Heart Failure Often Mistaken for Burnout: The Risk of Late Diagnosis

Heart failure is often diagnosed too late, even in patients who present with symptoms that are mistaken for less serious conditions like burnout or stress, according to a recent report from Dutch regional broadcaster Omroep West. The story highlights the case of Desiree, a resident of The Hague, whose persistent fatigue and shortness of breath were initially attributed to overwork before a delayed diagnosis revealed underlying heart failure.

Heart failure, a condition in which the heart cannot pump blood effectively to meet the body’s needs, affects an estimated 64 million people worldwide. In the Netherlands, cardiovascular diseases remain a leading cause of hospitalization and mortality, with heart failure contributing significantly to long-term disability and reduced quality of life. Early detection is critical, as timely intervention can slow disease progression, reduce hospitalizations, and improve survival rates.

Despite its prevalence, heart failure is frequently underrecognized in its early stages. Symptoms such as fatigue, breathlessness during mild exertion, swollen ankles, and rapid weight gain from fluid retention are often nonspecific and easily dismissed as signs of aging, stress, or mental health strain. In Desiree’s case, her initial symptoms led her and her healthcare providers to consider burnout—a state of emotional, physical, and mental exhaustion caused by prolonged stress—before further investigation pointed to cardiac dysfunction.

Medical experts emphasize that distinguishing between burnout and heart failure requires careful clinical evaluation. While both conditions can present with exhaustion and reduced exercise tolerance, heart failure is typically accompanied by objective signs such as elevated jugular venous pressure, pulmonary crackles on lung examination, abnormal electrocardiogram (ECG) findings, and elevated levels of biomarkers like B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP). Echocardiography remains the gold standard for assessing heart structure and function, particularly ejection fraction, which measures how well the heart pumps blood with each contraction.

According to the European Society of Cardiology, guidelines recommend a proactive approach to diagnosing heart failure in individuals over 60 or those with risk factors such as hypertension, diabetes, obesity, or a history of coronary artery disease. However, heart failure can also affect younger adults, particularly those with undiagnosed valvular disease, genetic cardiomyopathies, or complications from pregnancy-related conditions like peripartum cardiomyopathy.

Public health officials in the Netherlands have increasingly highlighted the need for greater awareness of heart failure symptoms among both patients and primary care providers. Campaigns led by organizations such as the Dutch Heart Foundation (Hartstichting) encourage individuals to seek medical evaluation for persistent or worsening symptoms, especially when they interfere with daily activities or worsen when lying down—a symptom known as orthopnea.

Lifestyle factors play a significant role in both the prevention and management of heart failure. Controlling blood pressure, maintaining a healthy weight, engaging in regular physical activity, limiting sodium intake, and avoiding tobacco and excessive alcohol consumption are all recommended to reduce cardiovascular strain. For those already diagnosed, adherence to prescribed medications—including ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and, in certain cases, SGLT2 inhibitors—has been shown to improve outcomes and reduce morbidity.

Ongoing research continues to explore biomarkers, imaging techniques, and digital health tools that could enable earlier detection of heart failure. Wearable devices that monitor heart rate, rhythm, and fluid status are being studied for their potential to alert users and clinicians to subtle changes that may precede clinical decompensation. However, experts caution that such technologies should complement, not replace, clinical assessment and diagnostic testing.

For individuals like Desiree, the delayed recognition of heart failure underscores the importance of listening to persistent bodily signals and advocating for further evaluation when symptoms do not align with initial assumptions. While burnout is a legitimate and growing concern in modern society, healthcare providers are urged to consider cardiac causes when fatigue and exertional intolerance persist despite rest and stress reduction efforts.

As populations age and the prevalence of metabolic risk factors rises, early identification of heart failure remains a critical challenge in cardiovascular care. Public education, improved diagnostic pathways in primary care, and greater clinician awareness of atypical presentations are essential steps toward reducing the burden of late-stage diagnosis and improving long-term outcomes for those affected.