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Heart failure (HF) is defined by the European Society of Cardiology as a clinical syndrome characterised by symptoms such as breathlessness, ankle swelling and fatigue that may be accompanied by signs such as elevated jugular venous pressure, pulmonary crackles and peripheral oedema. HF is caused by a structural and/or functional cardiac abnormality, and results in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.1
HF can be differentiated into three types based on measurement of left ventricular ejection fraction: HF with preserved ejection fraction; HF with mid-range ejection fraction; and HF with reduced ejection fraction.1
Heart failure is usually divided into two presentations: chronic heart failure (CHF) and acute heart failure (AHF). CHF describes those who have had an established diagnosis of HF or who have a more gradual onset of symptoms. If CHF deteriorates, either suddenly or slowly, the episode may be described as ‘decompensated’ HF. This can result in a hospital admission or treatment with intravenous (IV) diuretic therapy in the outpatient setting. AHF refers to rapid or gradual onset of symptoms and/or signs of HF, severe enough for the patient to seek urgent medical attention, leading to an unplanned hospital admission or an emergency department visit.
Epidemiology
There are around 920,000 people in the UK living with heart failure. Both the incidence and prevalence of heart failure increase with age, with the average age at diagnosis of 77 years.2
Types of HF
The main terminology used to describe HF is based on measurement of left ventricular ejection fraction (LVEF).1 Differentiating patients this way is important due to different underlying aetiologies, demographics, co-morbidities and response to therapies.1
HF with preserved ejection fraction (HFpEF)
Normal LVEF, typically considered as ≥50%1
HF with mid-range ejection fraction (HFmrEF)
Moderately reduced LVEF, 41–49%1
HF with reduced ejection fraction (HFrEF)
Reduced LVEF, typically considered as ≤40%1
AF, atrial fibrillation; HFrEF, heart failure with reduced ejection fraction; JVP; jugular venous pressure.
References
- McDonagh TA, et al. Eur Heart J 2021;42(36):3599–3726.
- National Institute for Health and Care Excellence (NICE). 2018. Chronic heart failure in adults: diagnosis and management. NICE guideline [NG106]. Available at: https://www.nice.org.uk/guidance/ng106 [Accessed October 2022].