Heart Failure

Issue

Vol. 2 No. 3 (2025)

Date Log

Submitted
March 12, 2025
Accepted
June 13, 2025
Published
July 7, 2025

Heart Failure | Symptoms, Causes, Diagnosis & Treatment

https://doi.org/10.69512/ajphi.v2i3.97
Aakriti Karki, MD
Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh
https://orcid.org/0009-0007-4024-1617
Lumanti Manandhar
Rajiv Gandhi University of Health Sciences, Bangalore, India
https://orcid.org/0009-0005-9167-3693

Corresponding Author(s) : Aakriti Karki, MD

iamaakritikarki@gmail.com

The American Journal of Patient Health Info, Vol. 2 No. 3 (2025)

Abstract


  1. Heart failure is a condition in which the heart can’t effectively pump blood and/or relax. It is classified into two main types: systolic (weakened pumping) and diastolic (impaired filling) dysfunction.

  2. Symptoms of heart failure, like shortness of breath, fatigue, and fluid retention, often correlate with the severity of cardiac impairment and require careful monitoring.

  3. An echocardiogram is a heart ultrasound that uses sound waves to create images of the heart. It helps doctors diagnose and monitor heart failure, which is the heart’s inability to pump enough blood and oxygen to the body.

  4. The American Heart Association and European Society of Cardiology recommend that doctors test for blocked heart arteries when someone is newly diagnosed with heart failure to determine whether they are causing the condition.

