UNDERSTANDING HEART FAILURE

What is heart failure?

If you have heart failure, your heart is weaker than normal. It cannot pump the normal amount of blood to your body. The bottom chambers of your heart (ventricles) pump blood out of your heart. The left ventricle is the main pumping chamber, and heart failure often involves this part of your heart. But some patients with heart failure have problems with their right ventricle.

The condition is lifelong (chronic). There is no cure, but there are many types of treatment to help you feel better and keep your heart working the best that it can. 

How common is heart failure?

More than 6 million Americans have heart failure. One million people are diagnosed with the condition each year. You are more likely to have heart failure when you are older. About 12% to 13% of people over 80 years of age have heart failure, and it is the #1 reason people over age 65 years of age are admitted to the hospital.

What causes heart failure?

Heart failure can be caused by many problems that damage the heart muscle. These include:

• High blood pressure (hypertension).
• Coronary artery disease.
• Heart attack.
• Cardiomyopathy (heart muscle weakness) often due to genetic conditions.
• Viruses (such as flu or COVID).
• Heart problems you have at birth (congenital).
• Diabetes.
• Renal (kidney) disease.
• Obesity.
• Valve disease.
• Abnormal heart rhythm (arrhythmia).
• Alcohol and drug abuse, smoking.
• Some types of chemotherapy.
• Amyloidosis.
• Sarcoidosis. 

How is heart failure diagnosed?

If your healthcare provider thinks you may have heart failure, you will have an exam, talk about your lifestyle habits and personal and family health history. You will also have tests to get more information.

Tests used to diagnose heart failure

• Blood tests to check your blood counts; cholesterol levels; see how well your liver, kidneys and thyroid are working; check for anemia or iron deficiency; and check the level of BNP in your blood. The level of this protein (NT-pro B-type Natriuretic Peptide) is higher than normal if your heart muscle is under stress.
• Chest X-ray to check the size of your heart and look for fluid in your lungs.
• Echocardiogram to see how well your heart can pump blood, measure the size of your heart chambers, check for problems with your heart valves and measure your ejection fraction.
• Electrocardiogram to check the electrical activity in your The electrical signals control your heart rate and rhythm.
• Stress test to see how your heart reacts when you exercise.
• Cardiac catheterization to check your heart from the This test helps your healthcare provider learn more about blood flow to and from your heart and how well your heart is working. A long, thin tube is inserted into a blood vessel and guided to your heart. You may need a left and/or right heart catheterization.
• Cardiac Magnetic Resonance Imaging (MRI). This test uses strong magnets and radio waves to create detailed pictures of your Your healthcare provider uses this test to check the size of your heart, see how well it is working, and look for problems with your heart valves and muscle.

Types of Heart Failure

The types of heart failure relate to ejection fraction. Ejection fraction (EF) is the amount of blood your heart pumps every time it contracts. A normal left ventricular EF is 55% to 70%. If your EF is lower than 50%, your ventricle may be larger than normal and cannot squeeze with normal force.

Types of heart failure, based on left ventricular ejection fraction

• Heart failure with preserved ejection fraction (HFpEF)/Diastolic failure: EF is 50% or higher. The ventricles are stiff and cannot relax enough to fully fill with So, even though your left ventricle can pump blood out without a problem, less blood is available with each contraction.
• Heart failure with mildly reduced ejection fraction (HFmrEF): 41% to 49%.
• Heart failure with reduced ejection fraction (HFrEF): 40% or lower.
• Heart failure with improved ejection fraction: Patients who were diagnosed with HFrEF and, with treatment, have an EF of 41% or higher.

Some patients have features of both heart failure with reduced and preserved ejection fraction. This combination is most common in older patients. 

 Stages of heart failure

There are four stages of heart failure: A, B, C and D. When using stages to talk about heart failure, it is possible for you to move from Stage A to B, C, or D, but you cannot go backwards to an earlier stage. Ask your healthcare provider which stage you are in.

Stage A: At-Risk for Heart Failure

Your risk of having heart failure is high because:

• You have a family history of heart failure and/or a medical condition that increases your risk of having heart failure. See the “Causes of Heart Failure” section for examples.
• You do not have symptoms of heart failure.

 Stage B: Pre Heart Failure

• There are changes in your heart’s structure and/or function, such as a valve problem or high pressures in the arteries around the heart.
• You do not have symptoms of heart failure.

Stage C: Symptomatic heart failure

• You have symptoms of heart failure or have had symptoms in the past.

Stage D: Advanced heart failure

• You have symptoms of heart failure that interfere with daily life.
• The symptoms do not get better with treatment.
• You may need repeat hospital stays because of your symptoms.

Your healthcare provider may also talk to you about the New York Heart Association (NYHA) clinical classifications of heart failure (Class I, II, III, IV) . These are based on symptoms you have and are different from the stages of heart failure. Unlike the stages of heart failure, you may move forward and backward through the classes depending on your symptoms and how bad they are.

• Class I: No You do not have any symptoms of heart failure.
• Class II: Mild You have symptoms when you are doing more than your usual care activities.
• Class III: Moderate symptoms. You have symptoms while you are doing your usual care activities
• Class IV: Severe symptoms. You cannot do your usual care Your symptoms may happen while you are resting or close to resting.

*If you wake up suddenly at night and need to sit up to catch your breath, call your healthcare provider in the morning.

Treatment for heart failure

The type of treatment you need to manage your heart failure depends on the stage you are at and the symptoms you have. The goals of treatment are to help you feel better and live a more active life. Your healthcare provider will talk to you about your plan of care, which is designed to help keep you out of the hospital, live a longer life and keep your heart failure from getting worse. Your plan may include:

• Medicine to help your heart work better and control your symptoms.
• Lifestyle changes, such as being active and moving more, eating a healthy diet, not smoking, etc.
• Daily self-checks to keep track of your symptoms and weight.
• Preventive care, such as staying up-to-date on vaccines.
• Follow-up visits to see how you’re doing and make changes to your treatment when needed.

If you have advanced heart failure, your healthcare provider may talk to you about:

• Devices to help support your heart.
• Heart transplant.
• Palliative or hospice care.

While there is no cure for heart failure, working with your healthcare provider and following your treatment plan can help you feel better and live the best life possible. Please talk to your healthcare provider about any questions or concerns you have.

Reviewed 8/24.