Heart Failure Care Staff Guide: Symptoms, Medicines and Monitoring

Heart failure means the heart cannot pump blood around the body as well as it should. It does not mean the heart has stopped, and it is not the same as a heart attack. For care staff, the practical point is that heart failure is a long-term condition. It can stay stable for years, but it can also change quickly, and noticing small changes early is one of the most useful things a care worker can do.

This guide explains what heart failure is, the symptoms to watch for, when to escalate, how the main medicines work, and what good day-to-day support looks like. It is written for care staff and is not a substitute for the advice of a resident's GP, specialist nurse or cardiology team.

What heart failure is, and who is affected

According to the NHS, heart failure happens when the heart struggles to pump blood properly. It can start suddenly, for example after a heart attack or an infection, or develop gradually because of long-term strain from conditions such as high blood pressure or coronary heart disease. Other causes listed by the NHS include heart valve disease, cardiomyopathy, heart rhythm problems, chronic kidney disease, anaemia and thyroid problems.

The NHS lists people aged 65 and over, people with overweight or obesity, smokers and heavy drinkers among those at higher risk. That is why heart failure is common among older people in care homes and often sits alongside other conditions such as lung disease, diabetes and kidney disease. Reading a resident's care plan as a whole, rather than one condition at a time, matters here.

Symptoms care staff should recognise

The NHS describes the main symptoms of heart failure as:

• breathlessness during everyday activity, or when lying down
• feeling weak, light-headed or very tired, especially after activity
• swelling in the feet, ankles, legs or tummy, or a bloated feeling
• sudden weight gain
• a cough at night, which can include frothy pink phlegm

Symptoms vary from day to day. A resident who needs an extra pillow to sleep, who is newly out of breath on the way to the dining room, or whose shoes suddenly feel tight may be showing early signs of fluid building up. These are easy to put down to ageing, so it helps to compare with the resident's own normal rather than a general standard.

When to escalate

The NHS gives clear guidance on how quickly to act:

• Call 999 for severe difficulty breathing, pale, blue or grey lips or skin, or if someone has passed out and is not responding normally.
• Get an urgent GP appointment or call NHS 111 for breathlessness when lying down or with everyday activity, frothy pink phlegm, or sudden weight gain.
• Arrange a routine GP review for any other possible symptoms of heart failure.

Record what you saw, when it started, and what is different from the resident's usual pattern. A calm, specific handover such as "more breathless than yesterday, ankles swollen since this morning, needed two pillows overnight" helps clinicians far more than "not herself today". Use the home's escalation process and follow any advance care plan.

How heart failure is diagnosed

The NHS explains that diagnosis usually involves blood and urine tests, an ECG, and scans such as a chest X-ray or an echocardiogram. Lung function tests may also be used, and the person is usually referred to a cardiologist. Care staff may be asked to help residents attend appointments and to pass on accurate information about symptoms between visits.

Medicines used to treat heart failure

There is no cure, but medicines can control symptoms and slow the condition. The NHS names diuretics such as furosemide, which help the body get rid of extra fluid, medicines such as candesartan or enalapril that widen blood vessels, and beta blockers that slow the heart. NICE guidance on chronic heart failure (NG106) recommends an ACE inhibitor, a beta-blocker and a mineralocorticoid receptor antagonist as first-line treatment for heart failure with reduced ejection fraction, with an SGLT2 inhibitor alongside.

What this means for care staff:

• Give medicines exactly as prescribed and record them accurately. Never stop or skip a heart failure medicine without advice, even if a resident seems well.
• Know that diuretics increase the need to pass urine. Support access to the toilet, particularly in the morning, and be aware of the link with falls and continence.
• Be alert to dizziness or light-headedness after a dose is started or increased, and report it. Our guide to postural hypotension explains how to spot and manage blood pressure drops on standing.
• Remember that NICE advises blood tests to check kidney function and electrolytes after starting or increasing certain heart failure medicines, so make sure appointments for these are not missed.

Residents with heart failure often take many tablets. Regular medicines reviews are part of good care, and our guide to polypharmacy and deprescribing covers what to look for.

Fluid, salt and diet

Many people assume everyone with heart failure must restrict fluids and salt. NICE says clinicians should not routinely advise people with heart failure to restrict their sodium or fluid intake, but individual advice from the heart failure team may differ. If a resident has a specific fluid or salt plan, it should be written in the care plan and followed exactly. NICE also advises people to avoid potassium-containing salt substitutes.

Daily weights, observations and recording

The NHS advises people with heart failure to weigh themselves regularly, because sudden weight gain can signal fluid retention. Where a resident's care plan includes regular weights, weigh at the same time of day, on the same scales, in similar clothing, and record the result every time. Report sudden gains straight away using the threshold set by the resident's heart failure team. Do not guess a threshold.

Staying active, vaccinations and rehabilitation

The NHS says everyone diagnosed with heart failure should be offered cardiac rehabilitation, which covers safe exercise, lifestyle guidance and support. NICE recommends a personalised, exercise-based programme with a psychological and educational component. Within the home, encourage movement that suits the resident, allow rest between activities, and watch for breathlessness that does not settle quickly.

NICE also recommends an annual influenza vaccination and a one-off pneumococcal vaccination for people with heart failure. Our guide to flu vaccination and immunisation programmes explains how care homes can support uptake. Chest infections can quickly make heart failure worse, and residents who also have lung disease will benefit from the approach in our COPD respiratory care guide.

Emotional wellbeing and planning ahead

Living with a condition that causes tiredness and breathlessness can be frightening and isolating. Notice low mood and anxiety, and raise them with the GP. The NHS notes that palliative care can be offered at any stage for symptom control and support, and NICE recommends that people with heart failure have access to professionals with palliative care skills. Conversations about preferences and future care should be sensitive and led by the resident's wishes.

Frequently asked questions

Is heart failure the same as a heart attack?

No. A heart attack is a sudden blockage of blood supply to the heart. Heart failure is a long-term condition where the heart does not pump effectively, although a heart attack can cause it.

Can someone with heart failure still go out and be active?

Often yes. The NHS encourages staying active and says cardiac rehabilitation should be offered. Activity should be matched to the individual and agreed with their clinicians.

What should I do if a resident's breathing suddenly gets worse?

Follow the NHS guidance above: severe breathing difficulty or blue, grey or pale lips and skin needs a 999 call. Stay with the resident, keep them as comfortable as possible and follow any emergency plan.

Building your knowledge

Understanding long-term conditions helps care staff spot problems early and communicate clearly with clinicians. Browse our CPD resources for care staff to keep your knowledge current. This article draws on the NHS heart failure information (reviewed June 2026) and NICE guideline NG106.