Heart failure is a complex syndrome where the heart cannot properly fill with or pump blood, resulting from structural or functional cardiac issues. It affects over 5 million Americans and is a leading cause of hospitalization. Mortality rates following hospitalization are 10.4% at 30 days and increase to 42.3% at 5 years. Symptoms include dyspnea, fatigue, edema and more. Causes include coronary artery disease, hypertension, cardiomyopathy and others. Diagnosis involves labs, imaging like echocardiogram and ischemic evaluation. Treatment ranges from lifestyle changes to advanced devices and transplantation.

1. Kristie Hankins ACNP-BC

2. Heart failure is a complex clinical syndrome that can result from
any structural or functional cardiac disorder that impairs the
ability of the ventricle to fill with or eject blood.

4. • 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

5. In general, the mortality following hospitalization for patients
with heart failure is 10.4% at 30 days, 22% at 1 year, and 42.3% at
5 years, despite marked improvement in medical and device
therapy . Each rehospitalization increases mortality by about
20-22%
Mortality is greater than 50% for patients with NYHA class IV,
ACC/AHA stage D heart failure. Heart failure associated with
acute MI has an inpatient mortality of 20-40%; mortality
approaches 80% in patients who are also hypotensive
(cardiogenic shock)

6. • 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.

9. • 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

10. • There is not one single diagnostic test to identify Heart
Failure!
• Labs
• Full baseline labs including BNP
• CXR
• EKG
• Echocardiogram
• Ischemic evaluation

11. 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)

12. • Revascularization procedures such as coronary artery bypass
grafting (CABG) and percutaneous coronary intervention
(PCI); valve replacement or repair.
• Ventricular Assist Device/Transplant

16. References
American College of Cardiology
American Heart Association