Understanding heart failure, living with it, and managing it well
“Heart failure” sounds alarming, but it does not mean your heart has stopped or is about to. It means the heart is not working as efficiently as it should, and with the right diagnosis and treatment, many people with heart failure can live full, active lives.
About this service
I’m Dr Chris Critoph, a Consultant Cardiologist based in Bournemouth, Dorset. Heart failure and cardiac devices are a particular clinical focus of mine. I established and lead the heart failure service at Bournemouth’s main NHS hospital and see patients privately from across Dorset and beyond for diagnosis, treatment, second opinions and ongoing management. I continue to run it as a major part of my NHS work alongside my private practice. This is a subspecialty I work in every week, not an occasional interest.
What is heart failure?
Despite the name, heart failure does not mean the heart has “failed” or stopped working. It means the heart is not pumping or filling as effectively as it should, whether because the heart muscle has become weakened, stiffened, or because another cardiac problem is affecting how it works. More than a million people in the UK are living with heart failure, and many others may remain undiagnosed. It is also a spectrum: some people have mild, well-controlled heart failure they barely notice day to day; others have more significant symptoms that need closer management. Treatment has advanced enormously, and the outlook for someone diagnosed and treated well today is very different from a generation ago.
Heart failure symptoms
Heart failure symptoms often develop gradually and can overlap with other conditions, which is exactly why proper assessment matters rather than guesswork. Reasons to consider an assessment include:
- Breathlessness that is new, or worse than before — particularly on exertion, when lying flat, or that wakes you at night
- Swelling of the ankles, legs, or abdomen
- Unusual tiredness or reduced ability to exercise compared with before
- Unexplained weight gain over a short period, which can reflect fluid retention rather than fat
- A racing or noticeably irregular heartbeat alongside any of the above
If you develop sudden, severe breathlessness — especially at rest, or with chest pain or fainting, this needs emergency assessment (999 or your nearest A&E), not a booked consultation.
What causes heart failure?
Heart failure is not a single disease — it is what happens when the heart is affected seriously enough by an underlying problem that its function becomes impaired. Common causes include coronary artery disease and previous heart attacks, long-standing high blood pressure, heart valve problems, and cardiomyopathies (diseases of the heart muscle itself, some of which are inherited — see my family history and inherited heart disease page for more on this). Certain persistent heart rhythm problems can also cause or worsen heart failure. In some people, a single clear cause is not identified.
Heart failure tests and diagnosis
A heart failure assessment usually starts with understanding your symptoms properly and then using targeted tests to work out whether heart failure is present, what type it is, and what may have caused it. This may include:
- A detailed history and examination, focusing on your symptoms, their pattern, and your broader cardiac and general health
- An ECG, to look at the heart’s electrical activity
- An echocardiogram — an ultrasound scan that shows how well the heart muscle and valves are working and is central to understanding what type of heart failure you have
- Blood tests, which may include NT-proBNP, a marker that can help assess whether heart failure is likely
- Depending on the findings, further tests to identify an underlying cause — for example cardiac MRI, coronary imaging or heart rhythm monitoring
Heart failure treatment and ongoing management
Treatment is tailored to the type and cause of heart failure. For heart failure with reduced ejection fraction, modern treatment is usually built around four established groups of disease-modifying medication: a renin-angiotensin system treatment (an ACE inhibitor, ARB or ARNI depending on the individual), a beta-blocker, a mineralocorticoid receptor antagonist (MRA), and an SGLT2 inhibitor. These medicines work in different ways, but together can improve symptoms, reduce the chance of hospital admission and improve long-term outcomes. In its more severe forms, heart failure can carry a prognosis worse than many cancers, but with the right, modern medication, properly optimised, that outlook can be dramatically improved, which is exactly why getting the diagnosis right and optimising treatment matters so much.
In everyday practice, some people remain on an incomplete combination of recommended treatments, or on doses that have not been revisited for some time. That does not necessarily mean previous care has been poor: blood pressure, kidney function, side effects and other illnesses can all limit what is possible. But it is worth reviewing treatment systematically, because there may be safe opportunities to improve it.
