Doctors are telling patients they’re obese, asthmatic or anaemic… really it could be a heart condition with a worse survival rate than many cancers – and people are missing out on a life-saving four-drug combination

Katie Denial was walking to her car after a family funeral when she suddenly became so breathless she had to lie down in the street, literally gasping for air.

When she saw her GP a few days later, she was told that the 20-minute episode was most likely a panic attack.

Over the following weeks Katie, then 24, became increasingly breathless and exhausted, so returned to her GP.

This time she was told she had a chest infection and was prescribed antibiotics. When those didn’t work, she was told she had asthma and given inhalers.

When she failed to respond to these, her GP said she was just unfit and depressed and prescribed antidepressants. Yet none of this tallied with her symptoms, she says.

‘I was being sent home from work as I was too sick and out of breath to cope,’ says Katie, a former children’s support worker from Sheffield.

She was also now having to sleep upright as lying down made her gasp for air. ‘It felt like I was drowning,’ she says. ‘Yet my doctor told me it was all in my head.’

There were other changes: in the space of a few months Katie gained 6st, despite going to Slimming World every week. One GP told her she would feel better if she lost some weight. ‘I told them, “I really am trying”,’ she says.

It was a year after her symptoms began – by which time Katie was too ill to climb the stairs – that her mum came over one day to find she had suddenly turned yellow.

Katie called 111 and when the call handler heard her struggling to breathe, she instantly despatched an ambulance. Hospital tests then revealed the true cause of Katie’s problems: she had heart failure, meaning her heart was too weak to pump enough blood around her body.

Katie’s breathlessness, sudden weight gain and trouble lying down were textbook symptoms, while her yellow skin was a sign that her liver was also being affected.

Often thought of as a condition that affects older people, in fact heart failure can affect any age – as a result of viral infections such as colds and flu, or during pregnancy, for example.

And without treatment the effects can be catastrophic.

The muscles and brain are slowly starved of oxygen, causing fatigue and dizziness. As the blood isn’t being pumped with force, it backs up in the veins, pushing fluid out into tissues – which can lead to sudden swelling in the legs, ankles and abdomen.

Fluid may also accumulate in the lungs, which may lead to a persistent cough and make it difficult to breathe, especially when lying down.

There are around a million people in the UK living with heart failure – it is both debilitating and dangerous: heart failure has a worse five-year prognosis than common cancers, such as breast and prostate.

 Yet delays in diagnosis are common, with symptoms often mistaken for being unfit or for conditions such as asthma, anxiety, obesity and anaemia.

Some of those affected assume it’s simply a sign of getting older, says Clare Taylor, a GP and a professor of general practice at the University of Birmingham.

As a result, most patients aren’t diagnosed until they’re seriously ill in hospital.

‘About 60 per cent of people get the diagnosis when they’re so sick they end up in A&E,’ says Professor Mark Petrie, a consultant cardiologist at Glasgow Royal Infirmary.

Patients diagnosed after being admitted to hospital are two-and-a-half times more at risk of dying in the year after that compared with those diagnosed earlier, according to a 2025 study in The Lancet Primary Care.

‘Mortality rates are higher for heart failure than they are for any cancer apart from lung cancer,’ says Professor Petrie. ‘And the quality of life is worse as well.’

The tragedy is that, whereas once there was little hope for those with heart failure, now in many cases there are effective treatments that don’t just improve symptoms but also help improve the strength of the heart.

However, new figures from the NHS National Heart Failure Audit reveal that few patients are given them.

This lack of access to suitable drugs – together with the delays in diagnosis – means heart failure continues to be lethal for many when it doesn’t need to be.

Now, campaign groups are calling for better awareness of the signs to ensure people are diagnosed quicker and get access to better care.

Heart failure becomes more common with age and typically occurs following a heart attack, as the heart then has to work harder to make up for the damage caused. The strain can lead the heart walls to thicken, which means that it doesn’t pump as effectively.

Yet around 100,000 people in the UK aged under 50 are living with heart failure – and the numbers are growing, according to a study in the European Journal of Preventive Cardiology in 2022. In fact, cases more than doubled among 16 to 50-year-olds between 1998 and 2017.

This is thought to be because of increased rates of obesity, type 2 diabetes and high blood pressure in this age group – which force the heart to work harder and the heart walls to thicken.

But in younger people, heart failure can also occur owing to conditions such as dilated cardiomyopathy, which causes the main beating chamber of the heart to stretch and become floppy. It can be genetic (as in Katie’s case) but can also occur following a virus and is linked to pregnancy. The impact can be life-changing.

By the time Katie was taken into hospital, her heart was working at a fraction of what it should be and her lungs were so full of fluid they stopped working. Doctors drained 32 litres of fluid from them.

She also had multiple blood clots because blood was pooling rather than circulating around her body. The risk of a cardiac arrest was so high a crash team followed her around with defibrillators whenever she moved from her bed.

‘The cardiologist told my mum that if I went into cardiac arrest, the chances of me surviving were very slim,’ says Katie. Her body was so starved of oxygen that for three weeks she had to wear a BiPAP hood, a clear helmet that pumped oxygen into her lungs, night and day.

The gold-standard treatment for the most common form of heart failure (known as heart failure with reduced ejection fraction, or HFrEF – where the heart is too weak to pump properly) is a cocktail of four drugs.

