title: Amazon Kindle

text: Amazon announced the second-iteration Kindle Paperwhite, marketed as the "All-New Kindle Paperwhite" and colloquially referred to as the Paperwhite 2, on September 3, 2013; the Wi-Fi version was released in on September 30 ($120 ad-supported, $140 no ads), and the 3G/Wi-Fi version was released in the US on November 5, 2013 ($190 ad-supported, $210 no ads). The Paperwhite 2 features a higher contrast E Ink Carta display technology, improved LED illumination, 25% faster processor (1 GHz) that allows for faster page turns, and better response to touch input compared to the original Paperwhite. It has the same 6" screen with 212 PPI, bezel and estimated 28-hour battery life as the original Paperwhite. The software features dictionary/Wikipedia/X-Ray look-up, Page Flip that allows the user to skip ahead or back in the text in a pop-up window and go back to the previous page, and Goodreads social integration.


title: Amazon Kindle

text: The Paperwhite 2 uses a similar experimental web browser with the same 3G data use restrictions as previous Kindles; there are no use restrictions when using Wi-Fi. The official Amazon leather cover for the Paperwhite 2 is the same item as was used for the original Paperwhite. The cover's magnets turn the screen on and off when it is opened and closed.


title: Amazon Kindle

text: Although released in 2013 with 2GB of storage, all versions of the Paperwhite 2 were sold with 4GB of storage by September 2014.


title: Amazon Kindle

text: Engadget rated the Paperwhite 2 as 93 of 100, saying while it offers few new features, "an improved frontlight and some software tweaks have made an already great reading experience even better."


title: Amazon Kindle

text: Amazon announced an upgraded basic Kindle and the Kindle Voyage on September 18, 2014. The Kindle 7 was released on October 2, 2014 ($80 ad-supported, $100 no ads). It is the first basic Kindle to use a touchscreen for navigating within books and to have a 1 GHz CPU. It is also the first basic Kindle available in international markets such as India, Japan and China. Amazon claims that a single charge lasts up to 30 days if used for 30 minutes a day without using Wi-Fi.


title: Amazon Kindle

text: The Kindle Voyage was released on November 4, 2014, in the U.S. It has a 6-inch, 300 ppi E Ink Carta HD display, which was the highest resolution and contrast available in e-readers, as of 2014, with six LEDs with an adaptive light sensor that can automatically illuminate the screen depending on the environment. It is available in Wi-Fi ($200 ad-supported, $220 no ads) and Wi-Fi + 3G ($270 ad-supported, $290 no ads) models. It has 4 GB of storage. Its design features a flush glass screen on the front and the rear has angular, raised plastic edges that house the power button, similar to the Fire HDX. At 0.3 inches, it is the thinnest Kindle to date. The Voyage uses "PagePress", a navigation system that has sensors on either side of the screen that turns the page when pressed. PagePress may be disabled, but the touchscreen is always active.


title: Amazon Kindle

text: "The Verge" rated the Voyage as 9.1 of 10, stating that "this is the best E Ink e-reader I've used, and it's unquestionably the best that Amazon has ever made. The thing is, it's only marginally better than the fantastic Paperwhite in several ways, and significantly better in none" and with those differences in mind, disliked how it costs $80 more than the Paperwhite. "Engadget" rated the Voyage as 94 of 100, stating that while it was "easily the best e-reader that Amazon has ever crafted," it was also the priciest at $199.


title: Amazon Kindle

text: The third-iteration Kindle Paperwhite, marketed as the "All-New Kindle Paperwhite" and colloquially referred to as the Paperwhite 3 and Paperwhite 2015, was released on June 30, 2015, in the US. It is available in Wi-Fi ($120 ad-supported, $140 no ads) and Wi-Fi + 3G ($190 ad-supported, $210 no ads) models. It has a 6-inch, 1448×1072, 300 ppi E Ink Carta HD display, which is twice the pixels of the original Paperwhite and has the same touchscreen, four LEDs and size as the previous Paperwhite. It has over 3 GB of user accessible storage. This device improved on the display of PDF files, with the possibility to select text and use some functionalities, such as translation on a PDF's text. Amazon claims it has 6 weeks of battery life if used for 30 minutes per day with wireless off and brightness set to 10, which is about 21 hours.


title: Amazon Kindle

text: The Paperwhite 3 is the first e-reader to include the Bookerly font, a new font designed by Amazon, and includes updated formatting functions such as hyphenation and improved spacing. The Bookerly font was added to most older models via a firmware update. The official Amazon leather cover for the Paperwhite 3 is the same item as was used with the previous two Paperwhite devices.


title: Amazon Kindle

text: In February 2016, the Paperwhite 2, Paperwhite 3, Kindle 7, and Voyage received the 5.7.2 update that included a new home screen layout, an OpenDyslexic font choice, improved book recommendations, and a new quick actions menu.


title: Amazon Kindle

text: On June 30, 2016, Amazon released a white version of the Paperwhite 3 worldwide; the only thing different about this version is the color of the shell.


title: Amazon Kindle

text: In October 2016, Amazon released the Paperwhite 3 "Manga Model" in Japan that has a 33% increase in page-turning speed and includes 32 GB of storage, which is space for up to 700 manga books. The Manga model launched at 16,280 yen (~$156) for the ad-supported Wi-Fi version or 12,280 yen (~$118) for Prime members.


title: Amazon Kindle

text: "The Verge" rated the Paperwhite 3 as 9.0 of 10, saying that "The Kindle Paperwhite is the best e-reader for most people by a wide margin" and liked the high-resolution screen but disliked that there was no adaptive backlight; this is featured on the Kindle Voyage. "Popzara" called the 2015 Paperwhite "the best dedicated E Ink e-reader for the money."


title: Amazon Kindle

text: Amazon announced the first-iteration Kindle Oasis on April 13, 2016, and it was released on April 27 worldwide. The Kindle Oasis is available in Wi-Fi and Wi-Fi + 3G models. The Oasis has a 6-inch, 300 ppi E Ink Carta HD display with ten LEDs. Its asymmetrical design features physical page turn buttons on one side and it has an accelerometer so the display can be rotated for one-hand operation with either hand. It has one thicker side that tapers to an edge that is 20% thinner than the Paperwhite. It includes a removable leather battery cover for device protection and increased battery life that is available in either black, walnut (brown) or merlot (red); the cover fits in the tapered edge. The Oasis has 28 hours of battery life if used with the battery cover with Wi-Fi off. However, without the cover, the Oasis battery lasts about seven hours. It has nearly 3 GB of user storage. The Oasis includes the Bookerly (serif) font and it is the first Kindle to include the Amazon Ember (sans-serif) font.


title: Amazon Kindle

text: "The Guardian"'s reviewer praised the Oasis's ease for holding, its lightweight design, long battery life, excellent display, even front lighting, usable page-turn buttons, and the luxurious cover. However, the reviewer believed the product was overpriced, noted that the battery cover only partially protects the back, and that the reader is not waterproof. The reviewer concluded, "…the Paperwhite will likely be all the e-reader most will need, but Oasis is the one you'll want. The Oasis is the Bentley to the Paperwhite's Golf – both will get the job done, just one is a cut above the other." "The Verge" rated the Oasis as 9 of 10, praising its thinness, its weight without the cover and the ability to read with one hand, but did not like that it is so expensive, has no adaptive backlight like the Voyage and it is not waterproof.


title: Amazon Kindle

text: Amazon's upgrade of the standard Kindle was released on June 22, 2016, in both black and white colors ($80 ad-supported, $100 no ads). The Kindle 8 features a new rounded design that is shorter, narrower, thinner, and lighter than the previous Kindle 7, and features double the RAM (512 MB) of its predecessor. The Kindle 8 is the first Kindle to use Bluetooth that can support VoiceView screen reader software for the visually impaired. It has the same screen display as its predecessor, a 167 ppi E Ink Pearl touch-screen display, and Amazon claims it has a four-week battery life and can be fully charged within four hours.


title: Amazon Kindle

text: Amazon released the second-iteration Kindle Oasis, marketed as the "All-New Kindle Oasis" and colloquially referred to as the Oasis 2, on October 31, 2017. It is available in 8 GB Wi-Fi, 32 GB Wi-Fi and 32 GB Wi-Fi + 3G ($350 no ads) models with a 7-inch E Ink display with 300 ppi. It has an asymmetric design like the first-iteration Oasis, so it works for one-handed use, and the device finish is made from aluminum. The device has a black front, with either a silver or gold colored back. The Oasis 2 is the first Kindle to be IPX8 rated so it is water-resistant up to two meters for up to 60 minutes, and first to be able to change the background black and the text to white. It is frontlit with 12 LEDs, and has ambient light sensors to adjust the screen brightness automatically. It supports playback of Audible audiobooks by pairing with A2DP supported external Bluetooth 4.2 speakers or headphones; the device can store up to 35 audiobooks with 8 GB or 160 audiobooks with the 32 GB model. The Oasis 2's internal battery lasts about six weeks of reading at 30 minutes a day.


title: Amazon Kindle

text: "The Verge" gave the Oasis 2 a score of 8 of 10, praising its design, display, and water resistance, but criticizing its high cost and inability to read an e-book while its related audiobook is playing. Techradar rated it as 4.5 of 5, saying the Oasis 2 is expensive but it praises as the best e-reader at the time with its lovely metal design, waterproofing and great reading experience.


title: Amazon Kindle

text: Amazon announced the fourth-iteration Kindle Paperwhite on October 16, 2018, and released it on November 7, 2018; it is colloquially referred to as the Paperwhite 4 and Paperwhite 2018. It is available in 8 GB Wi-Fi, 32 GB Wi-Fi and 32 GB Wi-Fi + 4G LTE models. It features a 6-inch plastic-backed display of Amazon's own design with 300 ppi and a flush screen featuring five LED lights. It is waterproof with an IPX8 rating, allowing submersion in 2 meters of fresh water for up to one hour. It supports playback of Audible audio books only by pairing with external Bluetooth speakers or headphones.


title: Amazon Kindle

text: "The Verge" rated the Paperwhite 4 as 8.5 of 10, praising its great display, water-resistance and battery life but criticizing its lack of physical buttons and no USB-C support.


title: Amazon Kindle

text: Amazon announced the Kindle (10th generation) on March 20, 2019, which features the first front light available on a basic Kindle. The front light uses 4 LEDs compared to the Paperwhite with 5 LEDs. Kindle 10 uses a 6-inch display with higher contrast than previous basic Kindles and has the same 167 ppi resolution. It has black and white colors.


