Heart failure (HF) is a clinical condition characterized by the heart’s inability to pump blood effectively enough to meet the body’s metabolic demands; typically this happens because of impaired ventricular filling or ejection. HF affects millions of people in the United States, with increasing prevalence, hospitalizations, and deaths. Classification of HF by left ventricular ejection fraction divides it into HF with preserved ejection fraction (HFpEF), mildly reduced ejection fraction, and reduced ejection fraction (HFrEF). Early diagnosis and appropriate staging, using tools such as natriuretic peptides and echocardiography, are essential for identifying HF and implementing effective treatment. In patients with HFrEF, guideline-directed medical therapy, comprising renin-angiotensin system inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, has demonstrated reductions in morbidity, mortality, and hospitalizations. Management of comorbidities such as the use of glucagon-like peptide-1 receptor agonists for obesity in patients with HFpEF has improved outcomes. Advanced therapies, cardiac rehabilitation, and supportive interventions, including vaccinations and mental health screening, contribute to improved patient quality of life. Focusing on pharmacologic and nonpharmacologic strategies is essential to reduce HF progression, minimize hospitalizations, and improve overall survival.
Case 4. SB is a 73-year-old man presenting with shortness of breath and lower-extremity edema. His dyspnea worsens when he is lying flat or with exertion, such as walking up a flight of stairs. His history includes uncontrolled hypertension, type 2 diabetes, and obesity. A baseline electrocardiogram demonstrates sinus rhythm with evidence of a previous anterolateral myocardial infarction.
Heart failure (HF) is a clinical condition in which the heart cannot effectively pump blood to meet the body’s metabolic demands, typically due to impaired ventricular filling or ejection. HF is increasing in the United States, driven mainly by an aging population. As of 2020, approximately 6.7 million people in the United States had HF, and that number is projected to reach 8 million by 2030.1 HF-related deaths increased from 275,000 in 2009 to 415,922 in 2020.1 Hospitalizations are also increasing, with an estimated 1.2 million hospitalizations for HF in 2017, a 26% increase from 2013.2
Heart Failure Classification
CLASSIFICATION BY LEFT VENTRICULAR EJECTION FRACTION
One method of HF classification is by left ventricular ejection fraction (LVEF). There are three main categories: HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF).2 HFpEF is defined as an LVEF of at least 50%, HFmrEF as an LVEF of 41% to 49%, and HFrEF as an LVEF of 40% or less. A fourth category, HF with improved ejection fraction (HFimpEF), applies to patients with HFrEF who have increased their LVEF to more than 40% with a minimum extension of at least 10% from their baseline LVEF. Previously, HFimpEF was referred to as HF with recovered ejection fraction, but this term can be misleading because structural abnormalities often persist.2,3
AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION HEART FAILURE STAGES
The American College of Cardiology/American Heart Association (ACC/AHA) staging system focuses on the progression of HF from risk factors to advanced disease, emphasizing prevention and early intervention.2 Progression through this staging system is unidirectional, meaning patients cannot revert to an earlier stage, even if symptoms improve or structural damage heals.
Read the full edition
Get immediate access, anytime, anywhere.
Choose a single edition, 1-year or 2-year full-access subscription.
Earn 4 CME credits for this edition.
