Heart failure

Overview

Heart failure is a clinical syndrome — breathlessness, fatigue and fluid retention from structural or functional cardiac abnormality. It is classified by ejection fraction: HFrEF (EF ≤40%), HFmrEF (41–49%), and HFpEF (≥50%). The classification matters because disease-modifying drug evidence differs sharply between bands. ^[9]

Diagnosis rests on symptoms plus natriuretic peptides plus echocardiography. In the emergency department study of 1586 dyspnoeic patients, BNP at a cutoff of 100 pg/mL achieved 83.4% diagnostic accuracy, and levels below 50 pg/mL carried a 96% negative predictive value — making a low peptide one of medicine's better rule-outs.^[9] Echo then establishes EF banding, structure and aetiology.

References13ShowHide

1. [1]McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure N Engl J Med, 2014.PMID 25176015
2. [2]McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) N Engl J Med, 2019.PMID 31535829
3. [3]Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure (EMPEROR-Reduced) N Engl J Med, 2020.PMID 32865377
4. [4]Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction (EMPEROR-Preserved) N Engl J Med, 2021.PMID 34449189
5. [5]Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) N Engl J Med, 2022.PMID 36027570
6. [6]Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure: the STRONG-HF randomised trial Lancet, 2022.PMID 36356631
7. [7]Anker SD, Comin Colet J, Filippatos G, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency (FAIR-HF) N Engl J Med, 2009.PMID 19920054
8. [8]Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction (TOPCAT) N Engl J Med, 2014.PMID 24716680
9. [9]Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure N Engl J Med, 2002.PMID 12124404
10. [10]Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure (SCD-HeFT) N Engl J Med, 2005.PMID 15659722
11. [11]Cleland JGF, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure (CARE-HF) N Engl J Med, 2005.PMID 15753115
12. [12]MERIT-HF Study Group Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) Lancet, 1999.PMID 10376614
13. [13]Ponikowski P, van Veldhuisen DJ, Comin-Colet J et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency (CONFIRM-HF) European Heart Journal, 2015.PMID 25176939