title: Amazon Kindle

text: Amazon released the third-iteration Kindle Oasis, colloquially referred to as the Oasis 3, on July 24, 2019. Externally it is nearly identical in appearance to the second-iteration Oasis, with a similar 7-inch, 300ppi E Ink display, adjustable warm light, one-handed design, waterproofing, aluminum exterior, Bluetooth support and Micro USB for charging. It adds a 25 LED front light that can adjust color temperature to warmer tones, the first Kindle to be able to do so. This device is available in two different colors; Graphite or Champagne Gold.


title: Amazon Kindle

text: "The Verge" gave the Oasis 3 an 8 of 10 rating, praising its design, display, and warmer E Ink display, but criticizing its high cost, no USB-C support and the lackluster update over the 2017 model.


title: Amazon Kindle

text: Amazon announced the Kindle Paperwhite (fifth iteration) on September 21, 2021, and it was released on October 27, 2021. It features 8 GB of storage and has similar dimensions to its predecessor but has a larger 6.8-inch display set in thinner bezels, 17 LEDs in the front light that can adjust color temperature to warmer tones (first featured in Kindle Oasis 3), an updated processor, and longer battery life that Amazon claims lasts up to ten weeks on a single charge. It is the first Kindle with a USB-C port. The Paperwhite 5 is also available in a higher cost Signature Edition that additionally supports Qi wireless charging, has 32 GB of storage, and includes a sensor that automatically adjusts the color temperature. Amazon has stated that some Qi chargers are incompatible and recommends using an Amazon charging dock.


title: Amazon Kindle

text: The Verge gave the Kindle Paperwhite (fifth iteration) 8.5 out of 10, praising the display and battery but did not like the lack of physical buttons and lack of support for e-books found outside of the Kindle Store. In September 2022, a model with 16 GB of storage was added.


title: Amazon Kindle

text: Amazon announced the Kindle (11th generation) on September 17, 2022. It is upgraded with a 300 ppi display, 16 GB of storage, and includes a USB-C port.


title: Amazon Kindle

text: Amazon announced the Kindle Scribe September 22, 2022 for availability Nov 30. It is similar to the Paperwhite, has 10.2 inch, 300 ppi display with a magnetically attaching basic or premium pen for writing, drawing, and annotating. Storage options are 16 GB, 32 GB or 64 GB.


title: Amazon Kindle

text: With the release of the Kindle Paperwhite in 2012, Amazon released a natural leather cover and a plastic back that is form-fitted for the device that weighs 5.6 ounces. The cover closes book-like from the left edge. The cover has magnets that activate the sleep/wake function in the Kindle when the cover is either closed or opened. The subsequent Amazon covers include this function.


title: Amazon Kindle

text: With the release of the Voyage in 2014, Amazon released two covers with either a polyurethane or a leather cover. The Voyage attaches to the rear of the Protective Cover magnetically and the case's cover folds over the top, and the case weighs 4.6 ounces. The case can fold into a stand, propping the Kindle up for hands-free reading. With the release of the Paperwhite 4 in 2018, Amazon released three versions of its cover: a water-safe fabric cover that can withstand brief exposure to water, a standard leather cover and a premium leather cover; these covers all weigh 4 ounces.


title: Amazon Kindle

text: In May 2016, Amazon released the official "Kindle Audio Adapter" for reading e-books aloud via a text-to-speech (TTS) system for the blind and visually impaired. This accessibility accessory, initially supported only for the Paperwhite 3 and Oasis, plugs in the USB port and connects to headphones or speakers. Once connected, the reader uses the Voiceview for Kindle feature to navigate the interface and listen to e-books via TTS. This feature only supports e-books, not audiobooks or music.


title: Amazon Kindle

text: Using the accessory reduces the Paperwhite 3's battery life to six hours. As an alternative to the official adapter, a generic USB to audio converter will also work with Voiceview.


title: Amazon Kindle

text: With the release of the 2021 Paperwhite Signature Edition, Amazon announced the Wireless Charging Dock which supports Qi charging up to 7.5 W.


title: Amazon Kindle

text: Kindle devices support dictionary and Wikipedia look-up functions when highlighting a word in an e-book. The font type, size and margins can be customized. Kindles are charged by connecting to a computer's USB port or to an AC adapter. Users needing accessibility due to impaired vision can use an audio adapter to listen to any e-book read aloud on supported Kindles, or those with difficulty in reading text may use the Amazon Ember Bold font for darker text and other fonts may too have bold font versions.


title: Amazon Kindle

text: The Kindle also contains experimental features such a web browser that uses NetFront based on WebKit. The browser can freely access the Kindle Store and Wikipedia on 3G models while the browser may be limited to 50 MB of data per month to websites other than Amazon and Wikipedia, Other possible experimental features, depending on the model are a "Text-to-Speech" engine that can read the text from e-books and an MP3 player that can be used to play music while reading.


title: Amazon Kindle

text: The Kindle's operating system updates are designed to be received wirelessly and installed automatically during a period in sleep mode in which Wi-Fi is turned on. A user may install firmware updates manually by downloading the firmware for their device and copying the file to the device's root directory. The Kindle operating system uses the Linux kernel with a Java app for reading e-books.


title: Amazon Kindle

text: Amazon offers an email-based service called "Send-to-Kindle" that allows the user to send files such as EPUB, PDF, HTML pages, Microsoft Word documents, GIF, PNG, and BMP graphics directly to the user's Kindle library at Amazon. When Amazon receives the file, it converts the file to Kindle File Format and stores it in the user's online library (called "Your Content" by Amazon). The Send-to-Kindle service's personal documents can be accessed by all Kindle hardware devices as well as iOS and Android devices using the Kindle app.


title: Amazon Kindle

text: Until August 2022, in addition to the document types mentioned above, this service can be used to send unprotected and original version only .mobi/.azw files to a user's Kindle library.


title: Amazon Kindle

text: Sending the file is free if downloaded using Wi-Fi, but, prior to 2021, cost $0.15 per MB when using Kindle's former 3G service.


title: Amazon Kindle

text: The first Kindle could read unprotected Mobipocket files (MOBI, PRC), plain text files (TXT), Topaz format books (TPZ) and Amazon's AZW format.


title: Amazon Kindle

text: The Kindle 2 added native PDF capability with the version 2.3 firmware upgrade. The Kindle 1 could not read PDF files, but Amazon provides experimental conversion to the native AZW format, with the caveat that not all PDFs may format correctly. The Kindle 2 added the ability to play the Audible Enhanced (AAX) format. The Kindle 2 can also display HTML files.


title: Amazon Kindle

text: The fourth and later generation Kindles, Touch, Paperwhite (all generations), Voyage and Oasis (all generations) can display AZW, AZW3, TXT, PDF, unprotected MOBI, and PRC files natively. HTML, DOC, DOCX, JPEG, GIF, PNG, and BMP are usable through Amazon's conversion service. The Keyboard, Touch, Oasis 2 & 3, Kindle 8 & 9, and Paperwhite 4 can also play Audible Enhanced (AA, AAX). The Kindle (7, 8 & 9), Kindle Paperwhite (2, 3, 4 & 5), Voyage and Oasis (1, 2 & 3) can display KFX files natively. KFX is Amazon's successor to the AZW3 format.


title: Amazon Kindle

text: Kindles cannot natively display EPUB files. However, at least two methods allow viewing the content of EPUB formatted content on Kindles:


title: Amazon Kindle

text: An e-book may be downloaded from Amazon to several devices at the same time, as long as the devices are registered to the same Amazon account. A sharing limit typically ranges from one to six devices, depending on an undisclosed number of licenses set by the publisher. When a limit is reached, the user must remove the e-book from some device or unregister a device containing the e-book in order to add the e-book to another device.


title: Amazon Kindle

text: The original Kindle and Kindle 2 did not allow the user to organize books into folders. The user could only select what type of content to display on the home screen and whether to organize by author, title, or download date. Kindle software version 2.5 allowed for the organization of books into "Collections" which behave like non-structured tags/labels: a collection can not include other collections, and one book may be added to multiple collections. These collections are normally set and organized on the Kindle itself, one book at a time. The set of all collections of a first Kindle device can be imported to a second Kindle device that is connected to the cloud and is registered to the same user; as the result of this operation, the documents that are on the second device now become organized according to the first device's collections. There is no option to organize by series or series order, as the AZW format does not possess the necessary metadata fields.


title: Amazon Kindle

text: X-Ray is a reference tool that is incorporated in Kindle Touch and later devices, the Fire tablets, the Kindle app for mobile platforms and Fire TV. X-Ray lets users explore in more depth the contents of a book, by accessing preloaded files with relevant information, such as the most common characters, locations, themes, or ideas.


title: Amazon Kindle

text: Users can bookmark, highlight, and search through content. Pages can be bookmarked for reference, and notes can be added to relevant content. While a book is open on the display, menu options allow users to search for synonyms and definitions from the built-in dictionary. The device also remembers the last page read for each book. Pages can be saved as a "clipping", or a text file containing the text of the currently displayed page. All clippings are appended to a single file, which can be downloaded over a USB cable. Due to the TXT format of the clippings file, all formatting (such as bold, italics, bigger fonts for headlines, etc.) is stripped off the original text.


title: Amazon Kindle

text: On July 18, 2011, Amazon began a program that allows college students to rent Kindle textbooks from three different publishers for a fixed period of time.


title: Amazon Kindle

text: Kindle devices may report information about their users' reading data that includes the last page read, how long each e-book was opened, annotations, bookmarks, notes, highlights, or similar markings to Amazon. The Kindle stores this information on all Amazon e-books but it is unclear if this data is stored for non-Amazon e-books. There is a lack of e-reader data privacy — Amazon knows the user's identity, what the user is reading, whether the user has finished the book, what page the user is on, how long the user has spent on each page, and which passages the user may have highlighted.


title: Amazon Kindle

text: Content from Amazon's Kindle Store is encoded in Amazon's proprietary Kindle formats (.azw, .kf8 and .kfx). In addition to published content, Kindle users can also access the Internet using the experimental web browser, which uses NetFront. Users can use the Kindle Store to access reading material using the Kindle itself or through a web browser to access content. The store features Kindle Unlimited for unlimited access to over one million e-books for a monthly fee.


