Heart Failure Diagnosis and Management
Definition and Classification
- Heart failure is a clinical syndrome characterized by typical symptoms and signs resulting from cardiac dysfunction, as defined by the European Society of Cardiology 1, 2
- The American Heart Association classifies heart failure by ejection fraction: Heart failure with reduced ejection fraction (HFrEF): LVEF ≤40%, Heart failure with mildly reduced ejection fraction (HFmrEF): LVEF 41-49%, and Heart failure with preserved ejection fraction (HFpEF): LVEF ≥50% 2, 3
- The New York Heart Association (NYHA) functional classification system is used to classify heart failure based on symptom severity, with classes ranging from I (no symptoms) to IV (severe symptoms) 2
Diagnostic Approach
- The European Society of Cardiology recommends essential diagnostic tests, including electrocardiogram (ECG), chest X-ray, echocardiography, and laboratory tests, to diagnose heart failure 1, 4
- Biomarkers such as B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) are elevated in heart failure, according to the American College of Cardiology 5, 2
- Cardiac troponins can be used to rule out acute coronary syndrome, as recommended by the American Heart Association 5
Management Strategies
- The European Heart Journal recommends non-pharmacological management strategies, including patient education on self-care behaviors, such as daily weight monitoring, sodium restriction, and fluid management 6
- The American College of Cardiology recommends pharmacological management strategies, including diuretics for symptom relief and volume management, and neurohormonal antagonists for HFrEF 5, 6
- SGLT2 inhibitors are now recommended for patients with HFpEF based on recent breakthrough trial data showing reduced cardiovascular death and heart failure hospitalizations, according to the European Heart Journal 3
Advanced Therapies
- The European Heart Journal recommends device therapy, including implantable cardioverter-defibrillator (ICD), for patients with heart failure 8
- Mechanical circulatory support and heart transplantation may be considered for eligible patients, according to the European Society of Cardiology 8