Heart Failure - Chronic Disease Summary

Overview

Heart failure is a clinical syndrome that causes significant morbidity and mortality and adversely impacts a person’s quality of life. It is further defined in the Introduction section.

Heart failure incidence increases with age with a higher increase in females as compared to males. The incidence of heart failure locally and regionally is featured in the Epidemiology section.

The Pathophysiology section further explains the mechanisms of the development of heart failure and its effects. Characteristics of heart failure with preserved ejection fraction and reduced ejection fraction are also in this section.

The Etiology section enumerates the common causes of heart failure.

The types of heart failure and classification of chronic heart failure based on duration since last admission are enumerated and described in the Classification section.  The development stages of heart failure as well as the functional capacity assessment can also be found in this section.

History and Physical Examination

Patients with heart failure may present with signs and symptoms depicting decreased exercise tolerance and fluid retention. The Clinical Presentation section describes the presentation of these two conditions including symptoms due to other conditions.

Predisposition to risk factors including family history is an important point to be elicited from the patient and is discussed in the History section.

In the Physical Examination section, specific signs of heart failure are enumerated and assessment of volume status is discussed. 

Diagnosis

Laboratory Tests and Ancillaries and Imaging studies to be considered in all and select patients suspected of heart failure are discussed in this section.

The Framingham diagnostic criteria for heart failure are in the Diagnosis or Diagnostic Criteria section.

Diseases that mimic heart failure should be ruled out and these are enumerated in the Differential Diagnosis section.

Management

Therapeutic strategies to manage patients with chronic heart failure are discussed in the Principles of Therapy section.

Drug options recommended for treating patients with chronic heart failure such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitor (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRAs) and sodium-glucose linked transporter or co-transporter 2 (SGLT) inhibitors are discussed in detail in the Pharmacological Therapy section. Adjunctive therapy and treatment of comorbidity discussions are also in this section.

Several non-drug options to consider that may aid in the management of chronic heart failure which include patient education, lifestyle modification, cardiac rehabilitation and interventional therapy are featured in the Nonpharmacological section. 

Surgery (eg coronary revascularization, valvular surgery and heart transplantation) that can be considered in select patients with chronic heart failure is further elaborated in the Surgery section.

The Prevention section discusses the different ways to control risk and prevent cardiovascular events in patients with high risk of chronic heart failure.

Regular follow-up even in patients with stable and well-controlled symptoms is discussed in the Monitoring section.  The Prognosis section lists the conditions associated with a poor outcome in patients with heart failure.