title: Amazon Kindle

text: Content for the Kindle can be purchased online and downloaded wirelessly in some countries, using either standard Wi-Fi or Amazon's 3G "Whispernet" network. Whispernet is accessible without any monthly fees or a subscription, although fees can be incurred for the delivery of periodicals and other content when roaming internationally beyond the customer's home country. Through a service called "Whispersync," customers can synchronize reading progress, bookmarks, and other information across Kindle hardware and other mobile devices. The Kindles that only can access Whispernet via the 3G network had that network turned off in December 2021 due to the carriers retiring 3G.


title: Amazon Kindle

text: For U.S. customers traveling abroad, Amazon originally charged a $1.99 fee to download e-books over 3G while overseas, but later removed the fee. Fees remain for wireless 3G delivery of periodical subscriptions and personal documents, while Wi-Fi delivery has no extra charge.


title: Amazon Kindle

text: In addition to the Kindle Store, content for the Kindle can be purchased from various independent sources such as Fictionwise and Baen Ebooks. Public domain titles are also obtainable for the Kindle via content providers such as Project Gutenberg, The Internet Archive and the World Public Library. In 2011, the Kindle Store had more than twice as much paid content as its nearest competitor, Barnes & Noble.


title: Amazon Kindle

text: Public libraries that offer books via OverDrive, Inc. also lend titles for the Kindle and Kindle reading apps in the US. Books are checked out from the library's own site, which forwards to Amazon for the completion of the checkout process. Amazon then delivers the title to the Kindle for the duration of the loan, though some titles may require transfer via a USB connection to a computer. If the book is later checked out again or purchased, annotations and bookmarks are preserved.


title: Amazon Kindle

text: Amazon released the "Kindle for PC" application in late 2009, available for Microsoft Windows systems. This application allows ebooks from Amazon's store or personal ebooks to be read on a personal computer, with no Kindle device required. Amazon released a "Kindle for Mac" app for Apple Macintosh & OS X systems in early 2010. In June 2010, Amazon released the "Amazon Kindle for Android". Soon after the Android release, versions for the Apple iOS (iPhone and iPad) and BlackBerry OS phones were available. In January 2011, Amazon released "Kindle for Windows Phone". In July 2011, Kindle for HP TouchPad (running webOS) was released in the U.S. as a beta version. In August 2011, Amazon released an HTML5-based webapp for supported web browsers called "Kindle Cloud Reader". In 2013, Amazon has expressed no interest in releasing a separate Kindle application for Linux systems; the Cloud Reader can be used on supported browsers in Linux.


title: Amazon Kindle

text: On April 17, 2014, Samsung announced it would discontinue its own e-book store effective July 1, 2014 and it partnered with Amazon to create the "Kindle for Samsung" app optimized for display on Samsung Galaxy devices. The app uses Amazon's e-book store and it includes a monthly limited selection of free e-books.


title: Amazon Kindle

text: In June 2016, Amazon released the Page Flip feature to its Kindle applications that debuted on its e-readers a few years previously. This feature allows the user to flip through nine thumbnails of page images at a time.


title: Amazon Kindle

text: Concurrently with the release of the first Kindle device, Amazon launched Kindle Direct Publishing, used by authors and publishers to independently publish their books directly to Kindle and Kindle Apps worldwide. Authors can upload documents in several formats for delivery via Whispernet and charge between $0.99 and $200.00 per download.


title: Amazon Kindle

text: In a December 5, 2009 interview with "The New York Times", Amazon CEO Jeff Bezos revealed that Amazon keeps 65% of the revenue from all e-book sales for the Kindle; the remaining 35% is split between the book author and publisher. After numerous commentators observed that Apple's popular App Store offers 70% of royalties to the publisher, Amazon began a program that offers 70% royalties to Kindle publishers who agree to certain conditions. Some of these conditions, such as the inability to opt out of the lendability feature, have caused some controversy.


title: Amazon Kindle

text: On January 21, 2010, Amazon announced the release of its Kindle Development Kit (KDK). KDK aims to allow developers to build "active content" for the Kindle, and a beta version was announced with a February 2010 release date. A number of companies have already experimented with delivering active content through the Kindle's bundled browser, and the KDK gives sample code, documentation and a Kindle Simulator together with a new revenue sharing model for developers. The KDK is based on the Java programming language's Personal Basis Profile packaged Java APIs.


title: Amazon Kindle

text: , the Kindle store offered over 400 items labeled as active content. These items include simple applications and games, including a free set provided by Amazon Digital Services. As of 2014, active content is only available to users with a U.S. billing address.


title: Amazon Kindle

text: In October 2014, Amazon announced that the Voyage and future e-readers would not support active content because most users prefer to use apps on their smartphones and tablets, but the Paperwhite first-iteration and earlier Kindles would continue to support active content.


title: Amazon Kindle

text: Specific Kindle device sales numbers are not released by Amazon; however, according to anonymous inside sources, over three million Kindles had been sold as of December 2009, while external estimates, as of Q4-2009, place the number at about 1.5 million. According to James McQuivey of Forrester Research, estimates are ranging around four million, as of mid-2010.


title: Amazon Kindle

text: In 2010, Amazon remained the undisputed leader in the e-reader category, accounting for 59% of e-readers shipped, and it gained 14 percentage points in share. According to an International Data Corporation (IDC) study from March 2011, sales for all e-book readers worldwide reached 12.8 million in 2010; 48% of them were Kindles. In the last three months of 2010, Amazon announced that in the United States its e-book sales had surpassed sales of paperback books for the first time.


title: Amazon Kindle

text: In January 2011, Amazon announced that digital books were outselling their traditional print counterparts for the first time ever on its site, with an average of 115 Kindle editions being sold for every 100 paperback editions. In December 2011, Amazon announced that customers had purchased "well over" one million Kindles per week since the end of November 2011; this includes all available Kindle models and also the Kindle Fire tablet. IDC estimated that the Kindle Fire sold about 4.7 million units during the fourth quarter of 2011. Pacific Crest estimated that the Kindle Fire models sold six million units during Q4 2012.


title: Amazon Kindle

text: Morgan Stanley estimates that Amazon sold $3.57 billion worth of Kindle e-readers and tablets in 2012, $4.5 billion in Kindle device sales in 2013 and $5 billion in Kindle device sales in 2014.


title: Amazon Kindle

text: Working Kindles in good condition can be sold, traded, donated or recycled in the aftermarket. Due to some Kindle devices being limited to use as reading device and the hassle of reselling Kindles, some people choose to donate their Kindle to schools, developing countries, literacy organizations, or charities. "The Kindle Classroom Project" promotes reading by distributing donated Kindles to schools in need. Worldreader and ‘’Develop Africa’’ ships donated e-readers to schools in developing countries in Africa for educational use. "Project Hart" may take donations of e-readers that could be given to people in need.


title: Amazon Kindle

text: Whether in good condition or not, Kindles should not be disposed of in normal waste due to the device's electronic ink components and batteries. Instead, Kindles at the end of their useful life should be recycled. In the United States, Amazon runs their own program, 'Take Back', which allows owners to print out a prepaid shipping label, which can be used to return the device for disposal.


title: Amazon Kindle

text: On July 17, 2009, Amazon withdrew from sale two e-books by George Orwell, "Animal Farm" and "Nineteen Eighty-Four", refunding the purchase price to those who had bought them, and remotely deleted these titles from purchasers' devices without warning using a backdoor after discovering that the publisher lacked rights to publish these books. The two books were protected by copyright in the United States, but they were in the public domain in Canada, Australia and other countries. Notes and annotations for the books made by users on their devices were left in a separate file but "rendered useless" without the content to which they were directly linked. The move prompted outcry and comparisons to "Nineteen Eighty-Four" itself: in the novel, books, magazines, and newspapers in public archives that contradict the ruling party are either edited long after being published or destroyed outright; the removed materials go "down the memory hole", the nickname for an incinerator chute used in "1984". Customers and commentators noted the resemblance to the censorship in the novel, and described Amazon's action in Orwellian terms. Ars Technica argued that the deletion violated the Kindle's terms of service, which stated in part:


title: Amazon Kindle

text: Amazon spokesman Drew Herdener said that the company is "changing our systems so that in the future we will not remove books from customers' devices in these circumstances." On July 23, 2009, Amazon CEO Jeff Bezos posted on Amazon's official Kindle forum an apology about the company's handling of the matter. Bezos said the action was "stupid", and that the executives at Amazon "deserve the criticism received".


title: Amazon Kindle

text: On July 30, 2009, Justin Gawronski, a Michigan high school senior, and Antoine Bruguier, a California engineer, filed suit against Amazon in the United States District Court for the Western District of Washington. Bruguier argued that Amazon had violated its terms of service by remotely deleting the copy of "Nineteen Eighty-Four" he purchased, in the process preventing him from accessing annotations he had written. Gawronski's copy of the e-book was also deleted without his consent, and found Amazon used deceit in an email exchange. The complaint, which sought class-action status, asked for both monetary and injunctive relief. The case was settled on September 25, 2009, with Amazon agreeing to pay $150,000 divided between the two plaintiffs, on the understanding that the law firm representing them, Kamber Edelson, "will donate its portion of that fee to a charitable organization". In the settlement, Amazon also provided wider rights to Kindle owners over its e-books:


title: Amazon Kindle

text: On September 4, 2009, Amazon offered all affected users a choice of restoring of the deleted e-books or receiving an Amazon gift certificate or check for $US30.


title: Amazon Kindle

text: In December 2010, Amazon removed three e-books written by Selena Kitt, along with works by several other self-published erotic fiction authors, for "offensive" content regarding consensual incest that violated Amazon's publishing guidelines. Kitt stated her opinion this Amazon policy was selectively applied to some books but not others that feature similar themes. For what Amazon describes as "a brief period of time", the books were unavailable for redownload by users who had already purchased them. This ability was restored after it was brought to Amazon's attention; however, no remote deletion took place.


title: Amazon Kindle

text: In October 2012, Amazon suspended the account of a Norwegian woman who purchased her Kindle in the United Kingdom, and the company deleted every e-book on her Kindle. Amazon claimed that she had violated their terms of service but did not specify what she had done wrong. After the woman contacted the media, Amazon restored her account and her purchased e-books.


