Heart Failure Diagnosis and Classification

Classification by Ejection Fraction

• The European Society of Cardiology recommends categorizing heart failure based on left ventricular ejection fraction (LVEF) as follows: Heart failure with reduced EF (HFrEF) has LVEF ≤40% 1, 2
• Heart failure with preserved EF (HFpEF) is characterized by LVEF ≥50% 1, 3

Underlying Etiology

• Ischemic heart disease, including myocardial scar, stunning/hibernation, and coronary artery disease, is a common underlying cause of heart failure 4
• Hypertension can lead to left ventricular hypertrophy and diastolic dysfunction, contributing to heart failure 4, 5
• Valvular heart disease, cardiomyopathies, toxic damage, arrhythmias, metabolic disorders, and infiltrative diseases are other potential underlying causes of heart failure 4

Functional Status

• The New York Heart Association (NYHA) functional classification is used to assess the functional status of heart failure patients, with Class I indicating no limitation of physical activity and Class IV indicating an inability to carry out any physical activity without symptoms 1

Diagnostic Evidence

• Symptoms and signs of heart failure, such as breathlessness, ankle swelling, and fatigue, are important diagnostic evidence 1, 6
• Biomarkers, including BNP and NT-proBNP, can be used to support the diagnosis of heart failure, with elevated levels indicating increased risk 7, 8
• Imaging findings, such as structural and functional cardiac abnormalities on echocardiography, are also important diagnostic evidence 7, 9