Congestive Heart Failure (CHF)

Congestive heart failure (CHF) happens when the heart cannot pump enough blood to meet the body’s needs. Lab tests help confirm or rule in heart-failure physiology, identify causes or triggers, and monitor safety while you and your clinician manage care.

A practical plan usually combines a natriuretic peptide (NT-proBNP or BNP) with electrolytes and kidney function, adds tests that uncover contributors (anemia, thyroid imbalance, iron deficiency), and uses troponin when symptoms suggest acute heart strain. These labs support screening in symptomatic peoplediagnostic work-ups, and ongoing monitoring, but they do not replace a physical exam, blood-pressure control, ECGs, imaging (echocardiogram), or emergency care for severe symptoms.

Signs, Symptoms & Related Situations

  • Fluid & breathing: shortness of breath with activity or lying flat, waking at night breathless, persistent cough, swelling in legs/ankles, rapid weight gain from fluid

  • Fatigue & exercise: low stamina, lightheadedness, reduced exercise tolerance

  • Heart sensations: palpitations, irregular heartbeat

  • Contributors/contexts: recent viral illness, high blood pressure, heart attack, alcohol excess, high-salt intake, medication changes (diuretics, ACEi/ARB/ARNI, MRAs), arrhythmias

  • Urgent care now: new or crushing chest pain, severe breathlessness at rest, fainting, confusion, pink frothy sputum, or one-sided weakness

Why These Tests Matter

What testing can do

  • Signal cardiac wall stress (NT-proBNP/BNP) to help differentiate heart vs. non-cardiac shortness of breath

  • Guide treatment safety by tracking kidney function and electrolytes during diuretics and other heart-failure medications

  • Reveal contributors such as anemiathyroid disease, or iron deficiency, and track overall risk (glucose/A1c, lipids)

What testing cannot do

  • Diagnose blocked arteries or measure ejection fraction—imaging and ECGs are still needed

  • Replace a clinician’s judgment when symptoms are severe or rapidly changing

  • Predict exact outcomes from a single value; trends matter most

What These Tests Measure (at a glance)

  • NT-proBNP or BNP (blood): peptides released with heart-wall stretch; higher values support heart-failure physiology and help track response. Caveats: levels can be lower in obesity and higher in kidney disease or atrial fibrillation—interpret in context.

  • High-sensitivity Troponin (hs-cTn): detects heart-muscle injury; used when symptoms suggest acute coronary syndrome or decompensation.

  • Comprehensive Metabolic Panel (CMP) & Electrolytes: sodium, potassium, chloride, CO2 (bicarbonate)creatinine/eGFRBUNAST/ALTalbumin—essential for medication safety and fluid status.

  • Magnesium & Phosphorus: rhythm stability and diuretic effects.

  • CBC (Complete Blood Count): screens for anemia or infection that can worsen symptoms.

  • Iron Studies (Ferritin, Iron, TIBC/Transferrin, % Saturation): detect iron deficiency, common in heart failure.

  • TSH (± Free T4): checks for thyroid dysfunction that can mimic or worsen heart failure.

  • Urinalysis & Urine Albumin-to-Creatinine Ratio (ACR): kidney health and vascular risk context.

  • Glucose/A1c & Lipids (± ApoB, Lp[a]): cardiometabolic risk that influences long-term outcomes.

  • Medication-specific labs (as directed):

    • Diuretics: electrolytes (Na/K/Mg), creatinine/eGFR

    • ACEi/ARB/ARNI & MRAs (spironolactone/eplerenone): potassium, creatinine/eGFR

    • Digoxin (if used): serum digoxin level with renal function and potassium

    • Anticoagulants (if used): PT/INR or drug-specific assays per clinician

Quick Build Guide

Situation Start with Add if needed
New/worsening shortness of breath NT-proBNP/BNP, CMP/electrolytes, CBC hs-Troponin (symptom-driven), TSH, iron studies
Known CHF, routine monitoring CMP/electrolytes, NT-proBNP/BNP trend Magnesium, ACR/urinalysis, A1c, lipids
Medication check-in (diuretics, ACEi/ARB/ARNI, MRA) CMP/electrolytes (K/Na/Cr/eGFR), magnesium Digoxin level (if on digoxin)
Fatigue/low exercise capacity CBC, iron studies, TSH Vitamin B12/folate (contextual)