title: Amazon Kindle

text: Computer programmer Richard Stallman criticized the Kindle, citing Kindle terms of service which can censor users, which require the user's identification, and that can have a negative effect on independent book distributors; he also cited reported restrictions on Kindle users, as well the ability for Amazon to delete e-books and update software without the users' permission.


title: Amazon Kindle

text: Since 2012, Amazon has sold e-books in China and later began selling the Kindle e-book readers from 2013 onwards. Amazon had also announced that it has sold several million Kindles in the country and that China became the world's biggest regional market for the Kindle in 2016. However, it was reported that Chinese consumers prefer using their smartphones over e-readers, notwithstanding competition from Tencent, Alibaba, JD.com and Douban, each with their own e-book readers or marketplaces. Domestically developed e-book readers from brands like Xiaomi, iReader and Onyx Boox also offer added competition to the Kindle. In 2022, Amazon announced it had stopped selling its Kindles to distributors in China and stated the online bookstore service would shut down in China on June 30, 2023.


title: Amazon Kindle

text: On January 4, 2022, a Kindle shortage was reported on Amazon's JD.com flagship store. Only the Kindle 10 had remained available for sale while other models like the Paperwhite, Oasis and Kids Edition had become out of stock. On the same day, It was announced that Amazon had also shut its Tmall flagship store, after having already closed its Kindle flagship store on Taobao earlier in October 2021. These led to speculation that Amazon was planning to exit the Chinese market altogether, although an official Amazon representative responded that they remain committed to serving Chinese consumers and they can continue to purchase the Kindle through offline and third-party online retailers.


title: Amazon Kindle

text: In June 2022, Amazon announced that it will shut down its Kindle bookstore in China and starting July 2023 Kindle users can no longer purchase online books in the country. However, existing customers could still download previously bought titles until June 2024.


title: Amazon Kindle

text: Also in June 2022, self-published authors protested against Amazon's e-book return policy; whenever an e-book return is made, royalties originally paid to the author at the time of purchase are deducted from their earnings balance, leaving authors with negative balances.


title: Kenny Chesney

text: Kenneth Arnold Chesney (born March 26, 1968) is an American country music singer, songwriter, and guitarist. He has recorded more than 20 albums and has produced more than 40 Top 10 singles on the US "Billboard" Hot Country Songs and Country Airplay charts, 32 of which have reached number one. Many of these have also charted within the Top 40 of the US "Billboard" Hot 100, making him one of the most successful crossover country artists. He has sold over 30 million albums worldwide.


title: Kenny Chesney

text: Chesney has received twelve Country Music Association Awards (including winning their top Entertainer of the Year honor four times) and eleven Academy of Country Music Awards (including four consecutive Entertainer of the Year awards from 2005 to 2008), as well as six Grammy Award nominations. He is one of the most popular touring acts in country music, regularly selling out the venues in which he performs. His 2007 "Flip-Flop Summer" Tour was the highest-grossing country road trip of the year.


title: Kenny Chesney

text: Chesney was born on March 26, 1968, in Knoxville, Tennessee, United States, at St. Mary's Medical Center and was raised in Luttrell. He is of English and Irish descent. He is the son of David Chesney, a former elementary school teacher, and Karen Chandler, a hair stylist in the Knoxville area. Chesney has one sibling, a younger sister named Jennifer Chandler. In 1986, Chesney graduated from Gibbs High School, where he played baseball and football. He received his first guitar, "The Terminor", for Christmas and began teaching himself how to play it. Chesney studied advertising at East Tennessee State University in Johnson City, where he was a member of the ETSU Bluegrass Program and the Lambda Chi Alpha fraternity and graduated in 1990. In 1989, he recorded a self-released demo album at the Classic Recording Studio in Bristol, Virginia. He sold 1,000 copies while performing at the local clubs in Johnson City and used the money from album sales to help himself buy a new guitar. After graduation from East Tennessee State in 1990, he headed to Nashville and performed at several local clubs, including The Bluebird Cafe. He became the resident performer at The Turf, a honky tonk bar in the city's historic district.


title: Kenny Chesney

text: In 1992, the head of writer relations at BMI, Clay Bradley, recommended Chesney to his friend, Troy Tomlinson, at Opryland Music Group by saying: "I met this kid today from East Tennessee. He's a good singer, a good songwriter, and more than anything, I think you're going to really like him as a person." Chesney performed five songs during his audition for Tomlinson. Tomlinson's reaction was enthusiastic, later telling HitQuarters:


title: Kenny Chesney

text: First of all I was attracted to the songs, because I thought that he painted great pictures in his lyrics, particularly for someone who had not been around the typical Music Row co-writes. I thought that he sang very well too. But more than anything there was a kind of this 'I-will-do-it' look in his eyes – I was really drawn in by the fact that he was so set on being successful in this business.


title: Kenny Chesney

text: Chesney left the audition with a songwriter's contract. A year later, an appearance at a songwriter's showcase led to a contract with Capricorn Records, which had recently started a country division.


title: Kenny Chesney

text: Chesney's debut album, "In My Wildest Dreams", was released on the independent Capricorn Records label in April 1994. The album's first two singles, "Whatever It Takes" and "The Tin Man", both reached the lower regions of the U.S. "Billboard" Hot Country Singles & Tracks chart. The album sold approximately 10,000 copies before Capricorn Records closed its country music division in Nashville later that year and moved to Atlanta.


title: Kenny Chesney

text: Chesney then signed with BNA Records, and released his second studio album "All I Need to Know" in 1995. The album produced three singles. "Fall in Love" and the title track both reached the Top 10, while "Grandpa Told Me So" peaked at number 23. That same year, Chesney co-wrote Confederate Railroad's single "When He Was My Age" from their album "When and Where". Chesney utilized fiddle and steel instrumentation within this album in order to highlight the down-home sentiments and the unique Tennessee twang in his voice. This album seemed to capture the traditional spirit that made country music popular.


title: Kenny Chesney

text: Chesney's third studio album and his second major-label one, entitled "Me and You", was released in 1996. Its first single, "Back In My Arms Again", peaked just outside the Top 40 on the country charts, while its title track (which Chesney had recorded on his previous album) and "When I Close My Eyes" (which was previously recorded by Keith Palmer on his 1991 debut album and then by Larry Stewart on his 1993 debut album "Down the Road") both peaked at number 2. "Me and You" was Chesney's first album to be certified gold by the Recording Industry Association of America (RIAA). A cover of Mac McAnally's 1990 single "Back Where I Come From" was also included on this album. Even though Chesney's version was never released as a single, it has been regularly performed during his concerts. In recognition of his successful year, Chesney was honored with the 1997 Academy of Country Music's New Male Vocalist of the Year award.


title: Kenny Chesney

text: "I Will Stand", Chesney's fourth album and his third from BNA Records, followed in 1997. The album's first single, "She's Got It All", became Chesney's first number one hit on the "Billboard" country charts and spent three weeks at that position. The album's second single, "A Chance", peaked just shy of the Top 10. The third single, "That's Why I'm Here", peaked at number 2 in 1998.


title: Kenny Chesney

text: "Everywhere We Go", Chesney's fourth album from BNA, came in 1999. That album produced two consecutive number one hits with "How Forever Feels" and "You Had Me from Hello" (the latter inspired by a line in the movie "Jerry Maguire"). The album also produced two more singles with "She Thinks My Tractor's Sexy" and "What I Need to Do", which peaked at numbers 11 and 8 on the country charts, respectively. "Everywhere We Go" was Chesney's first album to be certified platinum. The album marked a departure from his original neotraditional country sound, to his more familiar country pop/trop rock/Gulf and Western sound he has since become known for.


title: Kenny Chesney

text: By 2000, Chesney released his "Greatest Hits" compilation album. It included four new tracks, as well as updated versions of "Fall in Love", "The Tin Man", and "Back Where I Come From". The new version of "The Tin Man" was one of the disc's three singles, along with two of the new tracks, "I Lost It" and "Don't Happen Twice". In 2001 he performed with Kid Rock at a Waylon Jennings tribute concert covering Waylon's song Luckenbach Texas.


title: Kenny Chesney

text: The album "No Shoes, No Shirt, No Problems" was released in 2002. Its lead-off single, "Young", peaked at number 2, while the follower "The Good Stuff" spent seven weeks at number 1 and became "Billboard"s number one country song of the year for 2002. The video for "Young" was honored by CMT with the Video of the Year and Male Video of the Year awards for 2002. In 2003, ACM honored Chesney as Top Male Vocalist of the Year, while "The Good Stuff" received the award for Single Record of the Year. CMT later recognized the video for the album's title track as the Hottest Video of the Year.


title: Kenny Chesney

text: In 2003, Chesney recorded "All I Want for Christmas Is a Real Good Tan". The album's title track peaked at No. 30 on the country charts from holiday airplay. Other notable work Chesney did in 2003 is that he co wrote Kid Rock's single "Cold and Empty" from his self-titled 6th studio album "Kid Rock".


title: Kenny Chesney

text: 2004 saw the release of the album "When the Sun Goes Down". Its lead-off single, "There Goes My Life", spent seven weeks at number one on the "Billboard" country charts. On April 21, 2004, the accompanying music video for that song was honored by CMT with the Male Video of the Year award. The album's title track, a duet with Uncle Kracker, also went to number one. The music video for the album's third single, "I Go Back", was honored on April 11, 2005, with Country Music Television's Male Video of the Year Award. This song, along with the album's fourth single, "The Woman with You", both peaked at number two. The fifth single, "Anything But Mine", reached number one, and the final single, "Keg in the Closet", peaked to number six.


title: Kenny Chesney

text: "When the Sun Goes Down" was honored with the 2004 CMA award for Album of the Year while Chesney was honored as the Entertainer of the Year. He was also presented with AMA's 2004 Artist of the Year award.


title: Kenny Chesney

text: In January 2005, Chesney released the album "Be as You Are (Songs from an Old Blue Chair)", supporting it with his Somewhere in the Sun Tour. "Be as You Are" is composed mostly of ballads. The album qualified for RIAA Platinum and entered the top of both mainstream country and pop music.


title: Kenny Chesney

text: In spring 2005, Chesney was honored with the prestigious Triple-Crown Award presented by the Academy of Country Music. This award was presented after Chesney's 2004 Academy of Country Music's Entertainer of the Year award was combined with 1997's New Male Vocalist of the Year award and 2003's Top Male Vocalist of the Year award. The following year, on May 23, 2006, Chesney was honored with his second Entertainer of the Year at the Academy of Country Music Awards.


