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Heart failure: When the heart can no longer keep up

Shortness of breath, fatigue, swollen ankles… Heart failure can cause a range of daily challenges, markedly impacting patients’ quality of life. Although a serious condition, it can be stabilized with medication (and in some cases surgery), as well as lifestyle changes.

Heart failure occurs when the heart fails to drain and pump blood normally to and from the other organs in the body, leading to poor oxygenation and excess accumulation of fluids (edema). This highly debilitating condition is often age-related. However, it can also occur in young people, such as those with heart valve malformations.


Heart failure affects 64 million people worldwide.1


The prevalence of heart failure is around 2% in western countries (European Union, North America). Some Asian countries report much higher figures: 4.5% in Singapore and 6.7% in Malaysia.


Heart failure is set to become more common as a result of population ageing: 21.4% of the global population will be over 60 in 2050, compared with 13.5% in 2020.2

The heart, a pump that wears out

The heart is made up of four chambers (two atria and two ventricles) that contract in a coordinated manner to send blood to the lungs for reoxygenation, and then to the rest of the body. This pumping action is performed by the myocardium, a muscle that is supplied by the coronary arteries.

Heart failure is characterized by the confluence of both a gradual loss of heart muscle strength and an increase in the body’s need for oxygen. The body no longer receives the oxygen that it needs. Heart failure first manifests during physical exertion, and then at rest, which forces the heart to compensate by working harder. It starts beating faster, then gets larger (the chambers dilate, and the walls thicken).

Insight on heart failure

The heart expends more energy in order to circulate fluid in the body, leading to its gradual exhaustion. This creates the risk of cardiac decompensation, also known as the accumulation of fluids (essentially water and salt) in the lungs, known as pulmonary edema. Breathing becomes more difficult and at this stage, the patient requires emergency hospitalization for intensive care. Heart failure is a condition that worsens rapidly, putting a tremendous strain on the heart, lungs, kidneys, and other organs.

Initial symptoms: shortness of breath and fatigue

The first symptom of heart failure is shortness of breath, caused by the engorgement of blood in the lungs. Another symptom suggestive of heart failure is fatigue, which is caused by poor irrigation of the muscles that are deprived of adequate nutrients and oxygen.

Due to the accumulation of blood in the vessels, edemas can form in certain parts of the body (liver, neck veins, legs). Heart failure also causes water retention due to reduced kidney activity, in addition to memory and libido disorders.

Did you know?

A normal heart rate is between 60 to 100 bpm.

During a workout, it can reach between 130-150 bpm. Nevertheless, if you notice symptoms or think you may have an irregular heartbeat, talk to your doctor.

National Cancer Institute – NCI Dictionary of Cancer Terms. 2011.

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Doppler echocardiography to monitor the heart

In addition to a clinical examination and blood tests, heart failure is diagnosed on the basis of an electrocardiogram, which includes an exercise tolerance test for young subjects, and imaging.

Doppler echocardiography uses ultrasound to measure the size of the heart chamber and thickness of the muscle. It also evaluates the left ventricle’s capacity to fill and contract, the side responsible for pumping blood out into the body. Its results allow two main types of heart failure to be differentiated, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction.

B-type natriuretic peptide (BNP) and N-terminal (NT)-pro hormone BNP measurement in blood helps to determine if worsening fatigue or shortness of breath are due to heart failure or another problem. BNP/NT-proBNP are released in the heart in response to increases in pressure inside the heart. In patients with heart failure, BNP and NT-proBNP levels are higher than in patients with normal heart function.

The doctor also analyses cardiovascular risk factors, such as diabetes, atherosclerosis (fatty deposits on artery walls), smoking, obesity, and the presence of hypertension or coronary artery disease.

Lifestyle and treatment

Lifestyle changes made to adopt healthier habits are crucial changes that help preserve the heart. These include quitting smoking, a better diet with less fat, alcohol and salt, moderate exercise, and limiting fluid intake to reduce the risk of edema.

The main treatments for heart failure include medicines that act on various mechanism of actions3.

In addition to a specific treatment for heart failure, it is essential to target the causes, such as treating coronary artery disease, including angina, high blood pressure, dyslipidemia, or performing surgery for a defective heart valve.

Décryptage sur l'insuffisance cardiaque


Fourth leading global pharmaceutical group in cardiology worldwide* and second in Europe, Servier has been involved in cardiovascular disease treatments for more than 60 years. We aim to maintain our position through strategic and innovative life cycle management (LCM) to capitalize on our expertise in incremental innovation, particularly in the development of Single Pill Combinations (SPC). SPCs are medicines combined in a single tablet, which simplify treatment, thereby promoting better compliance.

The website MyHealthPartner  has been developed by Servier and offers a wealth of certified information on chronic diseases like heart failure. It enables patients to better understand their pathologies, associated risk factors, and symptoms.

*IQVIA, Analytics Link / World 74 countries – MAT Q1-2023


Heart failure is a life-threatening disease that requires regular medical follow-up, with doctor consultations at least every six months until the condition has stabilized.

In addition, it is strongly recommended that patients:

  • Adapt their lifestyle: in addition to managing heart failure treatments, other aspects of your lifestyle, such as diet, exercise, smoking, and alcohol consumption may need to change. Successful lifestyle changes are just as important as medical treatment for managing heart failure.
  • Self-monitor: weigh yourself at least twice a week, take your heart rate and blood pressure regularly, take note of any swelling of the ankles, and assess shortness of breath and fatigue. Warning signs of cardiac decompensation include severe weight gain over a few days (due to water accumulation), increased fatigue and difficulty breathing, palpitations, and loss of appetite or fever.
  • Manage their medications: it’s important that you take your heart failure medicine as prescribed so that you get the best possible outcomes from your treatment. You will most likely be prescribed more than one medicine. Throughout the day, you may have to remember to take your medication at several different times.

Global public health burden of heart failure, Cardiac Failure Review, April 2017,
Communication de Martin R. Cowie (cardiologist at Imperial College in London) at the 2015 Heart Failure Congress,%20United%20Kingdom).pdf
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1211-1259[AC1] 
Figures calculated based on World Population Prospects 2019 from the WHO (World Health Organization),
3 Renin-angiotensin-aldosterone system (RAAS) inhibitors, aldosterone antagonists, sodium-glucose co-transporter (SGLT) 2 inhibitors, beta-blockers and diuretics.