Quick Reference Guide to Heart Failure: Based on ESC 2023

Description

Heart Failure Overview

Heart failure (HF) is a complex condition characterized by the heart’s inability to pump blood effectively. It is categorized based on the ejection fraction (EF) of the left ventricle:

• HFrEF (Heart Failure with Reduced EF): EF <40%, linked to systolic dysfunction.
• HFmrEF (Mildly Reduced EF): EF 41-49%, featuring both systolic and diastolic issues.
• HFpEF (Preserved EF): EF ≥50%, primarily with diastolic dysfunction.
• HFimpEF (Improved EF): Previously reduced EF improved to ≥40% post-treatment.

Classifications

1. Functional: NYHA classes I-IV assess symptom severity and physical limitations.
2. Pathophysiological: Left-sided HF leads to pulmonary symptoms; right-sided HF affects systemic circulation.
3. Staging (ACC/AHA): Stages A-D guide progression and management strategies.

Pathophysiology

HF progression involves maladaptive responses, including:

• Neurohormonal Activation: RAAS and SNS lead to vasoconstriction, fluid retention, and myocardial remodeling.
• Inflammation and Oxidative Stress: Trigger chronic changes and fibrosis.
• Cardiac Remodeling: Hypertrophy and fibrosis reduce efficiency and compliance.

Diagnostic Biomarkers

• BNP and NT-proBNP: Key biomarkers for diagnosing and monitoring HF. High levels indicate HF severity, while reductions imply treatment effectiveness.

Management

1. Pharmacological:
   • First-line: ARNIs, ACE inhibitors, beta-blockers, and MRAs.
   • Additional: SGLT2 inhibitors and diuretics help reduce symptoms and improve outcomes.
2. Non-Pharmacological:
   • Lifestyle changes, exercise, and regular monitoring.
3. Device Therapy:
   • ICDs for arrhythmia prevention, CRT for synchronizing ventricular contractions, and LVADs for end-stage support.
4. Advanced Therapies:
   • Heart transplant for eligible patients with refractory HF.

Key Takeaways

• Comorbid Management: Addressing hypertension, diabetes, and kidney function is essential in HF management.
• Regular Monitoring: Critical to prevent HF progression and adjust therapy based on BNP/NT-proBNP levels.