What Comes Next: Heart Failure
Making Sense of Your Diagnosis
Reviewed by the Columbia Structural Heart and Valve Center Faculty, November 2025
Being diagnosed with heart failure (HF) can feel overwhelming at first. You want to know how serious it is, what treatments are available, and what it means for your future. You’re not alone: HF is one of the most common and treatable heart conditions, and new therapies have improved both quality of life and long-term survival.
Our What Comes Next series is designed to answer common questions and help you feel informed and supported as you take the next steps in your care.
I’ve Been Diagnosed with Heart Failure. How Serious Is It?
HF is a serious medical condition that requires careful management. Without proper treatment, HF is a life-threatening condition.
Will My Heart Just Stop Beating?
HF doesn’t mean your heart has stopped working - it means your heart isn’t pumping blood as effectively as it should.
There are two main types:
- HF with preserved ejection fraction (HfpEF): the heart pumps normally but is stiff and doesn’t fill properly.
- HF with reduced ejection fraction (HfrEF): the heart’s pumping strength is weaker than normal.
HF can also affect the right ventricle, which pumps blood to the lungs, the left ventricle, which pumps blood to the rest of the body, or to both ventricles. Which side is affected will lead to different symptoms and risks.
Overall, severity depends on how much your heart function is affected and whether you experience symptoms such as shortness of breath, swelling, or fatigue. Many people live full, active lives for years with the right treatment and follow-up.
What Causes Heart Failure?
HF can develop for many reasons, including:
- Coronary artery disease or a previous heart attack
- Heart valve disease
- Genetic cardiomyopathy (weakened heart muscle)
- Diabetes or obesity
- High blood pressure (hypertension)
- Irregular heart rhythms (atrial fibrillation)
Sometimes, multiple factors contribute. Treating the underlying cause is key to protecting your heart and preventing progression.
I Feel Fine. Why Should I Be Concerned?
Even if you feel okay, it’s crucial to stay on top of your care. HF can be stable for long periods and then worsen if you skip medications or develop another illness.
Common symptoms to watch for include:
- Shortness of breath with exertion or when lying flat
- Swelling in your ankles, legs, or abdomen
- Sudden weight gain
- Fatigue or low energy
- Coughing or wheezing at night
Report any changes as soon as you notice them. Quick adjustments in treatment can often prevent things from getting worse.
Will I Need a Procedure or a Device?
Not everyone does. Most people start with medications and lifestyle changes. If your heart remains weak despite optimal medical therapy, your cardiologist might discuss:
- Implantable cardioverter-defibrillator (ICD): prevents dangerous heart rhythms
- Cardiac resynchronization therapy (CRT): coordinates how the heart’s chambers beat
- Transcatheter edge-to-edge repair (TEER): resolves leakiness of one of the heart valves that can contributed to HF
- Left ventricular assist device (LVAD): for advanced cases when other options aren’t enough
Will I Need a Heart Transplant?
Only a very small number of patients ever need a heart transplant - usually those with advanced HF that doesn’t improve despite every other form of treatment.
Before that stage, there are many effective options to strengthen your heart, manage symptoms, and improve quality of life.
If a transplant does become necessary, your cardiology team will help you through every step of the evaluation process.
Modern transplant outcomes are excellent - most patients live 10 years or more after transplant, and many return to active, fulfilling lives.
What Are My Treatment Options?
HF is one of the biggest success stories in modern cardiology. Today’s treatments can improve both symptoms and survival. Options may include:
- Medications, such as:
- Beta-blockers
- Angiotensin receptor-neprilysin inhibitor (ARNI)
- Sodium-Glucose Cotransporter 2 inhibitors
- Mineralocorticoid receptor blockers
- Diuretics (“water pills”) to relieve fluid buildup
- Lifestyle changes like limiting salt, staying active, and avoiding alcohol or tobacco
- Monitoring programs at home or through remote sensors to track your heart function
Your care team will combine these to help your heart work as efficiently as possible.
Can Medications Cure Heart Failure?
There’s no complete cure for HF, but medications can reverse some of the damage and help your heart heal.
Many patients experience an improvement in their ejection fraction and heart function with consistent therapy. Some even return to normal heart function if treatment begins early and causes are corrected.
How Will I Know If It’s Getting Worse?
Your cardiologist will monitor your condition with echocardiograms, blood tests, and regular visits. You should also track:
- Daily weight changes
- New or worsening shortness of breath
- Increased swelling or fatigue
Keeping a symptom and weight diary can help your care team make timely adjustments to your medication.
Will I Feel Better After Treatment?
Yes. Most patients notice improvements in breathing, energy, and exercise tolerance within weeks to months of starting therapy. The earlier HF is treated, the better your heart can recover and the stronger you’ll feel.
Will Treatment Help Me Live Longer?
Absolutely. Modern HF therapies have dramatically improved life expectancy and symptom management compared with past decades. The combination of medications, close monitoring, and healthy habits can help you live longer, stay active, and feel better.
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