Alongside medication, treatment usually includes lifestyle measures and, for some people, device therapy such as cardiac resynchronisation therapy or a defibrillator-type device (see my cardiac device follow-up page). Ongoing monitoring and follow-up are a central part of managing heart failure well, rather than a one-off assessment.
Who this might be for
- You have breathlessness, swelling or fatigue that has not been fully explained
- You have been told you have heart failure and want a specialist second opinion or ongoing private care
- You have been diagnosed but feel your treatment has not been reviewed or optimised in some time
- You have a cardiac device related to heart failure and want ongoing specialist follow-up
Where I see patients
Consultations take place at Nuffield Health Bournemouth and the Dorset Heart Clinic. I see patients from across Dorset, including Bournemouth, Poole and the surrounding area, as well as from further afield. A virtual (phone or video) first appointment is also available if that suits you better — history-taking is a large part of an initial heart failure assessment, so this can be a genuine option. An in-person examination does have real advantages for this condition — listening to the heart and lungs and checking for fluid retention — so this may be recommended as a next step depending on what your history suggests. Initial consultations are £285, in line with my other services.
Frequently asked questions
Does heart failure mean my heart is about to stop?
No. Despite the name, it means the heart is not working as efficiently as it should; it does not mean that it has stopped or is about to stop. Many people live well with heart failure for many years once it is properly diagnosed and treated.
Can heart failure get better?
Yes. In some people, particularly when the heart’s pumping function is reduced, treating the underlying cause and using the right evidence-based medication can lead to substantial improvement, sometimes with the pumping function returning to the normal range. Meaningful recovery is more likely when the correct treatment is introduced promptly and properly optimised, which is one reason a careful medication review matters if treatment has not been revisited for some time. Improvement is not guaranteed and depends on the underlying cause; even when the ejection fraction recovers, ongoing treatment and follow-up are usually still important.
What are the main types of heart failure?
Heart failure with reduced ejection fraction (HFrEF) is where the heart muscle’s pumping (squeezing) strength is not as strong as it should be. Heart failure with preserved ejection fraction (HFpEF) is where the squeezing function of the heart is fine, but its relaxing (filling) function is affected. The two produce very similar symptoms, so the distinction is made using tests such as an echocardiogram rather than symptoms alone. The treatment, specifically which medications are recommended, differs between the two.
What is an ejection fraction?
Ejection fraction, or EF, is the percentage of blood pumped out of the main pumping chamber of the heart each time it contracts. It is one of the measurements used to classify heart failure and guide treatment, but it is not the whole story: people can have heart failure symptoms even when the ejection fraction is preserved.
What is an NT-proBNP blood test?
NT-proBNP is a blood test that measures a substance released when the heart is under increased pressure or stretch. A raised result can support the suspicion of heart failure and help decide whether further testing such as an echocardiogram is needed, but it is not diagnostic on its own and can also be affected by age, kidney function, heart rhythm and other factors.
I’ve been diagnosed with heart failure on the NHS — can I still see you privately?
Yes. Many patients I see privately for heart failure are looking for a specialist second opinion, a more detailed review of their treatment, or ongoing follow-up alongside their NHS care.
Is heart failure the same as a heart attack?
No. A heart attack is a sudden event, usually caused by a blocked coronary artery. Heart failure is an ongoing condition in which the heart is not working efficiently, and it can develop for a number of reasons, sometimes including damage from a previous heart attack.
Will I need a device, like a pacemaker?
Some people with heart failure benefit from a device, either to help the heart’s chambers beat in a more coordinated way, or to protect against dangerous heart rhythms, but many do not need one at all. This depends on the type of heart failure, the ECG, the ejection fraction, symptoms and the response to medical treatment.
Evidence and guidelines
This page reflects the 2026 European Society of Cardiology heart failure guidelines and prevalence data from the British Heart Foundation.
Ready to find out more?
Book a Consultation · Call 01202 084550 · info@coastalcardiology.co.uk
Written and medically reviewed by Dr Chris Critoph, Consultant Cardiologist. Clinical focus: heart failure, cardiomyopathy and cardiac devices. Last medically reviewed: September 2026.