Heart Failure Review: Track Weight and Breathlessness

A heart failure review looks at things that show up mostly at home. These include your weight over weeks, breathlessness on effort, swollen ankles in the evening, and how many pillows you need to sleep. You can note breathlessness and swelling in the symptom diary in Sam, where the monthly report shows your symptom days instead of a scattered set of notes. Your weight does not go into that diary, but one line per day alongside it makes the trend clear.

This is general information, not medical advice. Your heart care team decides what applies to you, what to record, and when to be concerned. This text is about preparing for a heart failure review, a regular check-up with your heart care team rather than a single named programme. How often you are seen depends on your care team.

What a heart failure review checks

A review goes over your symptoms since the last visit. The NHS names sudden weight gain, swelling in the feet, ankles, legs or tummy, and breathlessness when lying down or on everyday activity as key signs, and your care team decides which of them to follow in your case.

The review usually covers how your medicines are going and whether your daily life has changed. This is where your own notes help most, because a trend over weeks is easier for a team to read than one bad day described from memory.

The daily weight: one line per day

A single number on a clinic scale says little. A run over weeks says a lot. The NHS advises weighing yourself regularly, because a build-up of fluid can cause sudden weight gain. The British Heart Foundation says the same: sudden weight gain can mean too much fluid is collecting.

To keep the numbers comparable, aim for a consistent routine. Set it with your care team, such as the same time and similar clothing each day. One row per day with a date and number is enough. If you miss a few days, note the gap and keep going rather than guessing numbers.

What a change means for you is set by your care team. Ask them how much weight gain they want to hear about in your case. MedlinePlus gives 2 to 3 pounds (1 to 1.5 kg) in a day or 5 pounds (2 kg) in a week as the point to contact your provider, and says to weigh yourself every morning on the same scale before eating and after using the bathroom. Report sudden changes rather than waiting for the next review.

Breathlessness: not whether, but when

The question of how your heart copes is best answered with concrete activities, not adjectives. Useful lines to keep:

• One flight of stairs without stopping, or with a pause on the landing.
• The walk to the car, the bus stop or the shop.
• Making the bed, carrying shopping, or showering and drying off.
• Whether you can lie flat, or need to sit up.

If you note breathlessness on stairs, add where it starts and how long it takes to settle. A single line is enough: "Pause on the first landing, back to normal after two minutes." MedlinePlus lists shortness of breath when active, at rest or when lying down as reasons to contact your provider.

Swelling in the legs and ankles

Swelling from fluid is often caught by small things you notice in the evening and forget by morning. MedlinePlus lists swelling in the feet, ankles or legs as a reason to contact your provider. The NHS names swelling in the feet, ankles, legs or tummy as a symptom of heart failure.

Worth writing down:

• Do socks or shoes feel tighter in the evening than in the morning?
• Does a gentle press on the ankle or shin leave a dent?
• How far does the swelling reach, such as the ankle, the calf, or up to the knee?

A tick per day and a note on how high is enough. Together with the weight trend, it gives a picture your team can read quickly at the review.

Nights: lying flat and waking for breath

How you sleep is part of a review too. MedlinePlus lists shortness of breath when you lie down, or an hour or two after falling asleep, as a reason to contact your provider. Note how many pillows you use, whether you can lie flat, and whether breathlessness wakes you at night.

One or two lines a week is enough while things stay steady. When they change, write the date. The NHS says to seek urgent advice if you feel breathless when lying down or from everyday activity.

Waiting for signs vs calling early

Your care team sets your own thresholds, but these general signs warrant a call sooner rather than waiting for the next review. MedlinePlus advises contacting your provider for a weight gain of more than 2 to 3 pounds in a day or 5 pounds in a week, or when you feel short of breath when lying down. The NHS says to get urgent advice for breathlessness when lying down, coughing up frothy pink phlegm, or sudden weight gain.

For severe difficulty breathing (gasping, choking or not getting words out), pale, blue or grey lips or skin, or someone who has passed out and is not responding normally, the NHS says to call 999. Use your local emergency number (112 in the EU, 999 in the UK, 911 in the US). Do not drive yourself. A diary does not replace a call when things get worse.

A simple heart failure diary for the weeks before

Keep it small or you will not keep it. Paper, a notes app or a calendar all work. One line a day with date and weight, plus a note on pillows and whether the legs were swollen, is enough. Add a separate line for breathlessness episodes when they happen, with what triggered them and how long each lasted.

Before the review, write the three points you most want to raise at the top. If you have been in hospital, bring discharge and rehab letters. How daily habits and warning signs fit together is covered in living with heart failure: exercise and warning signs. If you measure at home, resting heart rate and activity in heart failure shows how that helps, and the doctor visit checklist for a chronic condition keeps appointments structured.

Bring your heart failure notes to the review in Sam

You arrive with weeks of notes instead of guesses from memory.

• Instead of a notes app: you add a symptom entry for breathlessness, swollen ankles and sick days, one per day.
• Instead of loose papers: cardiology and discharge letters stay in Health Vault rather than three folders.
• The monthly report (PDF) sums your symptom days to show or print.

Sam has no dedicated heart-failure diary. Your weight is not in the diary or the monthly report; if you log it in Apple Health, switch on the Blood pressure & glucose group to see it. The diary does not replace a call when things worsen. More in the heart failure hub.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Living with heart failure: exercise and warning signs
• Resting heart rate and activity in heart failure
• Cardiac rehab and daily life after heart failure
• Doctor visit checklist for a chronic condition

Sources

Updated: October 2026

• NHS: Living with heart failure (page last reviewed 26 June 2026)
• British Heart Foundation: Heart failure (page updated 18 July 2025)
• MedlinePlus (US National Library of Medicine): Heart failure - fluids and diuretics (reviewed 14 July 2024)