How much salt should I eat with heart failure?

Most guidelines recommend limiting sodium to around 2 g per day (equivalent to about 5 g of table salt). This means avoiding added salt at the table and in cooking, and limiting processed, packaged, and fast foods which are the largest sources of dietary sodium. Your dietitian or care team can provide personalised targets.

Do I need to restrict fluids with heart failure?

Not everyone with heart failure needs to restrict fluid intake. Fluid restriction (typically 1.5–2 litres per day) is generally recommended during periods of instability or in advanced disease. Your care team will advise you. Restricting salt is more universally important than restricting fluid.

Should I get a flu vaccine with heart failure?

Yes. Annual influenza vaccination is strongly recommended for people with heart failure. Respiratory infections are a common trigger for decompensation and hospitalisation. The pneumococcal vaccine is also recommended. Discuss your vaccination schedule with your GP.

Can I travel with heart failure?

Many people with stable heart failure travel safely, including by air. Long flights carry risks of fluid retention, deep vein thrombosis, and limited access to medical care. Plan ahead: carry a medicines list, ensure adequate supply of medicines, discuss flying with your cardiologist, and know the location of medical facilities at your destination.

What should I do if I feel depressed or anxious about my heart failure?

Depression and anxiety are common in heart failure and significantly worsen outcomes if left untreated. Tell your GP or cardiologist if you feel persistently low, hopeless, worried, or are struggling to cope. Effective treatments are available including talking therapies and, where appropriate, medication. Cardiac rehabilitation programmes also address mental health as part of comprehensive recovery.

Living With Heart Failure: Daily Care, Medicines, and Monitoring

Living with heart failure means making some changes to daily habits — but for most people, it also means remaining active, engaged, and enjoying life. The foundation of good heart failure management is understanding your condition, taking your medicines reliably, monitoring your symptoms, and knowing when to seek help.

This guide covers the practical, day-to-day side of living well with heart failure.

Your Medicines: Why They Matter

Heart failure medicines are not just for symptom relief — they change the course of the disease, reduce hospitalisation, and improve survival.

Take your medicines every day

Missing doses, even occasionally, can destabilise heart failure quickly. Common reasons people stop medicines — such as side effects, cost, or feeling better — should always be discussed with your care team rather than acting alone.

Do not stop any heart failure medicine without medical advice. Stopping beta blockers or ACE inhibitors abruptly can cause rebound effects.

Common heart failure medicines

Medicine class	Examples	What they do
ACE inhibitors / ARBs	Ramipril, perindopril, candesartan	Reduce workload; protect heart and kidneys
ARNI	Sacubitril/valsartan (Entresto)	More effective than ACE inhibitors in HFrEF
Beta blockers	Bisoprolol, carvedilol, metoprolol	Slow heart rate; reduce workload
MRA	Spironolactone, eplerenone	Reduce fluid, protect heart muscle
SGLT2 inhibitors	Dapagliflozin, empagliflozin	Reduce hospitalisations; benefits in both HFrEF and HFpEF
Diuretics	Furosemide (frusemide), bumetanide	Remove excess fluid; relieve breathlessness and swelling

Side effects to watch for

ACE inhibitors: persistent dry cough (switch to ARB if troublesome), low blood pressure
Beta blockers: fatigue (usually improves), cold hands and feet, dizziness
MRA (spironolactone): raised potassium — requires regular blood tests; gynaecomastia in men
SGLT2 inhibitors: genital thrush (common, manageable), urinary tract infections
Diuretics: low potassium, low sodium, dizziness, dehydration — all require monitoring

Always tell your care team about any new side effect rather than stopping medicine yourself.

Medicines to avoid

Certain medicines can worsen heart failure. Without specific medical advice:

Avoid NSAIDs (ibuprofen, naproxen, diclofenac) — promote fluid retention and reduce kidney function
Avoid verapamil and diltiazem in HFrEF — can reduce heart contractility
Avoid thiazolidinediones (glitazones) used in diabetes — cause fluid retention
Check all medicines — including over-the-counter, herbal, and supplements — with your pharmacist or care team

Carry a medicines list

Keep an up-to-date list of all your medicines, doses, and the conditions they are prescribed for. Carry it in your wallet and have it available at every medical appointment and in any emergency.

Daily Weight Monitoring

Weighing yourself every morning is one of the most important tools you have to detect early fluid build-up before symptoms worsen.

