Rising heart failure cases spur awareness of subtle symptoms like bendopnea
Health officials warn that many cases go undiagnosed as obesity, diabetes and hypertension rise and signs can be mistaken for aging
The number of Americans living with heart failure is projected to rise from 6.7 million in 2024 to 11.4 million by 2050, according to new forecasts. Health officials warn that a sizable share of cases remain undiagnosed because many symptoms are subtle or dismissed as aging or another condition. The forecast reflects rising rates of obesity, diabetes and high blood pressure, which fuel the development of heart failure.
Doctors stress that recognizing warning signs early can prevent hospitalizations and death. Dr. John Jefferies, chief medical officer of Daxor, said that symptom onset is associated with increased morbidity and mortality and that patients often ignore signs until the condition has progressed. He outlined several warning signs that should prompt medical evaluation: shortness of breath with exertion or when lying flat; sudden onset of breathlessness at night; persistent and unexplained fatigue; swelling of the legs, feet or abdomen; and rapid weight gain. He also noted a symptom sometimes called bendopnea, when a patient becomes short of breath while bending over.
Jefferies cautioned that many other symptoms can indicate heart failure but may not fit the classic picture, such as nausea, loss of appetite and a feeling of fullness. The range of symptoms can vary by age and gender, adding to the complexity of diagnosis. He added that a family history matters: Harvard Health notes that having one parent with heart failure can raise an individual's risk by as much as 70% compared with someone with no family history.
Beyond family history, risk factors for heart failure include chronic high blood pressure, diabetes, obesity, coronary artery disease and metabolic syndrome. Exposure to cardiotoxic agents—such as certain chemotherapy treatments—also increases risk. Understanding these factors can help people get ahead of the disease because, in many cases, symptoms appear after damage to heart muscle has already occurred. 
"Symptom onset is associated with increased morbidity and mortality," Jefferies said. "In some cases, partial reversal of the damage might be possible, but fully undoing it is rare. The goal is preservation of existing heart muscle function by stabilizing the condition through medical therapy, device therapy where appropriate, and lifestyle modifications." He emphasized that preventing hospitalization is a key objective: "Once the patient is hospitalized for heart failure, the risk of death and rehospitalization goes up dramatically." He cited data showing one-year mortality ranges from 20% to 30% after hospitalization and, by the second year, nearing 50%. 
Given the potential for life-threatening complications, experts say people should not wait for dramatic symptoms to seek care. Primary care clinicians can screen for risk, monitor blood pressure and assess metabolic health, while cardiologists can perform tests to evaluate heart function and determine appropriate treatments that may slow progression and improve quality of life.