Heart Failure — NZ Condition Guide | KiwiMeds

What is Heart Failure?

Heart failure is a condition where the heart is not pumping blood effectively enough to meet the body’s needs. Despite the name, it does not mean the heart has stopped — it means the heart is struggling to do its job. Heart failure is a serious, chronic condition affecting around 60,000–70,000 New Zealanders, and is a leading cause of hospitalisation. With modern treatment, many people with heart failure can live well for many years.

Symptoms

Symptoms of heart failure include shortness of breath (particularly on exertion or when lying flat), fatigue and weakness, swelling in the legs, ankles, and feet (oedema), rapid or irregular heartbeat, reduced ability to exercise, persistent cough or wheezing (sometimes with frothy sputum), increased need to urinate at night, and sudden weight gain from fluid retention. Symptoms can worsen suddenly — a heart failure exacerbation — often triggered by missing medications, excess salt or fluid intake, infection, or uncontrolled blood pressure.

Causes and Risk Factors

The most common causes of heart failure are coronary artery disease (narrowed heart arteries, often causing heart attacks), high blood pressure (long-standing hypertension strains the heart), and cardiomyopathy (disease of the heart muscle). Other causes include valvular heart disease, diabetes, obesity, alcohol excess, and certain medications or toxins. Risk factors mirror those for cardiovascular disease generally.

Diagnosis

Heart failure is diagnosed with a clinical assessment, blood tests (including BNP or NT-proBNP — biomarkers that rise in heart failure), chest X-ray, ECG, and most importantly an echocardiogram (heart ultrasound that assesses how well the heart is pumping). A cardiologist is usually involved in diagnosis and management.

Treatment in New Zealand

Modern heart failure treatment is very effective. The cornerstone medications for heart failure with reduced ejection fraction (HFrEF) — the most common type — are ACE inhibitors or ARBs (lisinopril, ramipril, candesartan), beta-blockers (carvedilol, bisoprolol, metoprolol), and SGLT2 inhibitors (empagliflozin, dapagliflozin — now funded by Pharmac and shown to reduce hospitalisations and mortality). Diuretics (furosemide) reduce fluid overload and symptoms. A specialised heart failure nurse or outpatient clinic is available at most NZ hospitals.

NZ-Specific Information

The Heart Foundation of New Zealand provides heart failure resources including a Heart Failure Diary to help people monitor symptoms and know when to seek help. SGLT2 inhibitors (dapagliflozin, empagliflozin) are now Pharmac-funded for heart failure — a major advance in treatment. Cardiac rehabilitation programmes are available through Te Whatu Ora.

Frequently Asked Questions

Is heart failure curable? In some cases (e.g. due to a reversible cause), heart function can improve significantly. For most people it is a chronic condition managed long-term. Should I restrict fluids? For some people with severe heart failure, fluid restriction is recommended. Your specialist will advise. Can I exercise with heart failure? Yes — supervised exercise (cardiac rehabilitation) improves symptoms and outcomes in stable heart failure.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Coenzyme Q10 (CoQ10) — The Q-SYMBIO trial demonstrated that CoQ10 supplementation (300 mg/day) significantly reduced major cardiovascular events, hospitalisation, and mortality over 2 years. CoQ10 supports mitochondrial energy production in myocardial cells and is among the best-evidenced supplements in heart failure.
• Omega-3 Fatty Acids — The GISSI-HF trial demonstrated that 1 g/day of omega-3 fatty acids reduced all-cause mortality and cardiovascular hospitalisations in chronic heart failure. Omega-3s reduce arrhythmia risk and provide anti-inflammatory cardiovascular benefit.
• Vitamin D — Vitamin D deficiency is prevalent in heart failure and independently associated with worse outcomes. Supplementation is warranted where deficiency is confirmed, supporting cardiac remodelling via calcium-handling and inflammatory pathway modulation.
• Magnesium — Loop diuretics commonly used in heart failure can deplete magnesium. Deficiency promotes arrhythmias and worsens cardiac function. Supplementation under medical supervision, guided by serum magnesium levels, is appropriate.
• Thiamine (Vitamin B1) — Loop diuretics increase urinary thiamine excretion. Thiamine deficiency can cause cardiac dysfunction (wet beriberi). Supplementation at 100–300 mg/day may improve cardiac function in those on long-term furosemide therapy.

Relevant Vaccinations

Individuals living with heart failure may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Influenza is a major precipitant of acute decompensated heart failure and hospitalisation. Annual vaccination is strongly recommended and funded for people with cardiac conditions.
• Pneumococcal — Pneumonia is a frequent and dangerous complication in heart failure. Pneumococcal vaccination is recommended and funded.
• COVID-19 — Heart failure is among the highest-risk conditions for severe COVID-19 outcomes. Maintaining up-to-date COVID-19 vaccination including booster doses is strongly recommended.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of heart failure. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Sodium restriction (≤2000 mg sodium/day) — Sodium restriction is foundational in heart failure management, reducing fluid retention and risk of acute decompensation. Avoid added salt and processed foods, and check food labels for sodium content.
• Oily fish — Provides omega-3 fatty acids with proven cardiovascular benefit in heart failure (GISSI-HF evidence). Aim for 2–3 servings per week.
• Potassium-rich foods (under medical guidance) — Potassium balance is critical in heart failure as multiple medications affect potassium levels. Dietary management requires individualised medical guidance — do not self-supplement without advice.
• Limit: alcohol — Alcohol is directly cardiotoxic. Even moderate consumption can worsen heart failure symptoms. Complete abstinence is recommended in alcohol-related cardiomyopathy.
• Fluid restriction (if advised by cardiologist) — In advanced heart failure with fluid overload, daily fluid restriction (typically 1.5–2 litres) may be prescribed. Always follow your cardiologist’s specific guidance.

Related Conditions & Medications

Related medications: Metoprolol. Related conditions: Hypertension, Atrial Fibrillation.