The routine:

Every morning, after your first toilet visit, before eating or drinking
Same time, same scales, same clothing (or no clothing)
On a hard floor, not carpet
Record the result in a diary or phone app

Responding to changes:

Stable weight → continue current plan
1–2 kg gain over 2–3 days → reduce salt intake, reduce fluid, contact your heart failure nurse
2 kg gain in 24–48 hours → contact GP or heart failure nurse the same day
Rapid weight gain with worsening breathlessness → call 000

See the full guide: Heart Failure Warning Signs: When Symptoms Need Urgent Care

Salt and Fluid Management

Reducing salt (sodium)

Excess sodium causes fluid retention — worsening swelling and breathlessness. Most guidelines suggest limiting sodium intake to around 2 g per day (about 5 g of table salt).

Practical steps:

Remove the salt shaker from the table
Avoid adding salt in cooking where possible
Read food labels — sodium content on Australian labels is per 100 g; look for less than 120 mg per 100 g
Limit processed meats (ham, salami, sausages), canned soups and sauces, takeaway food, bread, cheese, and crackers — the largest sources of hidden sodium in the Australian diet
Use herbs, lemon, and spices instead of salt for flavour

Fluid intake

Fluid restriction is not needed by everyone — ask your care team whether it applies to you
When fluid restriction is recommended, a typical target is 1.5–2 litres per day (counting all fluids: water, tea, coffee, soup, ice cream)
Reduce fluid intake on hot days or when constipation occurs cautiously — discuss with your team

Exercise and Physical Activity

Why exercise matters

Exercise is one of the most evidence-based interventions in heart failure. Regular, moderate exercise:

Improves breathing capacity and exercise tolerance
Reduces breathlessness and fatigue at a given workload
Reduces hospital admissions
Improves mood, anxiety, and quality of life
Does not worsen heart failure when done safely

How much exercise

For stable heart failure, guidelines recommend building gradually towards:

At least 150 minutes of moderate-intensity aerobic activity per week
Examples: walking, swimming, cycling (stationary bike)
Start low, go slow — begin at a level that is comfortable and increase gradually
Aim to reach a level where you can speak in sentences but feel some effort (rate of perceived exertion 3–5 out of 10)

Warning signs to stop exercising and seek help:

Sudden worsening breathlessness
Chest pain or pressure
Dizziness or near-fainting
Rapid pounding heartbeat

Cardiac rehabilitation for heart failure

Cardiac rehabilitation programmes specifically designed for heart failure include supervised exercise, education about medicines and self-management, nutrition advice, and psychological support. They are available across most of Australia.

Ask your cardiologist or GP for a referral. Evidence shows cardiac rehab reduces hospitalisations and improves quality of life significantly.

See: Cardiac Rehabilitation — What It Is and Why It Matters

Vaccinations

People with heart failure are at high risk of complications from respiratory infections. Recommended vaccinations include:

Influenza (flu) — annually every year, ideally before winter
Pneumococcal — recommended for adults with heart failure; ask your GP about the current recommended schedule
COVID-19 — as per current Australian national guidelines
Respiratory syncytial virus (RSV) — available for older adults; discuss with your GP

Respiratory infections are a leading trigger for heart failure decompensation and hospitalisation. Vaccination significantly reduces this risk.

Sleep and Sleep Apnoea

Sleep and heart failure

Poor sleep is common in heart failure due to:

Orthopnoea (breathlessness lying flat)
Paroxysmal nocturnal dyspnoea (waking breathless)
Nocturia (frequent need to urinate overnight due to fluid redistribution)
Sleep apnoea

Elevating the head of the bed or using more pillows can reduce orthopnoea.

Obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is very common in people with heart failure and worsens cardiac function. Symptoms include loud snoring, waking unrefreshed, and daytime sleepiness. If you have these symptoms, ask your GP for a sleep study assessment.

Treating sleep apnoea with CPAP may improve heart failure outcomes and quality of life.

Mental Health: Depression and Anxiety

Depression and anxiety affect approximately one in three people with heart failure and are associated with significantly worse outcomes, more hospital admissions, and reduced quality of life.

Common experiences

Persistent low mood or sadness
Worry or anxiety about symptoms, the future, or dying
Reduced motivation to take medicines or exercise
Social withdrawal
Difficulty concentrating

What to do

Tell your GP or cardiologist if you are struggling with your mood or anxiety — these are genuine medical issues, not weaknesses
Effective treatments include psychological therapies (CBT), support groups, and sometimes antidepressants (some are safer than others in heart failure — your doctor will advise)
Cardiac rehabilitation addresses mental health alongside physical health
Heart Foundation Australia provides peer support and resources

Kidney Monitoring

The heart and kidneys are closely interdependent. Worsening heart failure reduces blood flow to the kidneys; worsening kidney function makes heart failure harder to manage. This relationship is called cardiorenal syndrome.

