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Never stop heart medications on your own — not even when you feel better. Stopping suddenly can rapidly worsen the heart failure and trigger decompensation.
In heart failure (cardiac insufficiency), the heart is no longer able to pump enough blood through the body to supply all the organs with sufficient oxygen and nutrients. The heart is essentially a pump that over time loses power or can no longer fill properly. The result: the body is supplied less well, and at the same time blood backs up in front of the heart — which leads to the typical complaints such as breathlessness and fluid retention.
It is important to understand that heart failure is not a stand-alone illness that appears out of nowhere, but almost always the consequence of another heart or vascular condition. Most often the underlying cause is coronary heart disease (narrowed coronary arteries), a previous heart attack or years of poorly controlled high blood pressure. The heart then has to work permanently against increased resistance or has lost muscle tissue through the heart attack — over time it becomes exhausted.
There are broadly two courses. Chronic heart failure develops slowly over months and years; at first the body adjusts to the gradual deterioration, which is why it is often noticed late. Acute heart failure occurs suddenly — for example with a fresh heart attack or when chronic heart failure decompensates. It is a medical emergency. The good way out of the condition is through consistent, ongoing treatment: modern therapy can significantly relieve symptoms, prevent hospital stays and extend life.
What matters for treatment is how the heart is failing. To assess this, doctors measure the so-called ejection fraction (EF) in the cardiac ultrasound — the proportion of blood that the left ventricle ejects with each beat. A healthy heart ejects around 55 to 70 percent. The two main types are defined accordingly:
| Type | Ejection fraction | What happens |
|---|---|---|
| HFrEF (reduced EF) | 40 % or less | The heart muscle is too weak to eject the blood — a pumping problem |
| HFmrEF (mildly reduced) | 41–49 % | Borderline range between the two types |
| HFpEF (preserved EF) | 50 % or more | The muscle pumps normally but is too stiff and fills poorly — a filling problem |
Put simply: in HFrEF ("heart failure with reduced ejection fraction") the heart is too weak — it no longer pumps forcefully enough. In HFpEF ("preserved ejection fraction"), by contrast, the heart muscle has become too stiff and no longer expands properly during the filling phase, so that too little blood fits in. Both lead to similar complaints but are treated somewhat differently. HFpEF more often affects older people, frequently with high blood pressure, diabetes and obesity.
In addition, the NYHA classification (after the New York Heart Association) describes how much the heart failure limits you in everyday life. It is based solely on symptoms during exertion and helps to track the course:
| NYHA stage | Symptoms |
|---|---|
| NYHA I | No symptoms during normal physical exertion |
| NYHA II | Mild limitation — symptoms during greater exertion (e.g. climbing stairs) |
| NYHA III | Marked limitation — symptoms already during light everyday exertion |
| NYHA IV | Symptoms already at rest, bedridden |
The NYHA stage can improve with treatment — someone who starts at NYHA III can return to a lower stage with the right therapy. It is therefore an important gauge of whether the treatment is working.
The complaints of heart failure arise from two directions: the body is supplied less well with blood (hence exhaustion and a drop in performance), and at the same time fluid backs up (hence breathlessness and fluid retention). Because they often develop slowly, they are initially easily attributed to age or a lack of fitness. Typical signs are:
A particularly reliable warning sign is rapid weight gain: if you put on several kilos within a few days, your body is retaining water — an indication that the heart failure is currently going off track. This is exactly why daily weighing is such a valuable early-warning system (more on this in the everyday-life chapter).
Heart failure is almost always the result of another, often long-standing condition that overloads or damages the heart. By far the most common causes are:
The classic cardiovascular risk factors have an aggravating effect: smoking, obesity, lack of exercise, high alcohol consumption and older age. Many of these can be influenced — and this is exactly where prevention comes in: those who treat blood pressure, blood sugar and cholesterol in good time and give up smoking significantly reduce their risk of developing heart failure in the first place.
The suspicion of heart failure usually arises from the combination of complaints (breathlessness, oedema, exhaustion) and the medical history. Several targeted examinations serve to confirm it:
Diagnostics pursue two goals: first, to confirm the heart failure and determine its type; second, to find the underlying cause. Because only if this is also treated — for example narrowed coronary arteries or a valve defect — can the course really be influenced favourably.
The modern treatment of heart failure with reduced pump function (HFrEF) rests on four drug classes — the so-called four pillars. What is special about the current guideline recommendation: these four drug groups are no longer built up one after the other over months, but ideally all four are started together as quickly as possible and then increased in dose. Each pillar works through its own mechanism, and together they reduce symptoms, hospital stays and mortality more strongly than any single drug ever could.¹
Important: these medications are not merely a "symptom remedy". They intervene in the harmful remodelling processes of the heart and protect it in the long term. This is precisely why they keep working even when you feel free of symptoms right now — and must never be stopped on your own.
In HFpEF (preserved pump function) the evidence is thinner. Here the SGLT2 inhibitors are to the fore, together with the consistent treatment of accompanying conditions — above all high blood pressure, atrial fibrillation and obesity — as well as fluid removal as needed.
Four drug classes, different dose levels — brite reminds you of every tablet and documents weight and symptoms seamlessly for your next doctor's appointment.
The four pillars are the foundation — but treatment takes place for the most part in everyday life. Lifestyle and the right fluid removal help decide how well you feel and how rarely you have to go to hospital.¹,²
The diuretics (water tablets) play a special role. Strictly speaking they are not part of the four pillars, because they do not directly improve the prognosis — but they are indispensable for relieving fluid retention and breathlessness. Most often loop diuretics such as Furosemide or Torasemide are used. Their dose is often adjusted flexibly to body weight: if the weight rises due to fluid retention, more fluid is temporarily removed according to a medical plan.
If there is one single everyday tool in heart failure that makes the difference, it is daily weight monitoring. The reason: an impending deterioration (decompensation) usually announces itself days in advance through retained water — and the scales show this long before you feel marked breathlessness. Here is how best to proceed:
This simple routine is astonishingly effective: it turns a gradual deterioration into a visible signal to which you can respond early — often before a hospital stay becomes necessary. In everyday life, also watch out for increasingly swollen ankles, tighter shoes or a tighter waistband as further indications of fluid retention.
Two further everyday rules increase safety: take the tablets at fixed times and do not skip them, and be careful with painkillers — anti-inflammatory drugs (NSAIDs) such as Ibuprofen can cause fluid retention, strain the kidneys and weaken heart medications. It is better to discuss over-the-counter pain and cold remedies with your practice or pharmacy.
Log your morning weight in brite and see the trend as a curve. That way you spot fluid retention early and have everything ready at your doctor's appointment.
Chronic heart failure can worsen acutely within hours to days — this is called decompensation. It is an emergency because fluid backs up in the lungs (pulmonary oedema) and threateningly impairs breathing. You need to know these signs:
Less dramatic but equally important warning signs, for which you should contact your practice promptly: a weight gain above the warning threshold, increasing breathlessness during everyday activities, new or markedly worse leg oedema, a noticeably irregular or very fast pulse, and increasing exhaustion. Acting early often prevents an incipient deterioration from turning into an emergency.
Heart failure is treated not over weeks but over years — with four drug classes and daily weight monitoring. The therapy only works if it runs reliably and warning signs are noticed early. That is exactly where brite supports you.
