What does heart failure mean?

From the Guidelines

Heart failure is a chronic condition where the heart cannot pump blood effectively to meet the body's needs, leading to significant morbidity and mortality, and is broadly divided into three main subtypes: heart failure with reduced ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with preserved ejection fraction. It occurs when the heart muscle becomes weakened or stiff, reducing its ability to fill with or eject blood properly, and is associated with symptoms like shortness of breath, fatigue, and fluid retention (edema) in the legs, ankles, and sometimes lungs 1. Heart failure doesn't mean the heart has stopped working completely, but rather that it's not functioning optimally. The condition develops gradually as the heart tries to compensate for its reduced pumping capacity by enlarging, developing more muscle mass, or pumping faster. These temporary measures mask the problem, but eventually the heart cannot keep up with the demands placed on it.

Key Points

• Heart failure is typically caused by conditions that damage the heart, such as coronary artery disease, heart attacks, high blood pressure, valve problems, or cardiomyopathy.
• Management involves lifestyle changes, medications to improve heart function and reduce symptoms, and in some cases, devices or surgery to support heart function.
• The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) have developed guidelines on the diagnosis and treatment of heart failure, which are based on four progressive stages of heart failure, with progression from one stage to the next associated with reduced five-year survival and increased plasma natriuretic peptide concentrations 1.

Subtypes of Heart Failure

• Heart failure with preserved ejection fraction (HFpEF) is a condition characterized by clinical symptoms and signs of heart failure in the setting of normal or near-normal left ventricular ejection fraction, and is more commonly seen in individuals with cardiometabolic diseases, with incidence climbing with advancing age 1.
• Heart failure with reduced ejection fraction (HFrEF) and heart failure with mildly reduced ejection fraction (HFmrEF) are other subtypes of heart failure, each with distinct characteristics and management strategies. The most recent and highest quality study recommends that heart failure management should focus on reducing modifiable risk factors, improving symptoms, and reducing morbidity and mortality, with a particular emphasis on the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors in patients with HFpEF 1.

From the FDA Drug Label

The underlying cause of heart failure was coronary artery disease in 60% of patients; 71% had a history of hypertension, 43% had a history of myocardial infarction, 37% had an eGFR less than 60 mL/min/1.73m2, and 35% had diabetes mellitus. Patients with symptomatic chronic heart failure (NYHA class II to IV) and systolic dysfunction (left ventricular ejection fraction ≤40%) The underlying cause of heart failure was of ischemic etiology in 36% of patients.

Heart failure refers to a condition where the heart is unable to pump enough blood to meet the body's needs, often due to underlying conditions such as coronary artery disease, hypertension, myocardial infarction, or diabetes mellitus. It can be characterized by symptoms such as systolic dysfunction and left ventricular ejection fraction ≤40%. 2 2

From the Research

Definition of Heart Failure

• Heart failure (HF) is a condition in which the heart is unable to pump enough blood to meet the body's needs for blood and oxygen 3, 4, 5, 6, 7
• It is a clinical syndrome characterized by the inability of the heart to maintain a normal cardiac output without elevated intracardiac filling pressures, resulting in signs of pulmonary and peripheral edema and symptoms of dyspnea and fatigue 5
• Heart failure results from injury to the myocardium from a variety of causes, including ischemic heart disease, hypertension, and diabetes 6

Characteristics of Heart Failure

• HF is a grave disease with high morbidity and mortality 3
• It is associated with significant effects on patients, their families, and healthcare services 7
• People with HF can present with acute or chronic signs and symptoms, including dyspnea, peripheral edema, and ascites 6
• Constitutional symptoms such as nausea, lack of appetite, and fatigue are also common 6

Pathophysiology of Heart Failure

• The pathophysiology of HF involves compensatory mechanisms that occur as the failing heart attempts to maintain adequate function, including increasing cardiac output via the Frank-Starling mechanism and ventricular remodeling 6
• These compensatory mechanisms eventually lead to a vicious cycle of worsening heart failure 6