  5. There isn’t enough evidence to suggest that cutting out salt helps improve serious health outcomes in heart failure.

Keywords

American Heart Association Cardiac Rehabilitation Echocardiogram Ejection Fraction Heart Failure
Karki, MD, A., & Manandhar, L. (2025). Heart Failure | Symptoms, Causes, Diagnosis & Treatment. The American Journal of Patient Health Info, 2(3). https://doi.org/10.69512/ajphi.v2i3.97
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References
  1. Baman JR, Ahmad FS. Heart failure. JAMA. 2020;324:1015. Available from: https://pubmed.ncbi.nlm.nih.gov/32749448/
  2. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. Eur J Heart Fail. 2021;23:352–80. Available from: https://pubmed.ncbi.nlm.nih.gov/33605000/
  3. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17:559–73. Available from: https://pubmed.ncbi.nlm.nih.gov/32231333/
  4. Snipelisky D, Chaudhry S-P, Stewart GC. The many faces of heart failure. Card Electrophysiol Clin. 2019;11:11–20. Available from: https://pubmed.ncbi.nlm.nih.gov/30717842/
  5. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13:368–78. Available from: https://pubmed.ncbi.nlm.nih.gov/26935038/
  6. Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail. 2019;6:1105–27. Available from: https://pubmed.ncbi.nlm.nih.gov/31997538/
  7. Boorsma EM, ter Maaten JM, Damman K, Dinh W, Gustafsson F, Goldsmith S, et al. Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol. 2020;17:641–55. Available from: https://pubmed.ncbi.nlm.nih.gov/32415147/
  8. Crespo-Leiro MG, Barge-Caballero E. Advanced heart failure. Heart Fail Clin. 2021;17:533–45. Available from: https://pubmed.ncbi.nlm.nih.gov/34511203/
  9. Fitzsimons S, Doughty RN. Role of transthoracic echocardiogram in acute heart failure. Rev Cardiovasc Med. 2021;22. Available from: https://pubmed.ncbi.nlm.nih.gov/34565073/
  10. Donal E, L’official G, Kosmala W. New guidelines for managing chronic heart failure patients and new needs in echocardiography. Int J Cardiol. 2022;353:71–2. Available from: https://pubmed.ncbi.nlm.nih.gov/35074493/
  11. Iwano H, Little WC. Heart failure: what does ejection fraction have to do with it? J Cardiol. 2013;62:1–3. Available from: https://www.sciencedirect.com/science/article/pii/S0914508713001111
  12. Nagueh SF, Nabi F, Chang SM, Al-Mallah M, Shah DJ, Bhimaraj A. Imaging for implementation of heart failure guidelines. Eur Heart J Cardiovasc Imaging. 2023;24:1283–92. Available from: https://pubmed.ncbi.nlm.nih.gov/37418490/
  13. Zhu K, Ma T, Su Y, Pan X, Huang R, Zhang F, et al. Heart failure with mid-range ejection fraction: every coin has two sides. Front Cardiovasc Med. 2021;8. Available from: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.683418/full
  14. Davidson A, Raviendran N, Murali CN, Myint PK. Managing heart failure with preserved ejection fraction. Ann Transl Med. 2020;8:395–395. Available from: https://pubmed.ncbi.nlm.nih.gov/32355839/
  15. Fudim M, Butler J, Kittipibul V. Implantable hemodynamic-GUIDE monitors. J Am Coll Cardiol. 2024;83:695–8. Available from: https://pubmed.ncbi.nlm.nih.gov/38325995/
  16. Seko Y, Kishimori T, Kato T, Morimoto T, Yaku H, Inuzuka Y, et al. Coronary angiography in patients with acute heart failure: from the KCHF registry. ESC Heart Fail. 2022;9:531–44. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8787990/
  17. Vetrovsky T, Siranec M, Frybova T, Gant I, Svobodova I, Linhart A, et al. Lifestyle walking intervention for patients with heart failure with reduced ejection fraction: the WATCHFUL trial. Circulation. 2024;149:177–88. Available from: https://pubmed.ncbi.nlm.nih.gov/37955615/
  18. Kida K, Miyajima I, Suzuki N, Greenberg BH, Akashi YJ. Nutritional management of heart failure. J Cardiol. 2023;81:283–91. Available from: https://pubmed.ncbi.nlm.nih.gov/36370995/
  19. Verma N, Rastogi S, Chia Y, Siddique S, Turana Y, Cheng H, et al. Non‐pharmacological management of hypertension. J Clin Hypertens (Greenwich). 2021;23:1275–83. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8678745/
  20. Rees K, Taylor R, Ebrahim S. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2001. Chichester, UK: John Wiley & Sons, Ltd. Available from: https://pubmed.ncbi.nlm.nih.gov/15266480/
  21. Bozkurt B, Fonarow GC, Goldberg LR, Guglin M, Josephson RA, Forman DE, et al. Cardiac rehabilitation for patients with heart failure. J Am Coll Cardiol. 2021;77:1454–69. Available from: https://pubmed.ncbi.nlm.nih.gov/33736829/
  22. Horwich TB, Fonarow GC. Prevention of heart failure. JAMA Cardiol. 2017;2:116. Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2590068
  23. Colin-Ramirez E, Sepehrvand N, Rathwell S, Ross H, Escobedo J, Macdonald P, et al. Sodium restriction in patients with heart failure: a systematic review and meta-analysis of randomized clinical trials. Circ Heart Fail. 2023;16. Available from: https://pubmed.ncbi.nlm.nih.gov/36373551/
  24. Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K. Fluid and salt balance and the role of nutrition in heart failure. Nutrients. 2022;14:1386. Available from: https://pubmed.ncbi.nlm.nih.gov/35405998/
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Aakriti Karkia, Lumanti Manandharb

a Jalalabad Ragib Rabeya Medical College and Hospital, Sylhet, Bangladesh

b Rajiv Gandhi University of Health Sciences, Bangalore, India

Submitted on: 28th February, 2025

Last Submitted

Background

The heart works like a pump: it fills up with blood when resting and pushes the blood out when it beats. Heart failure (HF) happens when the heart is weak or stiff and can’t pump blood well enough to keep the body healthy. It doesn’t mean the heart stops working completely; it just can’t pump as well as it should. [1]

Understanding Your Heart & Heart Failure

The heart consists of four chambers—two upper chambers known as atria and two lower chambers known as ventricles. The chambers are interconnected and also connected with the lungs to create a system that maintains blood circulation.

Heart failure can affect either the left, the right, or both sides. If the left side isn’t working well, it can’t pump blood adequately to the body, making it work harder. If the right side has problems, it can’t push blood to the lungs easily, often because of extra pressure or strain.