How the Testing Process Works

  1. Select the right panel: choose a natriuretic peptide (NT-proBNP or BNP) plus CMP/electrolytes; add tests based on symptoms and medications.

  2. Prepare for collection: fasting is usually not required; follow any instructions on your order and list current medications/supplements.

  3. Get your draw: visit a nearby patient service center; most results post within a few days.

  4. Review with your clinician: combine labs with symptoms, exam, blood pressure, ECG, and imaging (echo) to confirm next steps.

  5. Set a cadence: recheck markers on a schedule aligned with medication changes and clinical status.

Interpreting Results (General Guidance)

  • Natriuretic peptides: rising values often reflect worsening congestion; falling values may signal improvement. Interpret with body size, rhythm (AF), and kidney function.

  • Electrolytes & kidney function: watch for low sodiumhigh/low potassium, or rising creatinine—especially after medication changes.

  • Troponin: even small elevations merit clinical review; acute patterns require urgent evaluation.

  • Anemia/iron/thyroid: correcting contributors can improve stamina; decisions belong with your clinician.
    Always interpret results with a qualified healthcare professional; do not start or stop medications based on labs alone.

Choosing Panels vs. Individual Tests

  • Symptom triage: NT-proBNP/BNP + CMP/electrolytes + CBC (± hs-Troponin)

  • Stable CHF follow-up: CMP/electrolytes + NT-proBNP/BNP trend (± magnesium, ACR)

  • Contributor check: CBC + Iron Studies + TSH

  • Risk context: A1c/Glucose + Lipid Panel (± ApoB, Lp[a])

  • Medication safety: targeted electrolytes/renal function (and digoxin level if applicable)

FAQs

Do I need to fast for CHF labs?
Usually no. Follow the instructions on your order.

Which is better—BNP or NT-proBNP?
Both reflect heart-wall stress. Your clinician will choose based on local practice and your kidney function/age.

Can kidney disease change results?
Yes. Kidney dysfunction can raise natriuretic peptide levels and affect electrolytes; interpretation adjusts for this.

My BNP fell—does that mean I’m cured?
Lower numbers often track improvement, but symptoms and exams still guide care. Continue regular follow-up.

Why check iron and thyroid?
Iron deficiencyanemia, and thyroid disorders can worsen fatigue and shortness of breath in CHF.

How often should I test?
It depends on symptoms and treatment changes. Many people test more often during medication adjustments, then less once stable.

Related Categories & Key Tests

  • Heart & Cardiovascular Tests Hub

  • Cardiovascular Disease (CVD) Tests • Cholesterol Tests • Diabetes & Insulin Resistance • Kidney Health • Electrolytes & Hydration • Thyroid Testing

  • Key Tests: NT-proBNP/BNP • CMP/Electrolytes (Na/K/Cl/CO2, BUN/Creatinine/eGFR, AST/ALT, Albumin) • hs-Troponin • Magnesium • CBC • Iron Studies (Ferritin/Iron/TIBC/Transferrin, %Sat) • TSH (± Free T4) • Urinalysis & ACR • A1c/Glucose • Lipid Panel • Digoxin level (if used)

References

  • American College of Cardiology/American Heart Association — Heart failure evaluation and monitoring guidance.
  • Heart Failure Society of America — Biomarker use in heart failure.
  • KDIGO — Kidney disease and albumin-creatinine testing recommendations.
  • AHA/CDC — Cardiometabolic risk and inflammation resources.
  • Clinical reviews on natriuretic peptides, troponin in acute and chronic heart failure, and medication-related electrolyte monitoring.

