CRT can help selected hearts whose chambers contract out of sync. An ICD treats dangerous rhythms; it does not itself strengthen the heart or remove fluid. Coronary or valve treatment helps only when there is a suitable indication. These treatments usually add to medicines rather than replace them, and referral may involve another specialist or a Heart Team.

Advanced and supportive care

When symptoms remain severe despite appropriate treatment, a specialist centre can assess suitability for a heart transplant or a mechanical support pump called an LVAD. These are major treatments for selected people and require referral. Supportive and palliative care can help with breathlessness, fatigue, distress and difficult decisions alongside active heart treatment, at any stage — it does not mean care has stopped.

Before your first visit

Bring discharge summaries, previous and recent echo reports, ECGs, blood tests and any angiography, MRI or device records
Bring the actual medicine strips or an up-to-date list with doses, including supplements, painkillers and medicines prescribed elsewhere
If available, bring a few days of morning weights, blood pressure readings and notes on breathlessness, swelling and sleep; do not delay a visit to collect a perfect record
Tell us about side effects, missed doses and cost difficulties — the plan needs to work in your real routine
You can bring a family member or caregiver. A routine consultation does not usually need fasting; follow any separate instructions for an arranged test

Day-to-day care

Weigh yourself each morning after passing urine and before breakfast, using the same scale. Record new swelling, breathlessness or a sudden rise in weight and contact your care team promptly rather than waiting for the next appointment
Keep a written medicine schedule. Do not stop treatment because the swelling settles or your EF improves; adjust a water tablet yourself only if you have been given a specific written plan
Reduce excess salt: pickles, papad, packaged namkeen, instant foods and salty restaurant meals can contribute substantially. Avoid potassium-based salt substitutes unless your clinician has checked they are suitable
Fluid advice is individual. Not everyone needs a strict restriction, and forcing extra water can worsen congestion. If a daily limit is prescribed, tea, coffee, milk and soup count too; discuss adjustments during hot weather or an illness
Once stable, build activity gradually with an agreed walking or rehabilitation plan. Prolonged bed rest weakens muscles, but new breathlessness at rest or worsening swelling is a reason for reassessment before exercise
Check before taking over-the-counter painkillers such as ibuprofen or diclofenac, which can worsen fluid retention and kidney function. Ask what to do with your medicines if vomiting, diarrhoea or poor intake makes you dehydrated
Keep blood-test and follow-up appointments even when you feel well. Ask for the plan in words you understand, and make sure a family member knows which symptoms need emergency care

What improvement can look like

Fluid-related symptoms may improve over days; stamina and heart function can take weeks to months to change. There is no fixed recovery timetable
An echo may be repeated after a period of treatment when the result could change management, including a device decision; scans are not needed at every visit
An improved EF is encouraging, but may represent remission while treatment is working. Stopping medicines can allow heart failure to return
Trials support timely treatment adjustment with close follow-up after a heart failure admission, but no clinic can promise freedom from hospitalisation or a particular lifespan
Progress includes everyday function, comfort and fewer setbacks, not just the EF number. Ongoing symptoms deserve reassessment even if the echo looks better

Cost & insurance

What affects the cost

The cost is usually spread over ongoing consultations, medicines and monitoring rather than one procedure bill; how often tests and visits are needed depends on your stability
Ask about a sustainable prescription and appropriate lower-cost options. If a medicine is unaffordable, tell the clinician before quietly dropping it
An admission, intravenous treatment, rehabilitation, a device or a valve procedure has its own costs and needs a separate estimate
Outpatient medicines and tests may have different insurance cover from a hospital admission. Confirm your own policy, pre-authorisation requirements and current cashless arrangements with the hospital and insurer before planning treatment

Common questions

Does heart failure mean my heart is about to stop?+

No. Heart failure means a problem with pumping or filling; cardiac arrest means the heart is no longer circulating blood effectively. They are different conditions, although heart failure can increase the risk of dangerous rhythms. Your outlook depends on the cause, severity, other illnesses and response to treatment — the name alone cannot predict it.