  • Systolic Heart Failure or Heart Failure with Reduced Ejection Fraction (HFrEF): This occurs when the left ventricle loses its ability to contract normally, reducing the force with which blood is pumped into the circulation. As a result, the heart cannot deliver sufficient blood to meet the body’s demands. [2]
  • Diastolic Heart Failure or Heart Failure with Preserved Ejection Fraction (HFpEF): In this condition, the left ventricle cannot relax properly, impairing its ability to fill with blood during the resting phase between heartbeats. Despite a preserved ejection fraction, the heart output is compromised due to inadequate filling. [2,3]

Top 5 Causes of Heart Failure

Heart failure happens when the heart can’t pump blood well enough to meet the body’s needs. The most common reasons include clogged heart arteries from heart attacks, which damage the heart muscle. Long-term high blood pressure makes the heart work too hard, causing it to get too thick or stiff. Problems with the heart’s electrical signals, called arrhythmias, can make it beat too fast or irregularly, weakening it over time. Faulty heart valves force the heart to work harder to push blood through, which can tire it out. Sometimes, infections from viruses can hurt the heart muscle directly. Also, certain toxins, like too much alcohol or some medicines, can damage the heart. All these problems make the heart less strong, leading to heart failure. [4,5]

Common Symptoms of Heart Failure

Heart failure symptoms vary depending on how much the heart’s ability to pump blood is affected. In some cases, symptoms often develop slowly, making early detection difficult. If you have any of these three symptoms, get checked for heart failure. [6]

Figure 1.

  • Some people get short of breath with limited activities or get tired early compared to their peers or regular selves. Shortness of breath, even at rest or when lying down, can be seen at later stages.
  • Persistent fatigue and weakness may occur, especially after routine activities.
  • Fluid buildup causes weight gain, leg swelling, and abdominal distention. [7]

How is Heart Failure Diagnosed?

Doctors may suspect heart failure if you have symptoms like swelling in the legs or shortness of breath during activities that require little effort. Many people with heart failure also have other heart conditions such as coronary artery disease (CAD), high blood pressure, irregular heartbeats, or a history of heart attacks. A detailed medical history is important to identify these risk factors and confirm the diagnosis. [3,8]

Figure 2.

To diagnose heart failure, doctors usually perform tests like chest X-rays, electrocardiograms (ECGs) to measure the heart’s electrical activity, and echocardiograms, which use ultrasound to create images of the heart. Blood tests that detect specific biomarkers can also help identify signs of damage or stress on the heart. These diagnostic tools are essential to determine the cause of heart failure and evaluate the degree of impairment. They are critical to guiding personalized treatment plans. [3]

How Does an Echocardiogram Help?

An echocardiogram is like a special ultrasound of your heart. It uses sound waves that are too high-pitched for people to hear; to create moving pictures of your heart. This test is safe and doesn’t hurt because it doesn’t use needles or surgery. Doctors use these pictures to see how well your heart is working, check how strongly it pumps blood, and look for any problems with its valves or movement. [9,10]

What is an Ejection Fraction?

The ejection fraction (EF) tells us how much blood the heart pumps out compared to how much it holds before pumping. It is shown as a percentage and indicates how well the heart pumps. A healthy heart typically exhibits an ejection fraction between 50% and 70%, which usually reflects optimal cardiac function. The EF can be measured with the help of an echocardiogram. [11]

1. Why does It Matter?

The echocardiogram also helps identify the cause of heart failure, whether due to problems with the heart muscle, heart valves, or another issue. This information is crucial for diagnosing the cause, choosing the right treatments, and predicting the patient’s long-term prognosis.The ejection fraction helps doctors understand how effectively the heart delivers blood to the body and is important for diagnosing and categorizing heart failure. [11,12]

2. Heart Failure with Reduced Ejection Fraction ( HFrEF )

It means your heart isn’t pumping out enough blood with each beat. Normally, it pushes out more than half (around 50-70%) of the blood inside it. However, in HFrEF, the pump is weak and pushes out less than 40% of the blood. This makes it hard for the body to get oxygen and nutrients.