Available Tests & Panels

Your Congestive Heart Failure (CHF) Tests menu is pre-populated in the Ulta Lab Tests system. Start with NT-proBNP/BNP and CMP/electrolytes, add CBCtroponin (when symptoms warrant), and contributor tests (iron studies, TSH). Include kidney markers for medication safety and consider A1c/lipids for long-term risk. Review results with your clinician to personalize follow-up.

 

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The ALP Test measures alkaline phosphatase enzyme levels in blood to evaluate liver, bone, and bile duct health. High ALP may indicate liver disease, bile duct obstruction, bone disorders, or certain cancers, while low levels may suggest malnutrition or deficiency. Doctors order this test to investigate symptoms like fatigue, abdominal pain, or bone pain and often pair it with other liver function tests. Results provide key insight into metabolic and organ health.

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Also Known As: Alkaline Phosphatase Test, Alk Phos Test, Alkp Test

The Alkaline Phosphatase Isoenzymes Test measures different forms of alkaline phosphatase (ALP) in the blood to determine their source, such as liver, bone, intestine, or placenta. Doctors use this test to evaluate abnormal ALP results, identify liver disease, bile duct obstruction, bone disorders like Paget’s disease, or certain cancers. It helps distinguish between conditions and guides accurate diagnosis and treatment planning.


Most Popular

The B-Type Natriuretic Peptide (BNP) Test measures BNP levels in blood to help diagnose and monitor heart failure and other cardiac conditions. High levels suggest the heart is under stress, often from congestive heart failure, hypertension, or heart disease. Doctors order this test for patients with shortness of breath, fatigue, or swelling. Results provide critical insight into heart function, guiding treatment and monitoring response to therapy.

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Also Known As: Brain Natriuretic Peptide Test

The Basic Metabolic Panel (BMP) Test measures eight markers, including glucose, calcium, sodium, potassium, chloride, carbon dioxide, BUN, and creatinine, to evaluate kidney function, blood sugar, and electrolyte balance. Doctors use this panel to detect diabetes, dehydration, and kidney disease, or to monitor treatment. It is commonly ordered in routine exams, emergency care, or pre-surgical testing to assess overall metabolic and organ health.

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Also Known As: BMP Test, Chemistry Panel, Chemistry Screen, Chem 7, Chem 11, SMA 7, SMAC7, Basic Metabolic Test, Chem Test, Chem Panel Test 

The BUN Creatinine Ratio Test compares blood urea nitrogen (BUN) to creatinine levels to assess kidney function and hydration status. A high ratio may indicate dehydration, gastrointestinal bleeding, or high protein intake, while a low ratio can suggest liver disease or malnutrition. Doctors order this test with kidney panels to evaluate fatigue, swelling, or abnormal lab results. Results help diagnose renal issues and guide treatment planning.

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Also Known As: Blood Urea Nitrogen to Creatinine Ratio

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The High-Sensitivity C-Reactive Protein (hs-CRP) Test measures very low levels of CRP in blood to evaluate inflammation and cardiovascular risk. Elevated hs-CRP may indicate increased risk for heart disease, heart attack, or stroke even before symptoms appear. Doctors use this test along with cholesterol and other markers to assess overall heart health, guide prevention strategies, and monitor treatment. It also helps evaluate chronic inflammation and metabolic conditions.

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Also Known As: Cardiac CRP Test, High Sensitivity C-Reactive Protein Test

The Cardio IQ™ NT-proBNP Test evaluates levels of NT-proBNP in blood to help assess heart function and cardiovascular stress. High concentrations are associated with heart failure, left ventricular dysfunction, and fluid imbalance. This test provides insight into cardiac performance, systemic health, and conditions such as hypertension or other disorders that impact cardiovascular risk.