title: Kenny Chesney

text: Chesney's next album, "The Road and the Radio", debuted at number one the "Billboard" 200 and produced five singles. "Living in Fast Forward", "Summertime", and "Beer in Mexico" all reached number one, while "Who You'd Be Today" and "You Save Me" both broke the Top 5. Chesney promotes his beliefs of perfection, as getting songs right in the studio, ultimately leads to performing it right on the road and on the radio.


title: Kenny Chesney

text: "Live: Live Those Songs Again", Chesney's first live album was released on September 19, 2006, via BNA Records. This album includes live renditions of 15 songs, 11 of which were singles. "Live Those Songs", "Never Gonna Feel Like That Again", "On the Coast of Somewhere Beautiful", and "Back Where I Come From" were never released by Chesney as singles, although "Back Where I Come From" was released as a single from Mac McAnally's 1990 album "Simple Life".


title: Kenny Chesney

text: Chesney collaborated with one of his personal heroes, Jimmy Buffett, on a remake of Hank Williams' single "Hey Good Lookin' (with Clint Black, Alan Jackson, Toby Keith, and George Strait), and a second song "License To Chill". Both songs are on Buffett's 2004 album "License To Chill".


title: Kenny Chesney

text: Chesney, along with Tim McGraw, contributed to a version of Tracy Lawrence's single "Find Out Who Your Friends Are", which can be found on his album "For the Love". The official single version, only featuring Lawrence's vocals, was released in August 2006 but did not reach the Top 40 on the country charts until January 2007, when 'the album was released. After the album's release, the version with him, Chesney, and McGraw began receiving significant airplay, helping to boost the single to No. 1 on the country charts. The song became Lawrence's first No. 1 single in 11 years, as well as the second-slowest climbing No. 1 single in the history of the "Billboard" music charts.


title: Kenny Chesney

text: With Neil Thrasher and Wendell Mobley, Chesney also co-wrote Rascal Flatts' 2007 single Take Me There", which served as the lead-off single to their album "Still Feels Good".


title: Kenny Chesney

text: Chesney also recorded a duet with Reba McEntire on her No. 1 2007 album "". "Every Other Weekend" peaked at No. 15 on the "Billboard" Hot Country Songs chart and No. 104 on the "Billboard" Bubbling Under Hot 100 Singles chart. The album has sold 2.1 million copies world-wide and is certified Platinum by the RIAA for sales of over 1 million. "Every Other Weekend" was the final single from the album.


title: Kenny Chesney

text: On November 7, 2007, Chesney was named the CMA Entertainer of the Year for the third time in four years. The following week, on November 15, 2007, the compilation "Super Hits" album was released as part of Sony BMG's "Super Hits" series.


title: Kenny Chesney

text: On September 11, 2007, Chesney released the album "". This album represented a move to a more gulf and western sound with a number of "breezy, steel-drum island songs". Kanye West and 50 Cent's albums "Graduation" and "Curtis" were both released that same day. Those artists were in the midst of a competitive sales war, with the latter claiming that he would end his solo rap career if West sold more albums than he did (remarks he later retracted as terms of his contract conflicted with the promise). Chesney, however, decided that he would give country music a place in the competition, claiming country artists were just as popular as those in the rap genre. Chesney came in third place in record sales among the three musical artists.


title: Kenny Chesney

text: The lead-off single from "Just Who I Am: Poets & Pirates" was "Never Wanted Nothing More". That song became Chesney's twelfth number one hit on the "Billboard" country charts. On the U.S. "Billboard" Hot Country Songs chart dated for the week ending on September 15, 2007, the album's second single "Don't Blink" debuted at No. 16, setting a new record for the highest debut on that chart since the inception of SoundScan electronic tabulation in 1990. This record was broken one week later by Garth Brooks' "More Than a Memory", which debuted at No. 1 on the same chart, making it the first song ever to do so. The third single, "Shiftwork" (a duet with George Strait) peaked at No. 2 on the country charts. During the week of June 28, 2008, the fourth and final single, "Better as a Memory", became Chesney's fourteenth number one hit.


title: Kenny Chesney

text: Chesney started his "Poets and Pirates Tour" on April 26, 2008, at Williams-Brice Stadium in Columbia, South Carolina. During the introduction of his set, his boot got caught between a hydraulic lift and the lip of the stage surface, which crushed his foot causing a severe hematoma in the ankle; most of the damage was centering within his toes. It took about 30 seconds for Chesney to pry his foot loose as he squatted down on the stage while the band continued to play an extended introduction of the song. When Chesney finally freed himself, he stood up and held his hand on his knee as he began singing.


title: Kenny Chesney

text: Chesney did not acknowledge the injury during the early part of his performance. However, he was visibly limping and seemed to rest near a drum riser while leaning over and holding his knee during the instrumental breaks of his songs. As he came offstage, a doctor from the University of South Carolina cut off Chesney's cowboy boot and immediately began treating the foot injury. X-rays that were taken afterwards revealed several crushed bones in his right foot.


title: Kenny Chesney

text: That injury did not have him cancel any shows, as saying "[the doctor] told me it's going to hurt – though nothing could hurt worse than Saturday, I don't think – and they can give me something to deaden the pain when I get out there. I also have to have a doctor standing by should something give, but I'm going to tape it up, and I'm going to get out there".


title: Kenny Chesney

text: On May 19, 2008, just a day after being honored as the ACM Entertainer of the Year at the 43rd Annual Academy of Country Music Awards, Chesney criticized the lack of choice in the producers' awarding the honor based on fan votes. "The entertainer of the year trophy is supposed to represent heart and passion and an amazing amount of sacrifice, commitment and focus", he said. "That's the way Garth [Brooks] won it four times, that's the way I won it, that's the way [George] Strait won it, Reba [McEntire], Alabama all those years. That's what it's supposed to represent."


title: Kenny Chesney

text: On July 24, 2008, Chesney announced that he would be releasing a new single from an upcoming album entitled "Lucky Old Sun". The song was titled "Everybody Wants to Go to Heaven", and for the chart week of August 16, 2008, it debuted at No. 22 on the "Billboard" Hot Country Songs chart. The album was released on October 14, 2008. "Everybody Wants to Go to Heaven" became a No. 1 hit. It was followed by a cover of Mac McAnally's 1990 single "Down the Road".


title: Kenny Chesney

text: Chesney's 2009 tour was titled the "Sun City Carnival Tour" and featured both small and large venues in order to keep his ticket prices down. The tour included a performance at Gillette Stadium again, marking the fifth year in a row that he played at the Foxboro, Massachusetts football field.


title: Kenny Chesney

text: In May 2009, Chesney released his second compilation album, "Greatest Hits II". This album included the No. 1 hit, "Out Last Night", as the lead single. On February 9, 2010, this album was re-released with two new tracks "This Is Our Moment" and "Ain't Back Yet", with the latter becoming the album's third single in February 2010. Also included on this album is one that Willie Nelson recorded before Chesney did, "I'm Alive". Chesney himself later recorded a version of the song as a duet with Dave Matthews. This version was released in August 2009 as the album's second single.


title: Kenny Chesney

text: In July 2010, Chesney released "The Boys of Fall" as the lead-off single from his album "Hemingway's Whiskey", which was released in September 2010. The song hit No. 1 on the Hot Country Songs chart for the week of October 9, 2010, marking Chesney's eighteenth number one hit.


title: Kenny Chesney

text: The second single from "Hemingway's Whiskey", "Somewhere with You", was released in November 2010. The song debuted at No. 35 on the country chart for the week of November 6, 2010. Both it and its followup, "Live a Little", went to number 1 on the country charts. The next single was "You and Tequila", co-written and originally recorded by Deana Carter. Chesney's rendition, which featured Grace Potter on backing vocals, went to number 3. After it, "Reality" also went to number 1.


title: Kenny Chesney

text: Chesney produced and narrated a biographical film, "The Color Orange", on his favorite football player growing up, University of Tennessee quarterback and Canadian Football League hall-of-fame Condredge Holloway. The film was produced for ESPN's "Year of the Quarterback" series, and premiered on February 20, 2011.


title: Kenny Chesney

text: Chesney released his fourteenth studio album, "Welcome to the Fishbowl", on June 19, 2012. Its lead-off single, a Tim McGraw duet titled "Feel Like a Rock Star", debuted at number 13 on the country charts, making it the second-highest debuting country song since the "Billboard" charts were first tabulated via Nielsen SoundScan, and the highest-debuting duet on that chart. Despite its high debut, the song peaked at number 11 only six weeks later before falling.


title: Kenny Chesney

text: BNA Records closed in June 2012. As a result, Chesney was transferred to Columbia Nashville. His first release under Columbia was the album's second single, "Come Over", which went to number 1. The album's third and final single was "El Cerrito Place", which was written by Keith Gattis and originally recorded by Charlie Robison. Chesney's rendition, which featured Grace Potter on backing vocals, went to number 10 on the country charts.


title: Kenny Chesney

text: Chesney released his fifteenth studio album, "Life on a Rock", on April 30, 2013. The first single from the album, "Pirate Flag", was released to iTunes on February 5, 2013, and peaked at number 3 on the Country Airplay chart in May 2013. Pirate Flag peaked at number 7 on Billboard's Hot Country Songs chart, May 25, 2013. The album's second single, "When I See This Bar", was released to country radio on June 10, 2013. When I see This Bar peaked at number 25 on Billboard's Hot Country Songs chart, September 14, 2013. This specific album was a drastic change from his regular country feel, to an all beach and island touch.


title: Kenny Chesney

text: In June 2014, Chesney released the new song "American Kids" to radio. This song served as the lead-off single from his sixteenth studio album "The Big Revival", which was released on September 23, 2014. The album's second single, "Til It's Gone", was released in mid-October. It reached number one on the Country Airplay chart the week of January 31, 2015. The third single "Wild Child", which is a duet with Grace Potter, was released two days later. It reached number one on the Country Airplay chart the week of June 27, 2015. The album's fourth single, "Save It for a Rainy Day", was released to country radio on June 29, 2015. It reached number one on the Country Airplay chart the week of October 9, 2015.


title: Kenny Chesney

text: On October 24, Chesney announced his 2015 tour "The Big Revival Tour", which began on March 26, 2015. On October 27, he and Jason Aldean announced that they would perform 10 joint stadium shows in the summer of that year. Two days later, Brantley Gilbert announced that he would be opening for the Chesney/Aldean stadium shows, as well as five additional shows on Chesney's solo tour.