3. Heart Failure with Preserved Ejection Fraction ( HFpEF )

Some people can have heart failure even if their ejection fraction is normal. This condition is called HFpEF. These individuals may not notice symptoms during everyday activities, but the heart still isn’t working properly. [13,14]

4. No Symptoms Does Not Always Mean No Problem

Patients with a normal ejection fraction often don’t show symptoms daily, so doctors need to use other tests besides ejection fraction to fully evaluate heart health.

Treatment of Heart Failure

Treating heart failure depends on what’s causing it, the symptoms a person has, and how well their heart is pumping blood. The management of heart failure involves:

Figure 3.

1. Medicine/ Pills

  • Doctors often prescribe diuretics, or “water pills,” to help remove extra bodily fluid and ease symptoms like swelling and breathlessness. [3,10]

2. Devices

  • Other medicines help the heart work better, keep people from returning to the hospital, and improve the heart's pumping action.
  • While taking medicine, doctors closely watch blood pressure, kidney health, and salt intake.
  • If the heart’s pumping weakens, doctors might use devices like pacemakers or implantable cardioverter-defibrillators (ICDs) that help control the heartbeat and stop dangerous rhythms. [15]
  • In very serious cases, some patients may need special machines called Left Ventricular Assist Devices (LVADs) or even a heart transplant.

3. Checking for Blocked Heart Arteries ( Coronary Artery Disease )

  • When someone is newly diagnosed with heart failure, doctors check if blocked arteries are causing it.
  • Stress tests or coronary angiography (using a thin tube and dye to see inside the arteries) help find blockages.
  • If doctors find blockages in the heart’s arteries, they can fix them using special procedures. One way is called balloon angioplasty, where a tiny balloon is put into the blocked artery and then inflated to open it up. Sometimes, doctors put in a small tube called a stent to keep the artery open so blood can flow freely. [16]
  • If the blockage is very bad or in many places, a bigger surgery called coronary artery bypass grafting (CABG) might be needed. In this surgery, doctors take a healthy blood vessel from another part of the body to create a new path for blood to flow around the blocked arteries, helping the heart get the needed blood and nutrients.

4. Lifestyle Changes

  • Eating healthy, exercising, and following the doctor’s advice on diet and medicines help slow down the disease. [17,18]
  • Controlling blood pressure with medicines and managing diabetes by eating right and staying active is very important. [19]
  • Medicines like statins and sometimes low-dose aspirin may also be recommended to lower cholesterol.

What is Cardiac Rehabilitation? How Exercise and Lifestyle Changes Help Heart Failure Patients?

Cardiac rehabilitation is a special program that helps people with heart problems get healthier and prevent their heart disease from getting worse. It usually takes place at a hospital or clinic and lasts about 12 to 18 weeks, with sessions lasting two to three hours each week. You should talk to your doctor before starting. Cardiac rehab helps people feel better, avoid hospital visits, and live longer with heart problems. [20,21] The program includes:

Figure 4.

  • Exercise: Safe activities like walking or cycling can make your heart stronger.
  • Healthy Eating Advice: Learning what foods help your heart stay healthy.Emotional Support: Talking with counselors to handle stress or worries.
  • Stress Control: Techniques to relax and keep your heart calm.
  • Quitting Smoking: Help to stop using tobacco, which hurts your heart.
  • Heart Health Education: Learning how to manage blood pressure, diabetes, and cholesterol to keep your heart working well.

When Do You Need Cardiac Rehabilitation?

People should join a cardiac rehabilitation program if they have had any of these heart problems: [21]

  • A heart attack or serious heart event in the last year.
  • Chest pain or pressure
  • Heart failure, which means the heart isn’t pumping well.
  • Recent heart treatments include getting a stent (a tiny tube to open blocked arteries), heart bypass surgery, valve surgery, or a heart transplant.

Easy Lifestyle Tips for a Healthy Heart

Living a healthy life and treating any health problems early can lower your chances of heart failure. Here are 10 scientifically proven, simple tips to prevent heart failure. [22]

Figure 5.

