Nutrition for Cats with Congestive Heart Failure

What is congestive heart failure?

Congestive heart failure (CHF) refers to the heart's inability to pump adequate blood to the body. There are many causes of CHF in cats. The main cause of CHF in cats is hypertrophic cardiomyopathy (HCM), in which the heart muscle gets thicker and thicker, and the heart chambers can no longer pump blood effectively.

CHF is fairly common in cats over the age of 10 years; about one-third of cats older than 10 have some degree of heart disease. However, not all cats show clinical signs right away. 

With so many cats at risk of developing heart disease in old age, it makes sense to consider ways in which nutrition may help keep these cats as healthy and comfortable as possible.

What should I feed my cat with CHF?

To determine the best way to feed your cat with CHF, you must work with your veterinarian to determine whether your cat has other medical conditions. For instance, hyperthyroidism, chronic kidney disease, and obesity are common health concerns in older cats. Any or all these conditions may be present and can influence dietary choices for a cat with CHF. The key to success is understanding which disease takes precedence.

Hyperthyroidism (high thyroid level) is diagnosed by simple blood tests and may be managed by medications, surgery, radioactive iodine therapy, or dietary therapy, depending on the patient’s circumstances. Feeding a veterinary therapeutic diet with reduced iodine levels has been shown to be effective in some studies, but it is not without controversy for long-term management. Discuss the advantages and disadvantages of each treatment option with your veterinarian; they can make a diet recommendation specific for your cat’s needs and your goals.

Chronic kidney disease (CKD) is often diagnosed in older cats and can occur in conjunction with heart disease. There are a number of veterinary therapeutic kidney diets designed to slow the progression of CKD. The nutrient profile of kidney diets includes reduced or restricted dietary phosphorus, modified dietary protein, and enhanced levels of nutrients such as potassium, B-vitamins, and omega-3 fatty acids.   

Veterinary therapeutic diets designed for cats with heart disease have a nutrient profile that includes restricted dietary sodium and chloride (also known as salt), and enhanced nutrients that support heart function (such as carnitine and taurine). While some sodium restriction is reasonable, it is more important that cats diagnosed with CHF eat an appropriate number of Calories each day, since the condition called cardiac cachexia can result in weight loss and muscle wasting.

"Omega-3 fatty acids may be added to some commercial veterinary diets, 
or your veterinarian may prescribe supplements."

The omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) have been shown to play a valuable role in fighting inflammation in several disease conditions. Omega-3 fatty acids may be added to some commercial veterinary diets, or your veterinarian may prescribe supplements. A suggested dose for EPA and DHA supplementation in cats with cardiac disease is 115 mg per kilogram of body weight.

Your veterinarian can calculate a Calorie goal for your cat’s daily needs. The long-term objective is to have your cat stay at a stable body weight and maintain a body condition score of 5 or 6 on a scale from 1 to 9. If you have been free-feeding and are unsure of the exact amount of food your cat eats each day, it is recommended that you gradually switch to pre-measured meal feeding so you can record the total Calories eaten at each meal. This process will allow you to manage your cat’s food intake, body weight, and overall quality of life.

Are there any other nutritional concerns for my cat with CHF?

Cats diagnosed with CHF often must receive two or more medications each day. To ensure your pet gets those medications, you may need to use foods or treats other than cat’s usual food at mealtimes. Work with your veterinary healthcare team to understand all your options and to make sure your choices do not contain an excessive amount of dietary sodium or fat.

Some pet owners choose to feed a homemade diet. In these instances, it is important to work with a veterinary nutritionist. Ask your veterinary healthcare team for a referral. Many people market themselves as “certified nutritionists”, but if they did not earn a college degree in animal nutrition, there are likely huge gaps in their knowledge and experience with formulation software.

Overall, the best nutritional plan for a cat with CHF is one that supports their daily energy needs, has balanced nutrients for all their medical conditions, and includes foods the cat will eat. While there are several veterinary therapeutic diets with beneficial nutrient profiles, these products are not ideal if the cat won’t eat them.

Home cooking may be preferred by the cat owner, but there are risks associated with feeding an improperly balanced recipe, as well as inadvertently high levels of sodium (many human foods contain excess sodium). Your veterinarian will help you determine the best approach for diet and feeding management at each stage of your cat's heart disease.