Heart failure is a complex clinical syndrome that can result fromany structural or functional cardiac disorder that impairs theability of the ventricle to fill with or eject blood.
• 5 million people in U.S. with heart failure• 670,000 people diagnosed with heart failure each year.• Heart failure is the primary reason for 12-15 million office visits and 6.5 million hospital days each year• Approximately 80% of patients hospitalized with heart failure are >65• Heart failure is the most common Medicare DRG• About 277,000 deaths per year related to heart failure• Rehospitalization rates are very high. Up to 50% at 6 months• Heart failure accounts for 34% of cardiovascular-related deaths
In general, the mortality following hospitalization for patientswith heart failure is 10.4% at 30 days, 22% at 1 year, and 42.3% at5 years, despite marked improvement in medical and devicetherapy . Each rehospitalization increases mortality by about20-22%Mortality is greater than 50% for patients with NYHA class IV,ACC/AHA stage D heart failure. Heart failure associated withacute MI has an inpatient mortality of 20-40%; mortalityapproaches 80% in patients who are also hypotensive(cardiogenic shock)
• Dyspnea• Fatigue• Activity Intolerance• Fluid Retention• Peripheral Edema• Orthopnea• PND• Common noncardiac signs and symptoms of heart failure include anorexia, nausea, weight loss, bloating, fatigue, weakness, oliguria, nocturia, and cerebral symptoms of varying severity, ranging from anxiety to memory impairment and confusion.
• Coronary Artery Disease• Hypertension• Dilated Cardiomyopathy• Valvular Heart Disease• Arrhythmia• Peripartum• Drug Use (recreational or precribed) • ETOH, Cocaine or cardiotoxic drugs (ex. Adriamycin• Infections or Inflammation• Congenital• Idiopathic
• There is not one single diagnostic test to identify Heart Failure!• Labs • Full baseline labs including BNP• CXR• EKG• Echocardiogram• Ischemic evaluation
Simple to complex• Dietary restrictions• Fluid restrictions• Pharmacologic therapies include the use of diuretics, vasodilators, inotropic agents, anticoagulants, beta-blockers, and digoxin.• Invasive therapies for heart failure include electrophysiologic intervention such as cardiac resynchronization therapy (CRT), pacemakers, and implantable cardioverter- defibrillators (ICDs)
• Revascularization procedures such as coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI); valve replacement or repair.• Ventricular Assist Device/Transplant
ReferencesAmerican College of CardiologyAmerican Heart Association