  • Exercise at least five days a week to keep your heart strong.
  • Stop smoking to protect your heart and lungs.
  • Eat lots of fruits and vegetables—about four servings every day.
  • Drink alcohol only a little bit—no more than one drink a day. Drinking too much can hurt your heart.
  • Stay away from drugs like cocaine, amphetamines, or any other harmful substances.
  • Work with your doctor to control high blood pressure if you have it.
  • Manage diabetes by eating healthy, exercising, and taking any medicine your doctor gives you.
  • Keep your cholesterol levels low to stop artery blockages that can cause heart attacks and damage your heart.
  • If heart failure runs in your family, talk to your doctor about tests to check your risk.
  • Some medicines used to treat cancer, including special ones called immunotherapy, can sometimes hurt your heart. So, if you’ve had these, your heart should be checked regularly.

Salt Restriction for People with Heart Failure

People with heart failure are often told to eat less salt. Some studies show that eating less salt doesn’t always reduce serious problems or hospital visits. However, reducing salt can help people feel better and prevent heart disease from worsening. So, it’s a good idea to limit salt, but you don’t have to stop eating it altogether. [23,24]

Managing Heart Failure at Home

It is important to check yourself regularly at home to prevent heart failure. One way to do this is by writing down your weight a few times weekly.  This helps spot if your body is holding too much fluid, so your doctor might need to change your medicine. Your logbook should also keep track of how you feel. [6]

It’s really important to have regular check-ups with your doctor, which include a physical exam and blood tests. These help the doctor see how your heart is doing and ensure your medicines work well. Your care team can adjust your medication by checking often to keep you feeling your best.

-> Things to Watch and Write Down:

  1. Is your shortness of breath getting worse?
  2. Can you do your normal activities without getting too tired?
  3. Do your feet, ankles, or legs look swollen?
  4. Has your weight stayed the same, or did it suddenly go up?
  5. Are you having chest pain? If yes, when does it happen?

When to Call Your Doctor?

If you notice any of these symptoms, call your doctor right away.

1. Breathing and Heart Symptoms

  • You have a dry cough that doesn’t go away.
  • You get short of breath doing normal activities.
  • Your feet, legs, or lower body swell up more than usual.
  • You suddenly gain 2–3 pounds in one day.

2. Feeling Dizzy or Confused

  • You feel dizzy or confused for no clear reason.

3. Sleeping Problems

  • You have trouble sleeping because you can’t lie flat without feeling like you can’t breathe.

Questions to Ask Your Doctor

  1. How bad is my heart problem?
  2. What did my tests and heart pictures show? How well is my heart pumping?
  3. Are there medicines that will help? Will they cause any side effects?
  4. What signs or problems should I tell you about right away?
  5. What changes in my daily habits will help me feel better and stay healthier?

Conflict of Interest

AK worked as a non-paid research assistant at ehealthyinfo 2023-24 and serves as the section editor for mental health at AJPHI. LM worked as a paid medical journalist at ehealthyinfo. There is no other conflict of interest to declare.