title: Kenny Chesney

text: On March 7, 2016, Chesney announced that he was in the studio working on new music. The lead single to the album is titled "Noise", which was released to country radio on March 24, 2016. The album, "Cosmic Hallelujah", was released on October 28. The second song in the album, "Setting the World on Fire", featuring singer P!NK was released to country radio on July 28, 2016.


title: Kenny Chesney

text: On August 25, 2012, at Gillette Stadium in Foxborough, Massachusetts, Kenny Chesney announced to his fans that he would call his fan following No Shoes Nation. The term No Shoes Nation originated from Chesney's hit song "No Shoes, No Shirt, No Problem". The symbol of No Shoes Nation is a black flag with a white skull and crossbones. The name was accompanied by a live album called "Live in No Shoes Nation", which topped the "Billboard" 200 after its release in late 2017. No Shoes Nation inspired the name of Chesney's Sirius XM channel, No Shoes Radio.


title: Kenny Chesney

text: In January 2018, it was announced that Chesney had ended his contract with Sony Music Nashville and signed to Warner Bros. Records Nashville. Chesney released his first album with Warner, entitled "Songs for the Saints", on July 27, 2018.


title: Kenny Chesney

text: In March 2020, he announced a new album called "Here and Now", which features the title track and "Tip of My Tongue", a leadoff single that was released in mid-2019. The album debuted at number one and became Chesney's 16th top 10 album on the US "Billboard" 200, with 233,000 units.


title: Kenny Chesney

text: In 2000, Chesney and Tim McGraw became involved in a scuffle with police officers in Buffalo, New York, after Chesney attempted to ride a police horse. McGraw came to Chesney's aid after police officers nearby believed the horse was being stolen. The two were arrested and charged, Chesney for disorderly conduct and McGraw for assault, but were acquitted in 2001.


title: Kenny Chesney

text: On May 9, 2005, Chesney married actress Renée Zellweger in a ceremony on the island of St. John. They had met in January at a tsunami relief event. On September 15 of that same year, after only four months of marriage, they announced their plans for an annulment. Zellweger cited fraud as the reason in the related papers, and after media scrutiny of her use of the word "fraud," she qualified the use of the term, stating that it was "simply legal language and not a reflection of Kenny's character." Chesney later suggested the failure of his marriage was due to "the fact that I panicked." In an interview by "60 Minutes" with Anderson Cooper, Chesney commented on the failed marriage, "The only fraud that was committed was me thinking that I knew what it was like… that I really understood what it was like to be married, and I really didn't." The annulment was finalized in late December 2005.


title: Kenny Chesney

text: In 2017, Chesney came to the aid of the U.S. and British Virgin Islands victims of Hurricane Irma, one of whom was given a free lift to the mainland United States. Chesney owns a mansion on St. John in the U.S. Virgin Islands, where many stayed to weather the storm. Chesney also set up a charitable fund, Love for Love City, to help victims of the storm. Chesney will donate all proceeds from "Songs for the Saints" to the fund.


title: Kenny Chesney

text: Chesney won the "Billboard" Touring Award for Top Package Tour five consecutive years between 2005 and 2009, and again in 2011


title: Heart failure

text: Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, and leg swelling. The shortness of breath may occur with exertion or while lying down, and may wake people up during the night. Chest pain, including angina, is not usually caused by heart failure, but may occur if the heart failure was caused by a heart attack. The severity of the heart failure is measured by the severity of symptoms during exercise. Other conditions that may have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.


title: Heart failure

text: Common causes of heart failure include coronary artery disease, heart attack, high blood pressure, atrial fibrillation, valvular heart disease, excessive alcohol consumption, infection, and cardiomyopathy. These cause heart failure by altering the structure or the function of the heart or in some cases both. There are different types of heart failure: right-sided heart failure, which affects the right heart, left-sided heart failure, which affects the left heart, and biventricular heart failure, which affects both sides of the heart. Left-sided heart failure may be present with a reduced ejection fraction or with a preserved ejection fraction. Heart failure is not the same as cardiac arrest, in which blood flow stops completely due to the failure of the heart to pump effectively.


title: Heart failure

text: Diagnosis is based on symptoms, physical findings, and echocardiography. Blood tests, and a chest x-ray may be useful to determine the underlying cause.


title: Heart failure

text: Treatment depends on severity and case. For people with chronic, stable, mild heart failure, treatment usually consists of lifestyle changes, such as not smoking, physical exercise, and dietary changes, as well as medications. In heart failure due to left ventricular dysfunction, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or valsartan/sacubitril along with beta blockers are recommended. In severe disease, aldosterone antagonists or hydralazine with a nitrate can be used. Diuretics may also be prescribed to prevent fluid retention and the resulting shortness of breath. Depending on the case, an implanted device such as a pacemaker or implantable cardiac defibrillator may sometimes be recommended. In some moderate or more severe cases, cardiac resynchronization therapy (CRT) or cardiac contractility modulation may be beneficial. In severe disease that persists despite all other measures, a cardiac assist device ventricular assist device (for the left, right, or both heart chambers), or, occasionally, heart transplantation may be recommended.


title: Heart failure

text: Heart failure is a common, costly, and potentially fatal condition, and is the leading cause of hospitalization and readmission in older adults. Heart failure often leads to more drastic health impairments than failure of other, similarly complex organs such as the kidneys or liver. In 2015, it affected about 40 million people worldwide. Overall, heart failure affects about 2% of adults, and as many as 6-10% of those over the age of 65. Rates are predicted to increase. The risk of death in the first year after diagnosis is about 35%, while the risk of death in the second year is less than 10% in those still alive. The risk of death is comparable to that of some cancers. In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions. Heart failure has been known since ancient times, it is mentioned in the Ebers Papyrus around 1550 BCE.


title: Heart failure

text: Heart failure is not a disease but a syndrome - a combination of signs and symptoms caused by the failure of the heart to pump blood to support the circulatory system at rest or during activity. It develops when the heart fails to properly fill with blood during diastole, resulting in a decrease in intracardiac pressures or in ejection during systole, reducing cardiac output to the rest of the body. The filling failure and high intracardiac pressure can lead to fluid accumulation in the veins and tissue. This manifests as water retention and swelling due to fluid accumulation (edema) called congestion. Impaired ejection can lead to inadequate blood flow to the body tissues, resulting in ischemia.


title: Heart failure

text: Congestive heart failure is a pathophysiological condition in which the heart's output is insufficient to meet the needs of the body and lungs. The term "congestive heart failure" is often used because one of the most common symptoms is congestion or fluid accumulation in the tissues and veins of the lungs or other parts of a person's body. Congestion manifests itself particularly in the form of fluid accumulation and swelling (edema), both in the form of peripheral edema (causing swollen limbs and feet) and pulmonary edema (causing difficulty breathing) and ascites (swollen abdomen).


title: Heart failure

text: Symptoms of heart failure are traditionally divided into left-sided and right-sided because the left and right ventricles supply different parts of the circulation, but sufferers often have both types of signs and symptoms. In biventricular heart failure, both sides of the heart are affected. Left-sided heart failure is the more common.


title: Heart failure

text: The left side of the heart takes oxygen-rich blood from the lungs and pumps it to the rest of the circulatory system in the body, except for the pulmonary circulation). Failure of the left side of the heart causes blood to back up into the lungs, causing breathing difficulties and fatigue due to an insufficient supply of oxygenated blood. Common respiratory signs include increased respitatory rate and labored breathing (nonspecific signs of shortness of breath). Rales or crackles heard initially in the lung bases and when severe in all lung fields indicate the development of pulmonary edema (fluid in the alveoli). Cyanosis, indicates deficiency of oxygen in the blood, is a late sign of extremely severe pulmonary edema.


title: Heart failure

text: Other signs of left ventricular failure include a laterally displaced apex beat (which occurs when the heart is enlarged) and a gallop rhythm (additional heart sounds), which may be heard as a sign of increased blood flow or increased intracardiac pressure. Heart murmurs may indicate the presence of valvular heart disease, either as a cause (e.g., aortic stenosis) or as a consequence (e.g., mitral regurgitation) of heart failure.


title: Heart failure

text: "Reverse" insufficiency of the left ventricle causes congestion in the blood vessels of the lungs, so that symptoms are predominantly respiratory. Reverse insufficiency can be divided into the failure of the left atrium, the left ventricle, or both within the left circuit. Patients will experience shortness of breath (dyspnea) on exertion and, in severe cases, dyspnea at rest. Increasing breathlessness while lying down, called orthopnea, also occurs. It can be measured by the number of pillows required to lie comfortably, with extreme cases of orthopnea forcing the patient to sleep sitting up. Another symptom of heart failure is paroxysmal nocturnal dyspnea: a sudden nocturnal attack of severe shortness of breath, usually occurring several hours after falling asleep. There may be "cardiac asthma" or wheezing. Impaired left ventricular "forward" function can lead to symptoms of poor systemic perfusion such as dizziness, confusion, and cool extremities at rest.


title: Heart failure

text: Right-sided heart failure is often caused by pulmonary heart disease (cor pulmonale), which is typically caused by issues with pulmonary circulation such as pulmonary hypertension or pulmonic stenosis. Physical examination may reveal pitting peripheral edema, ascites, liver enlargement, and spleen enlargement. Jugular venous pressure is frequently assessed as a marker of fluid status, which can be accentuated by testing hepatojugular reflux. If the right ventricular pressure is increased, a parasternal heave which causes the compensatory increase in contraction strength may be present.


title: Heart failure

text: "Backward" failure of the right ventricle leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body. This causes swelling under the skin (peripheral edema or anasarca) and usually affects the dependent parts of the body first, causing foot and ankle swelling in people who are standing up and sacral edema in people who are predominantly lying down. Nocturia (frequent night-time urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. In progressively severe cases, ascites (fluid accumulation in the abdominal cavity causing swelling) and liver enlargement may develop. Significant liver congestion may result in impaired liver function (congestive hepatopathy), jaundice, and coagulopathy (problems of decreased or increased blood clotting).


title: Heart failure

text: Dullness of the lung fields when percussed and reduced breath sounds at the base of the lungs may suggest the development of a pleural effusion (fluid collection between the lung and the chest wall). Though it can occur in isolated left- or right-sided heart failure, it is more common in biventricular failure because pleural veins drain into both the systemic and pulmonary venous systems. When unilateral, effusions are often right-sided.


