How to Cite This Chapter: Van Spall HGC, Rahman T. Heart Failure. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.2.19 Accessed September 30, 2020.
Last Updated: July 7, 2016
Last Reviewed: April 28, 2019
McMaster University Editorial Office
Section Editors: P.J. Devereaux
Authors: Harriette G.C. Van Spall, Tahseen Rahman
Polish Institute for Evidence Based Medicine Editorial Office
Section Editors: Andrzej Budaj, Wiktoria Leśniak
Main Documents Taken Into Account:
WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
Circulation. 2016 Sep 27;134(13):e282-93. doi: 10.1161/CIR.0000000000000435. Erratum in: Circulation. 2016 Sep 27;134(13):e298. PubMed PMID: 27208050.
Ponikowski P, Voors AA, Anker SD, et al; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
Eur Heart J. 2016 Jul 14;37(27):2129-200. doi: 10.1093/eurheartj/ehw128. PubMed PMID: 27206819.
Kitzman DW, Upadhya B. Heart failure with preserved ejection fraction: a heterogenous disorder with multifactorial pathophysiology.
J Am Coll Cardiol. 2014 Feb 11;63(5):457-9. doi: 10.1016/j.jacc.2013.10.007. PubMed PMID: 24184240; PubMed Central PMCID: PMC4283457.
Troughton RW, Frampton CM, Brunner-La Rocca HP, et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis.
Eur Heart J. 2014 Jun 14;35(23):1559-67. doi: 10.1093/eurheartj/ehu090. Review. PubMed PMID: 24603309; PubMed Central PMCID: PMC4057643.
Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239. doi: 10.1016/j.jacc.2013.05.019. PubMed PMID: 23747642.
Savarese G, Trimarco B, Dellegrottaglie S, et al. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials.
PLoS One. 2013;8(3):e58287. doi: 10.1371/journal.pone.0058287. Erratum in: PLoS One. 2014;9(4):e96706. PubMed PMID: 23472172; PubMed Central PMCID: PMC3589263.
McMurray JJ, Adamopoulos S, Anker SD, et al; ESC Committee for Practice Guidelines. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.
Eur Heart J. 2012 Jul;33(14):1787-847. doi: 10.1093/eurheartj/ehs104. Erratum in: Eur Heart J. 2013 Jan;34(2):158. PubMed PMID: 22611136.
Dickstein K, Vardas PE, Auricchio A, et al; ESC Committee for Practice Guidelines (CPG). 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association.
Eur Heart J. 2010 Nov;31(21):2677-87. doi: 10.1093/eurheartj/ehq337. PubMed PMID: 20801924.
Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases.
Eur Heart J. 2008 Jan;29(2):270-6. PubMed PMID: 17916581.
Metra M, Ponikowski P, Dickstein K, et al; Heart Failure Association of the European Society of Cardiology. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology.
Eur J Heart Fail. 2007 Jun-Jul;9(6-7):684-94. Review. PubMed PMID: 17481947.
Amabile CM, Spencer AP. Keeping your patient with heart failure safe: a review of potentially dangerous medications.
Arch Intern Med. 2004 Apr 12;164(7):709-20. Review. Erratum in: Arch Intern Med. 2004 Jul 12;164(13):1464. PubMed PMID: 15078640.
Definition and ClassificationTop
Heart failure (HF) is a condition in which an abnormal heart structure or function causes a reduction in cardiac output relative to metabolic requirements or in which cardiac output is maintained with an increase in filling pressures. Clinically, HF is a syndrome in which patients have symptoms (eg, shortness of breath, ankle and/or abdominal swelling, fatigue) and signs (eg, elevated jugular venous pressure, pulmonary crackles) of volume or pressure overload.
Heart failure can be classified as:
1) New-onset HF: Occurring for the first time, regardless of the dynamics of symptoms.
2) Acute decompensated HF: A rapid onset of or increase in symptoms and signs of HF.
3) Chronic HF, which can be further classified as stable, progressive, or advanced. Advanced HF represents a subset of chronic HF and is characterized by refractory, “end-stage” symptoms and circulatory compromise despite evidence-informed treatment.
For therapeutic and prognostic purposes, heart failure is also classified according to left ventricular ejection fraction (LVEF), which is defined as stroke volume (end-diastolic minus end-systolic volume) divided by the end-diastolic volume.
1) HF with reduced ejection fraction (HFrEF) is typically defined as clinical HF with ejection fraction (EF) ≤40%.
2) HF with preserved ejection fraction (HFpEF) is typically defined as clinical HF with EF ≥50% and evidence of diastolic dysfunction or elevated LV filling pressure.
The LVEF threshold for the diagnosis of HFrEF and HFpEF has varied across clinical trials and clinical practice guidelines. LVEF between 41% to 49% is considered to be in the gray zone, recently referred to as midrange EF (HFmrEF).
Clinically, HF may also be classified as left ventricular, right ventricular, or biventricular failure, depending on whether the predominant symptoms of congestion are pulmonary, systemic, or both.
High-output HF refers to clinical HF occurring due to increased cardiac output and hyperdynamic states, which may not always be associated with an underlying structural heart disease.