Peer Reviewed By

Abhushan Poudyal, MD

Creighton University Medical Center, Omaha, NE, USA

References

  1. Baman JR, Ahmad FS. Heart failure. JAMA. 2020;324:1015. Available from: https://pubmed.ncbi.nlm.nih.gov/32749448/
  2. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. Eur J Heart Fail. 2021;23:352–80. Available from: https://pubmed.ncbi.nlm.nih.gov/33605000/
  3. Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17:559–73. Available from: https://pubmed.ncbi.nlm.nih.gov/32231333/
  4. Snipelisky D, Chaudhry S-P, Stewart GC. The many faces of heart failure. Card Electrophysiol Clin. 2019;11:11–20. Available from: https://pubmed.ncbi.nlm.nih.gov/30717842/
  5. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol. 2016;13:368–78. Available from: https://pubmed.ncbi.nlm.nih.gov/26935038/
  6. Tomasoni D, Adamo M, Lombardi CM, Metra M. Highlights in heart failure. ESC Heart Fail. 2019;6:1105–27. Available from: https://pubmed.ncbi.nlm.nih.gov/31997538/
  7. Boorsma EM, ter Maaten JM, Damman K, Dinh W, Gustafsson F, Goldsmith S, et al. Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol. 2020;17:641–55. Available from: https://pubmed.ncbi.nlm.nih.gov/32415147/
  8. Crespo-Leiro MG, Barge-Caballero E. Advanced heart failure. Heart Fail Clin. 2021;17:533–45. Available from: https://pubmed.ncbi.nlm.nih.gov/34511203/
  9. Fitzsimons S, Doughty RN. Role of transthoracic echocardiogram in acute heart failure. Rev Cardiovasc Med. 2021;22. Available from: https://pubmed.ncbi.nlm.nih.gov/34565073/
  10. Donal E, L’official G, Kosmala W. New guidelines for managing chronic heart failure patients and new needs in echocardiography. Int J Cardiol. 2022;353:71–2. Available from: https://pubmed.ncbi.nlm.nih.gov/35074493/
  11. Iwano H, Little WC. Heart failure: what does ejection fraction have to do with it? J Cardiol. 2013;62:1–3. Available from: https://www.sciencedirect.com/science/article/pii/S0914508713001111
  12. Nagueh SF, Nabi F, Chang SM, Al-Mallah M, Shah DJ, Bhimaraj A. Imaging for implementation of heart failure guidelines. Eur Heart J Cardiovasc Imaging. 2023;24:1283–92. Available from: https://pubmed.ncbi.nlm.nih.gov/37418490/
  13. Zhu K, Ma T, Su Y, Pan X, Huang R, Zhang F, et al. Heart failure with mid-range ejection fraction: every coin has two sides. Front Cardiovasc Med. 2021;8. Available from: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.683418/full
  14. Davidson A, Raviendran N, Murali CN, Myint PK. Managing heart failure with preserved ejection fraction. Ann Transl Med. 2020;8:395–395. Available from: https://pubmed.ncbi.nlm.nih.gov/32355839/
  15. Fudim M, Butler J, Kittipibul V. Implantable hemodynamic-GUIDE monitors. J Am Coll Cardiol. 2024;83:695–8. Available from: https://pubmed.ncbi.nlm.nih.gov/38325995/
  16. Seko Y, Kishimori T, Kato T, Morimoto T, Yaku H, Inuzuka Y, et al. Coronary angiography in patients with acute heart failure: from the KCHF registry. ESC Heart Fail. 2022;9:531–44. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8787990/
  17. Vetrovsky T, Siranec M, Frybova T, Gant I, Svobodova I, Linhart A, et al. Lifestyle walking intervention for patients with heart failure with reduced ejection fraction: the WATCHFUL trial. Circulation. 2024;149:177–88. Available from: https://pubmed.ncbi.nlm.nih.gov/37955615/
  18. Kida K, Miyajima I, Suzuki N, Greenberg BH, Akashi YJ. Nutritional management of heart failure. J Cardiol. 2023;81:283–91. Available from: https://pubmed.ncbi.nlm.nih.gov/36370995/
  19. Verma N, Rastogi S, Chia Y, Siddique S, Turana Y, Cheng H, et al. Non‐pharmacological management of hypertension. J Clin Hypertens (Greenwich). 2021;23:1275–83. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8678745/
  20. Rees K, Taylor R, Ebrahim S. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2001. Chichester, UK: John Wiley & Sons, Ltd. Available from: https://pubmed.ncbi.nlm.nih.gov/15266480/
  21. Bozkurt B, Fonarow GC, Goldberg LR, Guglin M, Josephson RA, Forman DE, et al. Cardiac rehabilitation for patients with heart failure. J Am Coll Cardiol. 2021;77:1454–69. Available from: https://pubmed.ncbi.nlm.nih.gov/33736829/
  22. Horwich TB, Fonarow GC. Prevention of heart failure. JAMA Cardiol. 2017;2:116. Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2590068
  23. Colin-Ramirez E, Sepehrvand N, Rathwell S, Ross H, Escobedo J, Macdonald P, et al. Sodium restriction in patients with heart failure: a systematic review and meta-analysis of randomized clinical trials. Circ Heart Fail. 2023;16. Available from: https://pubmed.ncbi.nlm.nih.gov/36373551/
  24. Chrysohoou C, Mantzouranis E, Dimitroglou Y, Mavroudis A, Tsioufis K. Fluid and salt balance and the role of nutrition in heart failure. Nutrients. 2022;14:1386. Available from: https://pubmed.ncbi.nlm.nih.gov/35405998/

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