Heart failure

Not to be confused with cardiac arrest, myocardial infarction, or heart block.

Heart failure
Other namesCongestive heart failure (CHF), congestive cardiac failure (CCF)[1][2]
A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.
SpecialtyCardiology
SymptomsShortness of breath, exhaustion, swollen legs[3]
ComplicationsCardiac arrest
DurationLifetime
CausesHeart attack, high blood pressure, abnormal heart rhythm, excessive alcohol use, infection, heart damage[4]
Risk factorsSmoking, sedentary lifestyle, obesity, exposure to second-hand smoke[5]
Diagnostic methodEchocardiogram[6]
Differential diagnosisKidney failure, thyroid disease, liver disease, anemia, obesity[7]
MedicationDiuretics, cardiac medications[4][6]
Frequency40 million (2015),[8] 1–2% of adults (developed countries)[6][9]
Deaths35% risk of death in the first year[10]

Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.

Although symptoms vary based on which side of the heart is affected, HF typically presents with shortness of breath, excessive fatigue, and bilateral leg swelling.[3] The severity of the heart failure is mainly decided based on ejection fraction and also measured by the severity of symptoms.[7] Other conditions that have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.[7]

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.[4][6] These cause heart failure by altering the structure or the function of the heart or in some cases both.[6] 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.[11] Left-sided heart failure may be present with a reduced ejection fraction or with a preserved ejection fraction.[10] Heart failure is not the same as cardiac arrest, in which blood flow stops completely due to the failure of the heart to pump.[12][13]

Diagnosis is based on symptoms, physical findings, and echocardiography.[6] Blood tests, and a chest x-ray may be useful to determine the underlying cause.[14] Treatment depends on severity and case.[15] For people with chronic, stable, or mild heart failure, treatment usually consists of lifestyle changes, such as not smoking, physical exercise, and dietary changes, as well as medications.[16][17][18] In heart failure due to left ventricular dysfunction, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors, along with beta blockers, mineralocorticoid receptor antagonists and SGLT2 inhibitors are recommended.[6] Diuretics may also be prescribed to prevent fluid retention and the resulting shortness of breath.[19] Depending on the case, an implanted device such as a pacemaker or implantable cardiac defibrillator may sometimes be recommended.[15] In some moderate or more severe cases, cardiac resynchronization therapy (CRT)[20] or cardiac contractility modulation may be beneficial.[21] In severe disease that persists despite all other measures, a cardiac assist device ventricular assist device, or, occasionally, heart transplantation may be recommended.[19]

Heart failure is a common, costly, and potentially fatal condition,[22] and is the leading cause of hospitalization and readmission in older adults.[23][24] Heart failure often leads to more drastic health impairments than the failure of other, similarly complex organs such as the kidneys or liver.[25] In 2015, it affected about 40 million people worldwide.[8] Overall, heart failure affects about 2% of adults,[22] and more than 10% of those over the age of 70.[6] Rates are predicted to increase.[22]

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.[10] The risk of death is comparable to that of some cancers.[10] In the United Kingdom, the disease is the reason for 5% of emergency hospital admissions.[10] Heart failure has been known since ancient times in Egypt; it is mentioned in the Ebers Papyrus around 1550 BCE.[26]

