Heart Failure Diagnosis and Treatment

Diagnostic Steps

The European Society of Cardiology recommends assessing for typical symptoms and signs of heart failure, though these are not necessarily specific 1
Chest X-ray is used to detect cardiomegaly and pulmonary congestion 1
Electrocardiogram (ECG) has a >90% negative predictive value to exclude LV systolic dysfunction 1
Natriuretic peptide levels (BNP/NT-proBNP) have high negative predictive value and can rule out heart failure when normal 1
Echocardiography is used to confirm cardiac dysfunction and determine left ventricular ejection fraction (LVEF) 1

The European Society of Cardiology recommends ACE inhibitors as first-line therapy for patients with reduced left ventricular systolic function to reduce mortality and hospitalizations 2
Beta-blockers are recommended for all stable patients with mild to severe heart failure (NYHA class II-IV) with reduced ejection fraction 2
Diuretics are used for symptomatic treatment of fluid overload, always in combination with ACE inhibitors when possible 4
Mineralocorticoid receptor antagonists (spironolactone) are recommended for advanced heart failure (NYHA III-IV) to improve survival 5

Patient education about heart failure, symptom recognition, and self-management is recommended 4
Daily physical activity in stable patients is recommended to prevent muscle deconditioning 4
Control of sodium intake and avoidance of excessive fluid intake are recommended in severe heart failure 4
Avoidance of excessive alcohol consumption is recommended 4