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Also Known As: Brain Natriuretic Peptide Test, proBNP test,

The Chloride Random Urine Test measures chloride levels in a spot urine sample to help evaluate electrolyte and acid-base balance. Abnormal results may indicate dehydration, metabolic alkalosis, renal tubular disorders, or imbalances linked to adrenal gland conditions. This test provides clinical insight into kidney function, metabolic regulation, and systemic fluid balance by detecting changes in urinary chloride excretion.

Urine
Urine Collection
Also Known As: Random Urine Chloride Test

The HDL Cholesterol Test measures high-density lipoprotein cholesterol, often called “good” cholesterol, which helps remove excess cholesterol from the bloodstream. Higher HDL levels are linked to a lower risk of heart disease, while low levels may increase cardiovascular risk. Doctors use this blood test as part of a lipid panel to assess heart health, evaluate risk factors, and guide lifestyle or treatment strategies for cardiovascular disease prevention.

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Also Known As: Good Cholesterol Test

The Cholesterol Total Test measures the overall amount of cholesterol in blood, combining LDL and HDL, to evaluate cardiovascular health. High cholesterol is a major risk factor for heart disease, atherosclerosis, and stroke, while low levels may also affect health. Doctors use this test for routine screening, monitoring treatment, and assessing heart risk. Results provide key insight into lipid balance, helping guide lifestyle changes and therapy decisions.

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Also Known As: Blood Cholesterol Test

The Complete Blood Count with Differential and Platelets Test is a comprehensive blood test that checks red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The differential analyzes types of white blood cells to detect infections, anemia, clotting abnormalities, immune conditions, and certain cancers. This essential test is often ordered for routine health exams, diagnosis, and monitoring treatment progress.

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Also Known As: CBC Test, CBC with Differential and Platelets Test, CBC w/Diff and Platelets Test, Full Blood Count Test, Complete Blood Count Test

The Comprehensive Metabolic Panel (CMP) Test measures 21 markers to assess metabolic health, liver and kidney function, and electrolyte balance. It includes glucose, calcium, sodium, potassium, chloride, CO2, albumin, globulin, A/G ratio, total protein, bilirubin, ALP, AST, ALT, BUN, creatinine, BUN/creatinine ratio, and eGFR. The CMP helps detect diabetes, liver or kidney disease, and supports routine screening and chronic condition monitoring.

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Also Known As: CMP Test, Chemistry Panel Test, Chem Test, Chem 21 Test, Chem 14 Test 

The Digoxin Test evaluates concentration of digoxin in the bloodstream to help monitor therapy for heart failure and irregular heart rhythms. It ensures medication remains in the therapeutic range, preventing toxicity or reduced effectiveness. By measuring drug levels, this test supports safe cardiac management, assessment of arrhythmias, and ongoing cardiovascular health monitoring.

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The Electrolyte Panel Test measures sodium, potassium, chloride, and carbon dioxide in blood to evaluate fluid balance, kidney function, and acid-base status. Abnormal results may indicate dehydration, kidney disease, adrenal disorders, or respiratory issues. Doctors use this test to investigate symptoms such as weakness, confusion, or irregular heartbeat. Results provide essential insight into electrolyte balance, hydration, and overall metabolic and organ health.

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Also Known As: Lytes Panel, Anion Gap Panel, Electrolyte Test, Lytes Test, Anion Gap Test

Most Popular

The Ferritin Test measures ferritin, a protein that stores iron in the body, to evaluate iron levels and detect deficiency or overload. It helps diagnose anemia, iron deficiency, hemochromatosis, and chronic disease-related inflammation. Doctors often order the ferritin test to investigate fatigue, weakness, or unexplained symptoms. It is also used to monitor iron supplementation, treatment effectiveness, and overall iron metabolism health.

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Also Known As: Iron Storage Test

The Galectin-3 Test measures levels of galectin-3, a biomarker linked to heart failure, cardiac fibrosis, and inflammation. Elevated results may indicate worsening heart disease, increased risk of hospitalization, or progression of chronic conditions. Doctors use this blood test to assess heart health, guide treatment decisions, and monitor patients with heart failure, offering valuable insight into long-term cardiovascular risk and management.