  1. ^ Harrison RN, Daly L (2011). A Nurse's Survival Guide to Acute Medical Emergencies. Elsevier Health Sciences. p. 26. ISBN 978-0-7020-4900-2. Archived from the original on 9 August 2023. Retrieved 25 August 2020.
  2. ^ "Congestive heart failure (CHF)". Archived from the original on 6 April 2016. Retrieved 12 November 2018.
  3. ^ a b National Guideline Centre (UK) (September 2018). "2. Introduction". Chronic Heart Failure in Adults: Diagnosis and Management. National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE). ISBN 978-1-4731-3093-7. PMID 30645061. Archived from the original on 20 March 2023. Retrieved 11 February 2023.
  4. ^ a b c Cite error: The named reference AHA2022 was invoked but never defined (see the help page).
  5. ^ Skipina TM, Upadhya B, Soliman EZ (July 2021). Munafò M (ed.). "Secondhand Smoke Exposure is Associated with Prevalent Heart Failure: Longitudinal Examination of the National Health and Nutrition Examination Survey". Nicotine & Tobacco Research. 23 (9). Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco: 1512–1517. doi:10.1093/ntr/ntab047. eISSN 1469-994X. LCCN 00244999. PMID 34213549. S2CID 235707832.
  6. ^ a b c d e f g h Cite error: The named reference ESC2021 was invoked but never defined (see the help page).
  7. ^ a b c Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update. National Clinical Guideline Centre. August 2010. pp. 38–70. PMID 22741186.
  8. ^ a b GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  9. ^ Cite error: The named reference Lancet2005 was invoked but never defined (see the help page).
  10. ^ a b c d e National Clinical Guideline Centre (UK) (August 2010). Chronic heart failure: National clinical guideline for diagnosis and management in primary and secondary care: Partial update. National Clinical Guideline Centre. pp. 19–24. PMID 22741186.
  11. ^ "What is Heart Failure?". www.heart.org. Archived from the original on 10 August 2022. Retrieved 11 August 2022.
  12. ^ Willard & Spackman's occupational therapy. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2014. p. 1124. ISBN 978-1-4511-1080-7.
  13. ^ The Cardiac Care Unit Survival Guide. Lippincott Williams & Wilkins. 2012. p. 98. ISBN 978-1-4511-7746-6.
  14. ^ National Guideline Centre (UK) (September 2018). "1. Guideline summary". Chronic Heart Failure in Adults: Diagnosis and Management. National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE). ISBN 978-1-4731-3093-7. PMID 30645061. Archived from the original on 20 March 2023. Retrieved 11 February 2023.
  15. ^ a b Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update. National Clinical Guideline Centre. August 2010. pp. 34–47. PMID 22741186.
  16. ^ National Guideline Centre (UK) (September 2018). "6. Treating heart failure". Chronic Heart Failure in Adults: Diagnosis and Management. National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE). ISBN 978-1-4731-3093-7. PMID 30645061. Archived from the original on 19 March 2023. Retrieved 12 February 2023.
  17. ^ National Guideline Centre (UK) (September 2018). "7. Rehabilitation in chronic heart failure". Chronic Heart Failure in Adults: Diagnosis and Management. National Institute for Health and Care Excellence: Guidelines. London: National Institute for Health and Care Excellence (NICE). ISBN 978-1-4731-3093-7. PMID 30645061. Archived from the original on 21 March 2023. Retrieved 12 February 2023.
  18. ^ Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, et al. (March 2024). "Exercise-based cardiac rehabilitation for adults with heart failure". The Cochrane Database of Systematic Reviews. 2024 (3): CD003331. doi:10.1002/14651858.CD003331.pub6. PMC 10919451. PMID 38451843.
  19. ^ a b Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update. National Clinical Guideline Centre. August 2010. pp. 71–153. PMID 22741186.
  20. ^ Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA, et al. (October 2012). "2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]". Circulation. 126 (14): 1784–800. doi:10.1161/CIR.0b013e3182618569. PMID 22965336.
  21. ^ Kuck KH, Bordachar P, Borggrefe M, Boriani G, Burri H, Leyva F, et al. (January 2014). "New devices in heart failure: a European Heart Rhythm Association report: developed by the European Heart Rhythm Association; endorsed by the Heart Failure Association". Europace. 16 (1): 109–28. doi:10.1093/europace/eut311. PMID 24265466.
  22. ^ a b c Metra M, Teerlink JR (October 2017). "Heart failure". Lancet. 390 (10106): 1981–1995. doi:10.1016/S0140-6736(17)31071-1. PMID 28460827. S2CID 34893221.
  23. ^ Retrum JH, Boggs J, Hersh A, Wright L, Main DS, Magid DJ, et al. (March 2013). "Patient-identified factors related to heart failure readmissions". Circulation. Cardiovascular Quality and Outcomes. 6 (2): 171–177. doi:10.1161/CIRCOUTCOMES.112.967356. PMC 4082819. PMID 23386663.
  24. ^ Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. (January 2012). "Heart disease and stroke statistics--2012 update: a report from the American Heart Association". Circulation. 125 (1): e2–e220. doi:10.1161/cir.0b013e31823ac046. PMC 4440543. PMID 22179539.
  25. ^ "Do we expect the body to be a "One Hoss Shay"?". The Evolution and Medicine Review. 16 March 2010. Archived from the original on 4 July 2022. Retrieved 28 April 2022.
  26. ^ McDonagh TA (2011). Oxford textbook of heart failure. Oxford: Oxford University Press. p. 3. ISBN 978-0-19-957772-9. Archived from the original on 9 August 2023. Retrieved 27 December 2021.