Regular blood tests to monitor kidney function (eGFR, creatinine) and electrolytes (potassium, sodium) are important because:

Diuretics can reduce potassium (hypokalaemia) or, in high doses, impair kidney function
ACE inhibitors and MRAs can raise potassium (hyperkalaemia)
SGLT2 inhibitors and MRAs both affect kidney function in ways that need monitoring

Blood tests are typically done:

After starting or changing medicines
Every 6–12 months when stable
During any acute illness

Ask your GP how often you need your blood tests. Do not skip them.

See: What Is Chronic Kidney Disease?

Travel With Heart Failure

Many people with stable heart failure travel safely, including internationally. Planning ahead is essential.

Before you travel

Discuss your plans with your cardiologist or GP
Ensure you have enough medicine supply for the full trip, plus extra
Carry a written medicines list and a brief medical summary
Know the location of hospitals or cardiac facilities at your destination
Consider travel insurance that covers pre-existing conditions — heart failure must be declared

Long-haul flights

Remain well hydrated (water, not alcohol)
Move your legs regularly, wear compression stockings to reduce DVT risk
Fluid may accumulate during long flights — avoid excess salt in airline food
Pressurised cabin oxygen levels are slightly lower than sea level; most people with stable heart failure tolerate this well

Hot climates

Heat causes fluid shifts and vasodilation, which can worsen hypotension on heart failure medicines
Avoid excessive sun and heat exposure
Maintain hydration but within your recommended fluid limits
Monitor weight more carefully in hot weather

Care Planning and Palliative Care

Heart failure is a progressive condition. Conversations about future care preferences — while you are well — are important and empowering, not defeatist.

Advance care planning

An advance care directive records your wishes about treatment if you cannot speak for yourself
This includes decisions about resuscitation, implantable defibrillator (ICD) deactivation if implanted, and hospitalisation preferences
These discussions can be had with your GP, cardiologist, or a palliative care team

Palliative care

Palliative care is about quality of life and comfort — it is not only for the final stage of illness. It can be integrated early in heart failure management to:

Manage breathlessness, fatigue, and pain
Support psychological and spiritual wellbeing
Assist with care planning
Support family and carers

Palliative care and active cardiac treatment can occur simultaneously. See: Palliative Care — Guide Hub

Regular Reviews and Who Looks After You

People with heart failure typically see a team:

GP — coordinates overall care, manages medicines, does routine blood tests
Cardiologist — specialist review of echocardiogram, device management, and complex medicine decisions
Heart failure nurse — often the most accessible point of contact for day-to-day questions and symptom management
Pharmacist — medicines checks, adherence support
Dietitian — salt and fluid advice
Physiotherapist or exercise physiologist — cardiac rehabilitation

If you do not have a heart failure nurse as part of your care, ask your cardiologist to refer you. Access to a heart failure nurse is associated with reduced hospitalisation.

FAQ

Q: How often should I see my cardiologist? This depends on your severity and stability. Most people with heart failure are reviewed 3–6 monthly by their cardiologist and more frequently by their GP or heart failure nurse. After a hospitalisation, earlier follow-up (within 1–2 weeks) reduces readmission risk significantly.

Q: Can I drink alcohol with heart failure? Alcohol weakens the heart muscle and can worsen heart failure. If alcohol caused or contributed to your heart failure, abstinence is strongly recommended. For others, low levels of alcohol may be acceptable — discuss with your care team. Excessive alcohol is never appropriate with heart failure.

Q: What if I have both diabetes and heart failure? Both conditions worsen each other. SGLT2 inhibitors benefit both simultaneously. Target HbA1c levels and blood pressure control are particularly important. Avoid thiazolidinediones (glitazones) which worsen fluid retention. Close coordination between your endocrinologist, GP, and cardiologist is important.

Q: Is heart failure a terminal diagnosis? Heart failure is serious, but many people live with it for years or decades. Modern treatment has dramatically improved survival and quality of life. Advanced heart failure does have significant mortality, but trajectory varies enormously between individuals. Speak with your cardiologist for a personalised assessment.