The treatment is known as the ‘four pillars’ – with beta blockers to steady the heart; ACE inhibitors to relax the blood vessels, so the heart has less pressure to pump against); mineralocorticoid receptor antagonists (MRAs) to stop fluid retention by preventing the body holding on to salt and water; and SGLT2 inhibitors, which make the kidneys flush out excess sugar, salt and fluid.

The combination eases the strain on the heart so much that in some patients it recovers enough to pump normally again.

It can halve the risk of dying, according to a 2024 study in the journal npj Cardiovascular Health, and can cut hospital admissions by about 70 per cent, says Professor Petrie.

When Katie was diagnosed, her heart was pumping at just 17 per cent of its normal rate.

Initially, she was put on the first three drugs – but when she was given the final drug in 2021, her heart pumping rate climbed to 54 per cent.

‘Compared to what it was, it’s improved by leaps and bounds,’ she says.

Despite the startling improvement these drugs can make, the recently published National Heart Failure Audit found that only 50 per cent of hospital patients with HFrEF, the weak-pump type of heart failure Katie had, were discharged on all four drugs.

Only one hospital in England and Wales hit the target for sending 90 per cent of eligible patients home on them. In one area it was 17 per cent.

Only a third of hospitals hit the prescribing target for the newest drugs, SGLT2 inhibitors.

Meanwhile, the prescribing of MRAs was so poor the audit called it ‘unacceptably low’.

Patients over the age of 65 lost out most. They were more likely to be left solely on diuretics – water tablets – which flush out the excess fluid, so they ease the breathlessness and swelling, but don’t help the heart to strengthen.

Those with a form of heart failure where the muscle grows too stiff to fill properly between beats (heart failure with preserved ejection fraction, or HFpEF), which accounts for around 40 per cent of cases, are not suitable for the four-drug package.

But one of the newer SGLT2 drugs, dapagliflozin, cuts the risk of worsening symptoms and death by 18 per cent, according to research in the New England Journal of Medicine in 2022.

But access to this drug is also patchy. The NHS audit found that just 51 per cent of hospital patients with this form of heart failure were given an SGLT2 inhibitor.

Experts say that even those who do get the right drugs often get too low a dose.

‘Too many remain on suboptimal doses – little bits of everything, rather than effective doses,’ says Dr Fozia Ahmed, a consultant cardiologist at Manchester University NHS Foundation Trust.

‘We wouldn’t dream of not giving a patient with cancer effective doses of chemotherapy,’ she says, ‘but for some reason heart failure is seen as less of a priority.’

One problem, says Dr Ahmed, is that many still see heart failure as a condition where little could be done – ‘yet today heart failure is a treatable condition’.

Before a patient can be treated they need a diagnosis – and Katie’s story demonstrates the challenges with this.

Despite being too weak to climb the stairs, she was too embarrassed to let her mother call the emergency services the day she arrived at her home to find her critically ill.

‘By this point I’d had multiple GPs tell me it was a mental health issue,’ she says.

Yet after her emergency dash to hospital, she was so unwell she spent three months as an inpatient.

If a GP suspects heart failure, they can refer patients for a blood test called B-type natriuretic peptide (BNP), which checks levels of a hormone that rises when pressure builds inside the heart because it is struggling to pump properly. Patients then have an echocardiogram, an ultrasound scan, to check how well the heart is pumping to confirm the diagnosis.

Professor Petrie says some patients go on to wait ‘six months or even a year’ for one.

What’s more, many people with symptoms are not getting the blood test – even those at known risk.

When researchers screened more than 700 people with diabetes and one other risk factor for heart failure, such as a previous heart attack, one in four had undiagnosed heart failure, reported the journal JACC: Heart Failure earlier this year.

Nick Hartshorne-Evans, who founded the heart failure charity Pumping Marvellous in 2010 after being diagnosed with heart failure aged 39, says people are dying waiting for a diagnosis.

The charity is campaigning to alert patients and doctors to the warning signs – breathlessness, exhaustion and ankle swelling – that indicate the need for a blood test.

The charity has also helped establish five one-stop clinics – three in Liverpool, one in King’s Lynn, Norfolk, and one in Kilmarnock, Scotland – where patients with unexplained breathlessness have the blood test, a heart scan and a review in a single visit. There will be eight in total by the end of this year.

‘We’re identifying, diagnosing and treating people in 60 minutes,’ says Nick Hartshorne-Evans.

Katie, by contrast, spent a year going back and forth to her GP before she was diagnosed.

Because of the drugs she needed and the toll pregnancy would take on the heart, doctors told her it would not be safe to have children.

‘I’ve been through a grieving process. That was how I wanted my life to look and it’s not going to be like that,’ she says.

Unable to work, she moved back with her parents after her diagnosis. Aged 25 and unable to do what her peers were doing, she fell into depression.

What helped was a Facebook group that her cardiologist suggested she join, run by Pumping Marvellous.

‘I found there was a community of people with my condition, a whole family that I didn’t realise I had.’

She also helps with her sister Becky’s three children.

‘I get Mother’s Day presents, and I don’t feel like I’ve missed out,’ says Katie, now 36.

Her heart function has improved, but walking uphill leaves her breathless, and she is exhausted at the end of a long day.

‘I’m never going to run a marathon,’ she says. ‘But I know what I can and can’t do. I’ve adapted my life to suit my health.’

Katie now works as a patient educator with Pumping Marvellous. While she’s not angry, ‘the delays in diagnosing me were life-changing and I don’t want it to happen to others’.