Every year, Heart Failure Awareness Week serves as a crucial reminder that, while heart attacks often dominate headlines, heart failure remains a quieter chronic crisis affecting millions worldwide—and increasingly, in India.

Heart failure does not mean the heart has stopped working; rather, it indicates that the heart is unable to pump blood efficiently enough to meet the body’s needs. This inefficiency leads to symptoms such as breathlessness, fatigue, swelling, repeated hospitalisations, and, in many cases, premature death. Despite advancements in medicine, awareness about heart failure remains low, and its prevalence is a problem that India can no longer afford to overlook.

The Growing Burden in India

India is experiencing a cardiovascular epidemic. With rising rates of diabetes, hypertension, obesity, and coronary artery disease, the number of heart failure cases is climbing steadily. Estimates suggest that over 8 to 10 million Indians may be living with heart failure, many of whom remain undiagnosed.

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Unlike in Western countries, where heart failure typically affects older adults, Indian patients often develop the condition nearly a decade earlier. This trend means the disease impacts individuals during their most productive years, affecting families, workplaces, and the economy.

Late diagnoses exacerbate the challenge. Symptoms such as breathlessness and fatigue are often dismissed as mere “weakness” or “age-related.” Swelling in the legs is often treated symptomatically without investigating potential heart issues. By the time patients reach tertiary care centres, their condition may have already progressed significantly.

What Exactly Is Heart Failure?

Heart failure is a clinical syndrome characterised by the heart's inability to pump blood effectively. It usually develops following damage from:

  • Coronary artery disease or previous heart attacks
  • Long-standing high blood pressure
  • Diabetes
  • Valve disorders
  • Cardiomyopathy
  • Chronic kidney disease

There are two main types of heart failure:

1. Heart failure with reduced ejection fraction (HFrEF)—where the heart’s pumping ability is weakened.

2. Heart failure with preserved ejection fraction (HFpEF)—occurs when the heart pumps normally but becomes stiff and cannot fill properly.

Both types are serious and require lifelong management.

Warning Signs You Should Never Ignore

Heart failure symptoms often develop gradually and may include:

  • Shortness of breath during physical activity or while lying down
  • Persistent fatigue
  • Swelling in the feet, ankles, or abdomen
  • Rapid weight gain due to fluid retention
  • Frequent coughing or wheezing
  • Waking up breathless at night

If these symptoms persist for more than a few days, it is essential to seek medical evaluation. Early diagnosis can significantly improve outcomes.

What Is Heart Failure? (Image Credits: Canva)

Why Are Cases Rising?

India's rapid urbanisation has led to lifestyle changes that put extra strain on the heart, including:

  • Sedentary habits
  • Processed, high-salt diets
  • Increasing obesity rates
  • Tobacco use
  • Poor blood pressure control
  • Rising prevalence of diabetes

Additionally, limited routine screening in primary care means heart disease often goes undetected until complications arise. The COVID-19 pandemic has further exacerbated this issue, as viral infections, delayed hospital visits, and reduced follow-ups have contributed to the deterioration of cardiovascular health in many patients.

The Good News: Treatment Has Evolved

Medical science has made significant advancements, ensuring that heart failure is no longer a fatal condition. Modern management includes:

  • Guideline-directed medications that reduce mortality
  • Devices such as implantable cardioverter defibrillators (ICDs)
  • Cardiac resynchronisation therapy
  • Advanced therapies, including left ventricular assist devices (LVADs) and transplants in select cases
  • Structured cardiac rehabilitation programs

However, treatment is most effective when patients are diagnosed early and adhere strictly to their medication regimens and lifestyle modifications.

The Role of Lifestyle: Prevention Is Power

Prevention is India's most effective strategy against heart failure.

1. Control Blood Pressure - Hypertension is the most significant modifiable risk factor. Regular screening is crucial—even if you feel fine.

2. Manage Diabetes - Poorly controlled blood sugar accelerates heart damage. Maintaining strict glycemic control can reduce this risk.

3. Reduce Salt Intake - High salt consumption leads to fluid retention, putting additional strain on the heart.

4. Quit Tobacco - Smoking harms blood vessels and weakens the heart muscle.

5. Stay Physically Active - Engaging in at least 150 minutes of moderate activity each week is recommended.

6. Maintain a Healthy Weight - Obesity increases the workload on the heart and metabolic risks.

Early changes can prevent lifelong health issues.

The Human Cost: Beyond Statistics

Heart failure is not merely a medical diagnosis; it is a life-altering condition. Patients often face challenges such as

  • Frequent hospital admissions
  • Financial strain
  • Emotional distress
  • Loss of independence
  • Reduced quality of life

Caregivers also experience significant psychological and economic pressures. Therefore, awareness campaigns should emphasise not only medical management but also psychosocial support systems.

What Needs To Change In India?

Heart Failure Awareness Week should advocate for systemic changes:

  • Routine screening in primary care settings
  • Affordable access to essential heart medications
  • Public education campaigns in regional languages
  • Stronger referral systems
  • Integration of cardiac rehabilitation services
  • Expansion of insurance coverage for chronic cardiac care

India possesses world-class cardiology expertise, but gaps exist in access, affordability, and awareness.

Red Flags For Families

If a family member has:

  • A history of heart attacks
  • Long-standing hypertension
  • Diabetes
  • Chronic kidney disease

They should undergo periodic cardiac evaluations—even if they are asymptomatic. Screening tests may include:

  • ECG
  • Echocardiography
  • Blood tests, including BNP levels
  • Stress testing

Early detection can add years to life—and life to years.

A Call To Action This Awareness Week

This Heart Failure Awareness Week, let’s change the conversation:

  • From treatment to prevention
  • From late diagnosis to early detection
  • From stigma to support
  • From silence to conversation

Monitor your blood pressure. Have your blood sugar levels tested. Consult your doctor about your heart health. Encourage your parents to get screened. Raise awareness in your community.

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Your heart works tirelessly for you—every second, every day. It's time for us to show our hearts the same kindness.

When the heart weakens, everything slows down. But with awareness, action, and access to care, we can alter the course of heart failure in India.

And it starts now.

(Note: Dr (Prof) Sadhana Kala is a USA-trained robotic & laparoscopic surgeon, Uppsala University, Sweden, trained fertility specialist, Icon Endoscopic Surgeon of North India, and National Icon Endoscopic Surgeon of India. She is rated as India's Best Gynecologist by Google.)

(Disclaimer: The views expressed in this article are the personal opinions of the author.)