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The Homocysteine Test measures homocysteine levels in blood to assess risk for heart disease, stroke, and vascular problems. Elevated homocysteine may result from vitamin B6, B12, or folate deficiency and is linked to blood clots, cognitive decline, and osteoporosis. Doctors use this test to evaluate cardiovascular risk, monitor nutritional deficiencies, and guide treatment for metabolic or genetic conditions affecting homocysteine metabolism.

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Also Known As: Homocysteine Cardiac Risk Test

The Iron Total and Total Iron Binding Capacity (TIBC) Test measures iron levels in blood along with the blood’s ability to transport iron. It helps diagnose iron deficiency anemia, iron overload (hemochromatosis), and monitor nutritional or chronic health conditions. Low iron or high TIBC may indicate anemia, while high iron or low TIBC can suggest overload. Doctors use this test to evaluate fatigue, weakness, or other symptoms linked to iron and metabolic health.

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Also Known As: Serum Iron Test, Total Iron Binding Capacity Test, TIBC Test, UIBC Test

The Iron Micronutrient Test measures blood iron levels to evaluate nutritional status and detect deficiencies or excess. Iron is essential for hemoglobin production, oxygen transport, energy metabolism, and immune function. This test helps identify anemia, iron overload, absorption issues, or dietary imbalances, supporting diagnosis and management of overall health and vital body functions.

Patient must be 18 years of age or older.
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Also Known As: Serum Iron Test, Serum Fe Test

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The Iron Total Test measures iron levels in blood to evaluate nutritional status, red blood cell production, and overall metabolic health. Abnormal levels may indicate iron deficiency anemia, chronic blood loss, or poor absorption, while high levels may suggest hemochromatosis, liver disease, or iron overload. Doctors use this test to investigate fatigue, weakness, or pallor and to monitor treatment. Results provide key insight into anemia and iron balance.

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Also Known As: Serum Iron Test, Serum Fe Test

The Mineral Micronutrients Test Panel measures minerals: Calcium, Chromium, Copper, Iron, Magnesium RBC, Manganese, Molybdenum, Selenium, and Zinc to assess nutritional balance and overall health. These minerals are essential for bone strength, metabolism, energy production, antioxidant defense, and immune function. The panel helps detect deficiencies, excesses, or absorption issues, guiding health management.

Patient must be 18 years of age or older.

Most Popular

The Lipid Panel Test checks six key blood lipids: total cholesterol, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides, and the Chol/HDL ratio. This panel assesses risk for cardiovascular disease, heart attack, and stroke by evaluating cholesterol balance and fat levels in the blood. Doctors use lipid panel results for routine screening, treatment monitoring, and guiding lifestyle or medication adjustments.

Also Known As:  Lipid Profile Test, Cholesterol Panel Test, Lipids Blood Test 

The Lipid Panel with Ratios Test measures seven key markers: total cholesterol, HDL, LDL, non-HDL cholesterol, triglycerides, Chol/HDL ratio, and LDL/HDL ratio. This advanced panel evaluates cardiovascular risk by assessing cholesterol balance and fat metabolism. Doctors use it to detect high cholesterol, atherosclerosis risk, and heart disease, and to monitor treatment. Often part of routine exams, it provides insight into long-term heart and metabolic health.

Also Known As: Lipid Profile Test, Cholesterol Panel Test, Lipid Blood Test

The Metanephrines Fractionated Free Plasma Test measures free metanephrine and normetanephrine levels to evaluate adrenal gland function and catecholamine metabolism. Elevated concentrations may indicate pheochromocytoma, paraganglioma, or other endocrine tumors. Providers use this test to investigate unexplained hypertension, palpitations, headaches, or symptoms linked to excess catecholamine production.