title: Heart failure

text: If a person with a failure of one ventricle lives long enough, it will tend to progress to failure of both ventricles. For example, left ventricular failure allows pulmonary edema and pulmonary hypertension to occur, which increase stress on the right ventricle. Though still harmful, right ventricular failure is not as deleterious to the left side.


title: Heart failure

text: Since heart failure is a syndrome and not a disease, establishing the underlying cause is vital to diagnosis and treatment.


title: Heart failure

text: Heart failure is the potential end stage of all heart diseases. Common causes of heart failure include coronary artery disease, including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause. In addition, viral infections of the heart can lead to inflammation of the muscular layer of the heart and subsequently contribute to the development of heart failure. Genetic predisposition plays an important role. If more than one cause is present, progression is more likely and prognosis is worse.


title: Heart failure

text: Heart damage can predispose a person to develop heart failure later in life and has many causes including systemic viral infections (e.g., HIV), chemotherapeutic agents such as daunorubicin, cyclophosphamide, trastuzumab and substance use disorders of substances such as alcohol, cocaine, and methamphetamine. An uncommon cause is exposure to certain toxins such as lead and cobalt. Additionally, infiltrative disorders such as amyloidosis and connective tissue diseases such as systemic lupus erythematosus have similar consequences. Obstructive sleep apnea (a condition of sleep wherein disordered breathing overlaps with obesity, hypertension, and/or diabetes) is regarded as an independent cause of heart failure. Recent reports from clinical trials have also linked variation in blood pressure to heart failure and cardiac changes that may give rise to heart failure.


title: Heart failure

text: High-output heart failure happens when the amount of blood pumped out is more than typical and the heart is unable to keep up. This can occur in overload situations such as blood or serum infusions, kidney diseases, chronic severe anemia, beriberi (vitamin B/thiamine deficiency), hyperthyroidism, cirrhosis, Paget's disease, multiple myeloma, arteriovenous fistulae, or arteriovenous malformations.


title: Heart failure

text: Chronic stable heart failure may easily decompensate. This most commonly results from a concurrent illness (such as myocardial infarction (a heart attack) or pneumonia), abnormal heart rhythms, uncontrolled hypertension, or a person's failure to maintain a fluid restriction, diet, or medication.


title: Heart failure

text: Other factors that may worsen CHF include: anemia, hyperthyroidism, excessive fluid or salt intake, and medication such as NSAIDs and thiazolidinediones. NSAIDs increase the risk twofold.


title: Heart failure

text: A number of medications may cause or worsen the disease. This includes NSAIDs, COX-2 inhibitors, a number of anesthetic agents such as ketamine, thiazolidinediones, some cancer medications, several antiarrhythmic medications, pregabalin, alpha-2 adrenergic receptor agonists, minoxidil, itraconazole, cilostazol, anagrelide, stimulants (e.g., methylphenidate), tricyclic antidepressants, lithium, antipsychotics, dopamine agonists, TNF inhibitors, calcium channel blockers (especially verapamil and diltiazem), salbutamol, and tamsulosin.


title: Heart failure

text: By inhibiting the formation of prostaglandins, NSAIDs may exacerbate heart failure through several mechanisms, including promotion of fluid retention, increasing blood pressure, and decreasing a person's response to diuretic medications. Similarly, the ACC/AHA recommends against the use of COX-2 inhibitor medications in people with heart failure. Thiazolidinediones have been strongly linked to new cases of heart failure and worsening of pre-existing congestive heart failure due to their association with weight gain and fluid retention. Certain calcium channel blockers, such as diltiazem and verapamil, are known to decrease the force with which the heart ejects blood, thus are not recommended in people with heart failure with a reduced ejection fraction.


title: Heart failure

text: Certain alternative medicines carry a risk of exacerbating existing heart failure, and are not recommended. This includes aconite, ginseng, gossypol, gynura, licorice, lily of the valley, tetrandrine, and yohimbine. Aconite can cause abnormally slow heart rates and abnormal heart rhythms such as ventricular tachycardia. Ginseng can cause abnormally low or high blood pressure, and may interfere with the effects of diuretic medications. Gossypol can increase the effects of diuretics, leading to toxicity. Gynura can cause low blood pressure. Licorice can worsen heart failure by increasing blood pressure and promoting fluid retention. Lily of the valley can cause abnormally slow heart rates with mechanisms similar to those of digoxin. Tetrandrine can lead to low blood pressure through inhibition of L-type calcium channels. Yohimbine can exacerbate heart failure by increasing blood pressure through alpha-2 adrenergic receptor antagonism.


title: Heart failure

text: Heart failure is caused by any condition that reduces the efficiency of the heart muscle, through damage or overloading. Over time, these increases in workload, which are mediated by long-term activation of neurohormonal systems such as the renin–angiotensin system and the sympathoadrenal system, lead to fibrosis, dilation, and structural changes in the shape of the left ventricle from elliptical to spherical.


title: Heart failure

text: The heart of a person with heart failure may have a reduced force of contraction due to overloading of the ventricle. In a normal heart, increased filling of the ventricle results in increased contraction force by the Frank–Starling law of the heart, and thus a rise in cardiac output. In heart failure, this mechanism fails, as the ventricle is loaded with blood to the point where heart muscle contraction becomes less efficient. This is due to reduced ability to cross-link actin and myosin myofilaments in over-stretched heart muscle.


title: Heart failure

text: No diagnostic criteria have been agreed on as the gold standard for heart failure. In the UK the National Institute for Health and Care Excellence recommends measuring brain natriuretic peptide 32 (BNP) followed by an ultrasound of the heart if positive. This is recommended in those with shortness of breath. In those with worsening heart failure, both a measure of BNP and of troponin are recommended to help determine likely outcomes.


title: Heart failure

text: One historical method of categorizing heart failure is by the side of the heart involved (left heart failure versus right heart failure). Right heart failure was thought to compromise blood flow to the lungs compared to left heart failure compromising blood flow to the aorta and consequently to the brain and the remainder of the body's systemic circulation. However, mixed presentations are common and left heart failure is a common cause of right heart failure.


title: Heart failure

text: More accurate classification of heart failure type is made by measuring ejection fraction, or the proportion of blood pumped out of the heart during a single contraction. Ejection fraction is given as a percentage with the normal range being between 50 and 75%. The two types are:


title: Heart failure

text: 1) Heart failure due to reduced ejection fraction (HFrEF): Synonyms no longer recommended are "heart failure due to left ventricular systolic dysfunction" and "systolic heart failure". HFrEF is associated with an ejection fraction less than 40%.


title: Heart failure

text: 2) Heart failure with preserved ejection fraction (HFpEF): Synonyms no longer recommended include "diastolic heart failure" and "heart failure with normal ejection fraction." HFpEF occurs when the left ventricle contracts normally during systole, but the ventricle is stiff and does not relax normally during diastole, which impairs filling.


title: Heart failure

text: Heart failure may also be classified as acute or chronic. Chronic heart failure is a long-term condition, usually kept stable by the treatment of symptoms. Acute decompensated heart failure is a worsening of chronic heart failure symptoms, which can result in acute respiratory distress. High-output heart failure can occur when there is increased cardiac demand that results in increased left ventricular diastolic pressure which can develop into pulmonary congestion (pulmonary edema).


title: Heart failure

text: Several terms are closely related to heart failure and may be the cause of heart failure, but should not be confused with it. Cardiac arrest and asystole refer to situations in which no cardiac output occurs at all. Without urgent treatment, these events result in sudden death. Myocardial infarction ("Heart attack") refers to heart muscle damage due to insufficient blood supply, usually as a result of a blocked coronary artery. Cardiomyopathy refers specifically to problems within the heart muscle, and these problems can result in heart failure. Ischemic cardiomyopathy implies that the cause of muscle damage is coronary artery disease. Dilated cardiomyopathy implies that the muscle damage has resulted in enlargement of the heart. Hypertrophic cardiomyopathy involves enlargement and "thickening" of the heart muscle.


title: Heart failure

text: An echocardiogram (ultrasound of the heart) is commonly used to support a clinical diagnosis of heart failure. This can determine the stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat), the end-diastolic volume (EDV, the total amount of blood at the end of diastole), and the SV in proportion to the EDV, a value known as the ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function. Normally, the EF should be between 50 and 70%; in systolic heart failure, it drops below 40%. Echocardiography can also identify valvular heart disease and assess the state of the pericardium (the connective tissue sac surrounding the heart). Echocardiography may also aid in deciding specific treatments, such as medication, insertion of an implantable cardioverter-defibrillator, or cardiac resynchronization therapy. Echocardiography can also help determine if acute myocardial ischemia is the precipitating cause, and may manifest as regional wall motion abnormalities on echo.


title: Heart failure

text: Chest X-rays are frequently used to aid in the diagnosis of CHF. In a person who is compensated, this may show cardiomegaly (visible enlargement of the heart), quantified as the cardiothoracic ratio (proportion of the heart size to the chest). In left ventricular failure, evidence may exist of vascular redistribution (upper lobe blood diversion or cephalization), Kerley lines, cuffing of the areas around the bronchi, and interstitial edema. Ultrasound of the lung may also be able to detect Kerley lines.


title: Heart failure

text: An electrocardiogram (ECG/EKG) may be used to identify arrhythmias, ischemic heart disease, right and left ventricular hypertrophy, and presence of conduction delay or abnormalities (e.g. left bundle branch block). Although these findings are not specific to the diagnosis of heart failure, a normal ECG virtually excludes left ventricular systolic dysfunction.


title: Heart failure

text: Blood tests routinely performed include electrolytes (sodium, potassium), measures of kidney function, liver function tests, thyroid function tests, a complete blood count, and often C-reactive protein if infection is suspected. An elevated brain natriuretic peptide 32 (BNP) is a specific test indicative of heart failure. Additionally, BNP can be used to differentiate between causes of dyspnea due to heart failure from other causes of dyspnea. If myocardial infarction is suspected, various cardiac markers may be used.


title: Heart failure

text: BNP is a better indicator than N-terminal pro-BNP for the diagnosis of symptomatic heart failure and left ventricular systolic dysfunction. In symptomatic people, BNP had a sensitivity of 85% and specificity of 84% in detecting heart failure; performance declined with increasing age.