My EF is normal. Can I still have heart failure?+

Yes. In heart failure with preserved EF, the squeeze may look normal but the heart fills at abnormally high pressure. Diagnosis needs symptoms and supporting findings from examination, echo and sometimes blood tests or further testing. Neither a normal EF nor a single BNP result settles the question on its own.

My EF is 30%. Does that mean only 30% of my heart is working?+

No. It means the left ventricle pushes out about 30% of the blood it contains with each beat. A healthy heart does not empty completely either. An EF of 30% is reduced and needs assessment and treatment, but it is not a measure of how much heart muscle is alive or a prediction of how long you will live.

Will the clinic visit be painful? Do I need admission?+

A routine visit involves a conversation, examination and review of reports. ECG and echo are painless; blood tests involve a needle prick. Admission is not needed simply to attend the clinic. Severe breathlessness, unstable blood pressure or major fluid overload may need hospital care. An angiogram or implant is a separate decision, not an automatic part of the visit.

Why do I need several medicines when one water tablet makes me feel better?+

A water tablet relieves fluid build-up. In reduced-EF heart failure, other medicines protect the heart and reduce future risk through different mechanisms, even when you cannot feel them working. Their benefits do not make every drug suitable for everyone: blood pressure, kidney function, potassium, side effects and cost guide the combination.

Why have I been prescribed a diabetes tablet when I do not have diabetes?+

Some SGLT2 inhibitors also treat heart failure in people without diabetes. They are being used for their heart failure benefit, not because the prescription proves you have diabetes. Ask about genital infection symptoms and the plan for illness, prolonged fasting or surgery, when a temporary pause may be needed under medical guidance.

Can I stop medicines once my EF returns to normal?+

Usually, heart failure treatment needs to continue. A better EF can mean the medicines are controlling the condition rather than that the tendency has disappeared. In TRED-HF, patients with recovered dilated cardiomyopathy often relapsed after supervised withdrawal. That trial does not describe every cause of heart failure, but it is a strong reason not to stop treatment on your own.

Should everyone with heart failure restrict water and stop eating salt?+

No single limit suits everyone. Avoid excess salt, but keep food nourishing and workable. Fluid restriction is considered according to congestion, blood sodium, kidney function and treatment; it is not automatic for every stable patient. Ask for your own daily plan, including how to handle heat, vomiting or diarrhoea. Do not replace ordinary salt with a potassium salt without checking.

Can I exercise, work or travel with heart failure?+

Many people can once the condition is stable. The starting point depends on symptoms, fitness and the kind of work or journey involved. Cardiac rehabilitation can help you increase activity with supervision. Discuss physically demanding work, flights, altitude and recent hospitalisation individually; carry medicines and a brief medical summary when travelling.

Am I too old for treatment, or will kidney disease prevent it?+

Age alone is not a reason to withhold treatment. Frailty, kidney function, blood pressure, other illnesses and your priorities matter more than a birthday. Kidney disease often changes the choice, dose or monitoring of medicines rather than ruling out care. A small change in a blood result needs interpretation, not automatic stopping of every heart tablet.

Will I need a pacemaker, ICD, surgery or a transplant?+

Most plans begin with medicines and treatment of the cause. CRT helps selected patients with electrical delay; an ICD reduces risk from certain dangerous rhythms. Some valve or coronary problems need an intervention or surgery. Transplant and LVAD assessment are for selected advanced cases at specialist centres. None is decided from an EF number alone, and each needs its own discussion of likely benefit and risk.

When should I call the clinic, and when should I go to hospital?+

New swelling, a sudden rise in weight, needing more pillows or increasing breathlessness warrants prompt contact with your treating team, even before a planned review. Severe breathlessness at rest, chest pain, fainting, new confusion or swelling of the tongue or throat needs emergency care immediately. If you cannot reach the team and symptoms are worsening, seek urgent in-person assessment rather than waiting for a callback.

References

Medically reviewed by Dr Kunal Ajay Patankar, DrNB (Cardiology) · Last reviewed September 2026. This page is educational and not a substitute for a personal consultation.

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