*4.1.2.1 Progressive physical decline*

The symptoms of advanced stage heart failure generally include shortness of breath during exercise or at rest, orthopnoea, lack of energy, fatigue, anorexia, weight loss, depression, sleep disorders, pain, and cognitive disorders [8]. Decreasing physical ability causes difficulties in daily living activities, or lethargy, fatigue and shortness of breath during activities, thereby affecting patients psychologically.
