Synopsis

 

• Airway / Breathing: Often, positive end-expiratory pressure (PEEP) is required via a continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) machine for increased work of breathing, hypoxia, or evidence of pulmonary edema on examination or imaging.
• Circulation: Often, the patient presents as hypertensive (> 180/110); use aggressive vasodilators such as sublingual nitroglycerin (NTG) (paste takes 30 minutes to onset) or an NTG drip.

• Reduced ejection fraction (EF):
  • HF with reduced EF (HFrEF): systolic heart failure (left ventricular ejection fraction [LVEF] 40% or below)
  • HF with improved EF (HFimpEF): previous HFrEF on therapy and LVEF 40% or above
• Mid-range EF:
  • HF with mildly reduced EF or mid-range EF (HFmrEF): HF with LVEF between 40% and 50%
  • Requires serial monitoring to project trajectory over time and further objective measures
• Impaired ventricular filling:
  • HF with preserved EF (HFpEF): diastolic heart failure (LVEF 50% or above)
  • At least 50% of cases and prevalence is increasing

• Stage A: at risk for HF
• Stage B: pre-HF
• Stage C: symptomatic HF
• State D: advanced HF

• Characterizes symptoms and functional capacity of symptomatic and advanced HF
• Independent predictor of mortality
  • Class 1: no limitation of physical activity
  • Class 2: slight limitation of physical activity
  • Class 3: marked limitation of physical activity
  • Class 4: symptoms with rest; discomfort with any activity

• Ischemic heart disease
• Valvular dysfunction, arrythmias, right ventricular (RV) pacing, cardiomyopathies (ie, familial, genetic, postpartum), infection and inflammation (eg, myocarditis, HIV, COVID-19, Chagas disease), thyroid disease, autoimmune diseases (eg, sarcoidosis, amyloidosis), hemochromatosis, cardiotoxic medications (eg, chemotherapy)

• New annual diagnosis: approximately 500 000 patients per year.
• Mortality: approximately 300 000 individuals per year.
• Self-identified non-Hispanic Black patients have highest incidence of HF hospitalizations and mortality.
• Incidence is proportional to age and is higher in men, as women present later.
• Lifetime risk of development is approximately 20% in those 40 years and older.
• Survival median time once classified as NYHA class 3 is 1.7 years for men and 3.2 years for women, with a 5-year survival rate of 25% and 38%, respectively.