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Symptoms of heart failure that require immediate attention include shortness of breath, persistent coughing or wheezing, fatigue, confusion, bloating and swelling.

The study "is not so much a wake-up call as a reminder," said Dr. Howard S. Weintraub, clinical director of the New York University Center for the Prevention of Cardiovascular Disease.

The Mayo Clinic report provides a valuable account of the progress of treating heart attack survivors in one relatively isolated area, Weintraub said. The finding that heart failure increases the risk of sudden death came as no surprise, he said. "The sicker you are after a disastrous event, the more likely it is that another disaster will occur," Weintraub said.

What the study does not provide is identification of specific indicators of the risk of sudden death, he said.

"It's important to know what predisposes one to sudden death," Weintraub said. "We need to be diligent, still."

More information

Aspects of recovery from a heart attack are described by the American Academy of Family Physicians.

SOURCES: Veronique Roger, M.D., professor, medicine and epidemiology, Mayo Clinic, Rochester, Minn.; Howard S. Weintraub, M.D., associate professor, medicine, and clinical director, Center for the Prevention of Cardiovascular Disease, New York University; Nov. 5, 2008, Journal of the American Medical Association