title: Heart failure

text: Hyponatremia (low serum sodium concentration) is common in heart failure. Vasopressin levels are usually increased, along with renin, angiotensin II, and catecholamines to compensate for reduced circulating volume due to inadequate cardiac output. This leads to increased fluid and sodium retention in the body; the rate of fluid retention is higher than the rate of sodium retention in the body, this phenomenon causes hypervolemic hyponatremia (low sodium concentration due to high body fluid retention). This phenomenon is more common in older women with low body mass. Severe hyponatremia can result in accumulation of fluid in the brain, causing cerebral edema and intracranial hemorrhage.


title: Heart failure

text: Angiography is the X-ray imaging of blood vessels, which is done by injecting contrast agents into the bloodstream through a thin plastic tube (catheter), which is placed directly in the blood vessel. X-ray images are called angiograms. Heart failure may be the result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle). As a result, coronary catheterization may be used to identify possibilities for revascularisation through percutaneous coronary intervention or bypass surgery.


title: Heart failure

text: Various algorithms are used for the diagnosis of heart failure. For example, the algorithm used by the Framingham Heart Study adds together criteria mainly from physical examination. In contrast, the more extensive algorithm by the European Society of Cardiology weights the difference between supporting and opposing parameters from the medical history, physical examination, further medical tests, and response to therapy.


title: Heart failure

text: By the Framingham criteria, diagnosis of congestive heart failure (heart failure with impaired pumping capability) requires the simultaneous presence of at least two of the following major criteria or one major criterion in conjunction with two of the minor criteria.


title: Heart failure

text: Minor criteria are acceptable only if they can not be attributed to another medical condition such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome. The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.


title: Heart failure

text: Heart failure is commonly stratified by the degree of functional impairment conferred by the severity of the heart failure (as reflected in the New York Heart Association (NYHA) Functional Classification.) The NYHA functional classes (I–IV) begin with class I, which is defined as a person who experiences no limitation in any activities and has no symptoms from ordinary activities. People with NYHA class II heart failure have slight, mild limitations with everyday activities; the person is comfortable at rest or with mild exertion. With NYHA class III heart failure, a marked limitation occurs with any activity; the person is comfortable only at rest. A person with NYHA class IV heart failure is symptomatic at rest and becomes quite uncomfortable with any physical activity. This score documents the severity of symptoms and can be used to assess response to treatment. While its use is widespread, the NYHA score is not very reproducible and does not reliably predict the walking distance or exercise tolerance on formal testing.


title: Heart failure

text: In its 2001 guidelines, the American College of Cardiology/American Heart Association working group introduced four stages of heart failure:


title: Heart failure

text: The ACC staging system is useful since stage A encompasses "pre-heart failure" – a stage where intervention with treatment can presumably prevent progression to overt symptoms. ACC stage A does not have a corresponding NYHA class. ACC stage B would correspond to NYHA class I. ACC stage C corresponds to NYHA class II and III, while ACC stage D overlaps with NYHA class IV.


title: Heart failure

text: Histopathology can diagnose heart failure in autopsies. The presence of siderophages indicates chronic left-sided heart failure, but is not specific for it. It is also indicated by congestion of the pulmonary circulation.


title: Heart failure

text: A person's risk of developing heart failure is inversely related to level of physical activity. Those who achieved at least 500 MET-minutes/week (the recommended minimum by U.S. guidelines) had lower heart failure risk than individuals who did not report exercising during their free time; the reduction in heart failure risk was even greater in those who engaged in higher levels of physical activity than the recommended minimum.


title: Heart failure

text: Heart failure can also be prevented by lowering high blood pressure and high blood cholesterol, and by controlling diabetes. Maintaining a healthy weight, and decreasing sodium, alcohol, and sugar intake, may help. Additionally, avoiding tobacco use has been shown to lower the risk of heart failure. According to Johns Hopkins and the American Heart Association there are a few ways to help to prevent a cardiac event. Johns Hopkins mentions that stopping tobacco use, reducing high blood pressure, physical activity and your diet can drastically effect the chances of developing heart disease. High blood pressure accounts for most cardiovascular deaths. High blood pressure can be lowered into the normal range by making dietary decisions such as consuming less salt. Exercise also helps to bring blood pressure back down. One of the best ways to help avoid heart failure is to promote healthier eating habits like eating more vegetables, fruits, grains, and lean protein.


title: Heart failure

text: Diabetes is a major risk factor for heart failure. For women with Coronary Heart disease (CHD), diabetes was the strongest risk factor for heart failure. Diabetic women with depressed creatinine clearance or elevated BMI were at the highest risk of heart failure. While the annual incidence rate of heart failure for non-diabetic women with no risk factors is 0.4%, the annual incidence rate for diabetic women with elevated body mass index (BMI) and depressed creatinine clearance was 7% and 13%, respectively.


title: Heart failure

text: Treatment focuses on improving the symptoms and preventing the progression of the disease. Reversible causes of heart failure also need to be addressed (e.g. infection, alcohol ingestion, anemia, thyrotoxicosis, arrhythmia, and hypertension). Treatments include lifestyle and pharmacological modalities, and occasionally various forms of device therapy. Rarely, cardiac transplantation is used as an effective treatment when heart failure has reached the end stage.


title: Heart failure

text: In acute decompensated heart failure, the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that airway, breathing, and circulation are adequate. Immediate treatments usually involve some combination of vasodilators such as nitroglycerin, diuretics such as furosemide, and possibly noninvasive positive pressure ventilation. Supplemental oxygen is indicated in those with oxygen saturation levels below 90%, but is not recommended in those with normal oxygen levels in normal atmosphere.


title: Heart failure

text: The goals of the treatment for people with chronic heart failure are the prolongation of life, prevention of acute decompensation, and reduction of symptoms, allowing for greater activity.


title: Heart failure

text: Heart failure can result from a variety of conditions. In considering therapeutic options, excluding reversible causes is of primary importance, including thyroid disease, anemia, chronic tachycardia, alcohol use disorder, hypertension, and dysfunction of one or more heart valves. Treatment of the underlying cause is usually the first approach to treating heart failure. In the majority of cases, though, either no primary cause is found or treatment of the primary cause does not restore normal heart function. In these cases, behavioral, medical and device treatment strategies exist that can provide a significant improvement in outcomes, including the relief of symptoms, exercise tolerance, and a decrease in the likelihood of hospitalization or death. Breathlessness rehabilitation for chronic obstructive pulmonary disease and heart failure has been proposed with exercise training as a core component. Rehabilitation should also include other interventions to address shortness of breath including psychological and educational needs of people and needs of caregivers. Iron supplementation appears useful in those with iron deficiency anemia and heart failure.


title: Heart failure

text: The latest evidence indicates that advance care planning (ACP) may help to increase documentation by medical staff regarding discussions with participants, and improve an individual's depression. This involves discussing an individual's future care plan in consideration of the individual's preferences and values. The findings are however, based on low-quality evidence.


title: Heart failure

text: The various measures often used to assess the progress of people being treated for heart failure include fluid balance (calculation of fluid intake and excretion) and monitoring body weight (which in the shorter term reflects fluid shifts). Remote monitoring can be effective to reduce complications for people with heart failure.


title: Heart failure

text: Behavior modification is a primary consideration in chronic heart failure management program, with dietary guidelines regarding fluid and salt intake. Fluid restriction is important to reduce fluid retention in the body and to correct the hyponatremic status of the body. The evidence of benefit of reducing salt, however, is poor as of 2018.


title: Heart failure

text: Exercise should be encouraged and tailored to suit individual's capabilities. A meta-analysis found that centre-based group interventions delivered by a physiotherapist are helpful in promoting physical activity in HF. There is a need for additional training for physiotherapists in delivering behaviour change intervention alongside an exercise programme. An intervention is expected to be more efficacious in encouraging physical activity than the usual care if it includes "Prompts and cues" to walk or exercise, like a phone call or a text message. It is extremely helpful if a trusted clinician provides explicit advice to engage in physical activity ("Credible source"). Another highly effective strategy is to place objects that will serve as a cue to engage in physical activity in the everyday environment of the patient ("Adding object to the environment"; e.g., exercise step or treadmill). Encouragement to walk or exercise in various settings beyond CR (e.g., home, neighbourhood, parks) is also promising ("Generalisation of target behaviour"). Additional promising strategies are "Graded tasks" (e.g., gradual increase in intensity and duration of exercise training), "Self-monitoring", "Monitoring of physical activity by others without feedback", "Action planning", and "Goal-setting". The inclusion of regular physical conditioning as part of a cardiac rehabilitation program can significantly improve quality of life and reduce the risk of hospital admission for worsening symptoms, but no evidence shows a reduction in mortality rates as a result of exercise. Despite cardiac rehabilitation being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. The reasons why this happens are complex, heterogeneous, and encompass healthcare system-, referring physician-, program-, and patient-level barriers. According to Alexandre et al., the main reasons for HFrEF patients not being enrolled in cardiac rehabilitation were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Furthermore, whether this evidence can be extended to people with HFpEF or to those whose exercise regimen takes place entirely at home is unclear.


title: Heart failure

text: Home visits and regular monitoring at heart-failure clinics reduce the need for hospitalization and improve life expectancy.


title: Heart failure

text: Quadruple medical therapy using a combination of angiotensin-receptor neprilysin inhibitors (ARNI), beta blockers, mineralocorticoid receptor antagonists (MRA), and sodium glucose cotransporter-2 inhibitors (SGLT2 inhibitors) is now the standard of care as of 2021.


title: Heart failure

text: First-line therapy for people with heart failure due to reduced systolic function should include angiotensin-converting enzyme (ACE) inhibitors (ACE-I), or angiotensin receptor blockers (ARBs) if the person develops a long-term cough as a side effect of the ACE-I. Use of medicines from these classes is associated with improved survival, fewer hospitalizations for heart failure exacerbations, and improved quality of life in people with heart failure.


title: Heart failure

text: Beta-adrenergic blocking agents (beta blockers) also form part of the first line of treatment, adding to the improvement in symptoms and mortality provided by ACE-I/ARB. The mortality benefits of beta blockers in people with systolic dysfunction who also have atrial fibrillation is more limited than in those who do not have it. If the ejection fraction is not diminished (HFpEF), the benefits of beta blockers are more modest; a decrease in mortality has been observed, but reduction in hospital admission for uncontrolled symptoms has not been observed.