H
eart failure affects more than 5.7 million Americans, and some one million new cases are identified each year.1,3 At age 40, the risk of developing heart failure is one in five, and the prevalence for those 65 years or older is about 10 per 1000 individuals.3 The cost of heart failure is high, estimated at $30.7 billion annually in the United States alone. (This approximation includes healthcare services, medications, and missed days of work.)1,3 By the year 2030, the annual cost is expected to reach $69.7 billion, or approximately $244 for every adult in the country. That is a 127 percent increase from 2012.3 Related deaths also remain high, with one in nine deaths associated with heart failure. Almost half of those diagnosed with heart failure will die within five years.1,3 The hospitalization rate for heart failure is a concern; and patients with prior hospitalizations have a 50 percent chance of readmission within six months of discharge.4 The rate of these annual hospitalizations is highest for black men, followed by black women, white men, and white women.3 Defined, evidence-biased treatment and coordination of individualized care should help reduce both the incidence and cost of heart failure.6,8,9
Definition of Heart Failure Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body’s need for blood and oxygen. It usually results in an enlarged heart and can be caused by a structural or functional cardiac disorder.5,15 Figure 1: Normal Heart Vs. Heart Failure Heart5
CONTINUING EDUCATION resulting decreased filling occurs in diastolic dysfunction. These conditions are usually found together. (See Figure 2.)6 Figure 2: Types of Heart Failure6,8,9 CLASSIFICATION
EJECTION FRACTION
DESCRIPTION
1. Heart Failure with Reduced Ejection Fraction (HFrEF)
≤ 40 %
Also referred to as systolic HF. Randomized controlled trials have mainly enrolled patients with HFr EF, and it is only in these patients that efficacious therapies have been demonstrated to date.
2. Heart Failure with Preserved Ejection Fraction (HFpEF)
≥ 50%
Also referred to as diastolic HF. Several different criteria have been used to further define HFp EF. The diagnosis of HFp EF is challenging because it is largely one of excluding other potential noncardiac causes of symptoms suggestive of HF. To date, efficacious therapies have not been identified.
a. HFpEF, borderline
41% to 49%
These patients fall into a borderline or intermediate group. Their characteristics, treatment patterns, and outcomes appear like those of patients with HFpEF.
b. HFpEF, improved
>40
It has been recognized that a subset of patients with HFpEF previously had HFrEF. These patients with improvement or recovery in EF may be clinically distinct from those with persistently preserved or reduced EF. Further research is needed to better characterize these patients.
In patients hospitalized with heart failure, 53 percent had HF with reduced ejection fraction (HFrEF), and 47 percent had HF with preserved EF (HFpEF).3 Black men had the highest proportion of hospitalized HFrEF events (70 percent), while white women had the highest proportion of hospitalized HFpEF events (59 percent).3
Classifications and Stages The major symptoms of heart failure are related to fluid overload that causes dyspnea, orthopnea, and edema, with abdominal pain due to hepatic congestion and abnormal distention caused by ascites.2,6,16 There is also a reduction in cardiac output resulting in fatigue and weakness.2,6 Management of heart failure includes lifestyle modifications and medications, with the goal of improving symptoms and reducing mortality and morbidity.2,6
Types of Heart Failure Decreased cardiac contractility occurs in systolic dysfunction. Abnormal cardiac relaxation due to stiffness with
Heart failure can be classified using The American College of Cardiology Foundation (ACCF)/ American Heart Association (AHA) stages of heart failure to establish the development and progression of disease. This considers both risk factors for heart failure and symptoms of heart disease.6 There are four levels, and as the disease progresses from one level to the next, patients will not return to an earlier stage. The New York Heart Association (NYHA) functional classification focuses on symptoms and exercise capacity in Stages C Innovatix | innovatix.com 19