Feature Report

Why is heart failure a forgotten condition?

People may have heard of HF, but most people do not know what it is. Public awareness of HF is poor compared to other heart diseases. Even if people have heard of HF, many may confuse it with a heart attack and few people are aware of the 3 ‘red flag’ symptoms of: breathlessness, fatigue and swelling of the ankles.

A fundamental issue with HF also lies in its name: in the minds of many people, ‘failure’ implies death or irreversibility – a ‘lost cause’.

HF is not an illness in itself, but a condition that often results from other illnesses. As a result, many people may not recognise that HF is amenable to treatment – when in fact appropriate treatment for HF makes a huge difference to patient outcomes.

The fact that HF occurs mainly in the older population may also explain part of our neglect for the condition. Surveys have shown that many people may not recognise symptoms or signs of HF until it has reached a severe stage,1 or they may mistake symptoms as being the natural result of ageing. They may prefer to “suffer in silence” instead of drawing attention to their suffering and becoming a potential burden for their families. Many may also lack the knowledge, confidence and support to self-care and live with HF.2

Compared to other cardiovascular diseases, data on the incidence of, and mortality from, HF are limited. Generally, there are very few reliable and up-to-date estimates of the number of people affected by, or dying from, HF. For example, HF does not feature in the European Cardiovascular Statistics or in the Global Burden of Disease studies co-sponsored by the World Health Organisation.

A complicating factor is that some countries’ guidance on death certificates states that HF is a mode of death, which can discourage doctors from recording it as the cause of death.3 As a result, the recorded number of deaths attributed to HF may be underestimated. Often, the cause of death may be recorded as the underlying illness that caused HF to develop, rather than HF itself.4

  • Ponikowski P, Anker S, AlHabib K, et al. Heart failure: preventing disease and death worldwide. : European Society of Cardiology., 2014.

  • Remme WJ, McMurray JJ, Rauch B, et al. Public awareness of heart failure in Europe: first results from SHAPE. European heart journal 2005;26(22):2413-21.

  • Sutherland K. Bridging the quality gap: Heart failure.: The Health Foundation 2010.

  • Sutherland K. Bridging the quality gap: Heart failure.: The Health Foundation 2010.