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The Metanephrines Fractionated 24 Hour Urine Test measures breakdown products of catecholamines, including normetanephrine and metanephrine, to help detect pheochromocytoma and paraganglioma. By analyzing hormone metabolites over a full day, it offers valuable insights into adrenal gland activity, sympathetic nervous system function, and unexplained symptoms such as hypertension, headaches, and palpitations.

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Urine Collection

Congestive Heart Failure is also known as CHF or heart failure. Whatever you call it, this condition is one where the human heart is unable to pump blood with the efficiency that it once did. This means that blood, as well as other various fluids, start backing up inside the body. The effect is particularly pronounced in the feet, hands, lungs, and liver. 

The human heart has two different sides to it, as well as four different chambers. The right side is what takes in blood depleted of oxygen from throughout the body, sending it into the lungs. Once the lungs replenish the oxygen in the blood, it’s the left side that pumps this fresh blood back out into the overall body. 

Congestive Heart Failure is a very serious condition, one that is progressive. It’s often chronic, and it can threaten your life. It might impact the left side of the heart, the right side, or even both sides. Those with CHF have lowered amounts of nutrients and oxygen delivered to their organs, resulting in lost functions and damage. 

CHF can happen for several different reasons. Most frequently, the heart undergoes damage, which might be hypertension/high blood pressure, prior heart attacks, or even cardiomyopathy, which is direct damage right to the actual heart muscle. Congestive Heart Failure can also happen if there is any damage to the heart valves or pericardium scarring to the membrane that physically surrounds the human heart. On rare occasions, CHF happens if the heart must start beating with more force than is typical, as which can happen with hyperthyroidism, where it simply can’t keep up with the current demand. Congestive Heart Failure risks are elevated among those with diabetes, the overweight and obese, smokers, and anyone who abuses cocaine and/or alcohol. 

CHF is very common in elderly individuals since the human heart tends to lose efficiency with age. The National Heart, Lung and Blood Institute has estimates showing that between 5.5 and 6 million Americans have heart failure at any given time. For those older than 65, it’s among the most frequent reasons for hospitalization. 

Symptoms/Signs 

When blood backs up starting from the heart’s right side, then Congestive Heart Failure symptoms typically start with ankles and legs swelling in ways that get worse if a person stands up but gets better if they lie down. If blood starts backing up from the heart’s left side, then it moves into the lungs, resulting in coughing or breathing, particularly during periods of lying down flat or exercise, even if it’s just walking up a set of stairs. Many individuals that suffer heart failure have demonstrated symptoms of blood that’s backing up simultaneously on both sides of the heart. 

On top of shortness of breath and edema/swelling, other symptoms can include the following: 

  • Rapid pulse, heart palpitations 
  • Fatigue, weakness 
  • Less stamina, lower ability to do physical exercise 
  • Wheezing, coughing 
  • Sudden gains of weight 
  • Lost appetite 
  • Nausea 

Laboratory testing can include the following: 

BNP or N-terminal pro-BNP: BNP stands for B-type natriuretic peptide, which is a measurement of concentrations of a specific hormone the left ventricle produces. Given its role as the heart’s primary pumping chamber, the left ventricle’s production of BNP helps doctors both diagnose and grade how serious heart failure is. 

Metabolic Panel: This looks for things like liver disease, electrolyte imbalances, and kidney failure, given how many kidney disease symptoms are very similar to the ones of Congestive Heart Failure. 

CBC: A complete blood count looks for anemia, which not only has symptoms like CHF but can also contribute to CHF. 

Thyroid Testing: Such tests check the thyroid hormone levels in the blood. Heart failure can result from both hyperthyroidism and hypothyroidism, which are respectively too much or too little thyroid hormone. 

Two relatively new tests are now available for those already diagnosed with CHF to predict their prognosis. ST2 and Galectin-3 tests both measure protein levels in the blood. If these biomarkers are elevated, they might indicate someone who has heart failure is at a higher risk of complications and requires more assertive levels of treatment.